Let's really talk about Healthcare

[john5746]

OK, this thread is for those who agree that the US system is among the worst in the "first" world.

 

Fareed Zakaria recently aired a nice special about how to save the American healthcare system.

 

In that special, he presented the following arguments:

 

The Nobel Prize-winning economist, Kenneth Arrow, outlined in the 1960s why markets don't work well when it comes to health care. He explained that people don't know when they will need health care and that when they do need it, the cost is often prohibitive. This means you need some kind of insurance or a government-run system.

 

A general insurance system can only work if everyone is insured. That's what the Swiss and Taiwanese found out. Otherwise, only the people who are sick will want to buy insurance and the insurance companies will spend most of their time and effort trying to kick sick people out of the system and denying coverage to those who might get sick.

That's why the Heritage Foundation, a conservative think tank, came up with the idea of an individual mandate, requiring that people buy health insurance in exactly the same way that people are required to buy car insurance.

 

That's why Mitt Romney chose this model as a market-friendly system for Massachusetts when he was governor. And that's why Newt Gingrich praised the Massachusetts model as the most important step forward in health care in years.

 

He then provided glimpses into a few of the better healthcare systems that we might possibly learn from:

 

Taiwain

 

Something like US medicare for all citizens, but if covers everything and they employ IT(smart card) to improve administration efficiency and improve the care for the costliest patients. But, they rely on the asian work ethic to provide great care at low cost. Their doctors work their a$$ off.

 

Switzerland

 

Obamacare on steroids. Provides lots of choice, maybe too much choice. Costs are an issue with this system.

 

England - complete government run system. Has had issues with wait times and not covering certain procedures.

 

Others

 

The Obama health care plan is not perfect by any measure. It still maintains the connection between employment and health care, which is massively inefficient and a huge burden on American business.

While businesses often talk about the need to reduce regulations to be competitive globally - a cause I support - they strangely rarely talk about their single biggest handicap against global competitors.

American companies have to pay high tens of billions of dollars to provide health care for their employees and former employees while their German, Canadian, Japanese, and British counterparts pay nothing - zero - in health care costs.

 

The Obama health care bill expands access to 30 million Americans. That's good economics and also the right thing to do, but it does little by way of controlling costs.

There are several experiments and pilot programs in it. There are new trends emerging, but little in the way of systemic cost controls. That's largely a failure of nerve amongst the entire political establishment.

Every expert realizes that no matter what the system of health, you will need to have some kind of board that decides that some things are covered and others are not.

This has been demagogued as “death panels” when it is really the only sensible way to make the system work. No one is saying that you can't get any procedure you want - merely that there are some that your insurance doesn't pay for.

The other unusual aspect of health care, Kenneth Arrow points out, is that the buyers really don't have much knowledge.

You can decide that you don't want a new car, or can comparison shop for a new TV, but you can't decide that you don't want a bypass.

That's why costs have come down in optional areas like LASIK surgery but not in ones where the consumer really can't walk away.

 

In other words, we ain't talking about broccoli.

 

So, what system would be best for the US or if you live in another country, perhaps one of those mentioned, how good/bad is your system?

 

It seems like the Swiss system is the most realistic for the US - maybe we could employ IT to help people determine the best insurance for them, like we do for flights and other things.

Edited April 4, 2012 by john5746

[iNow]

Given that your OP requests us to assume for the purpose of discussion that the US system might be improved by modeling other countries...

 

I would support something like the Taiwanese model.

 

They came into this and put hard study into the other systems available throughout the world. While they quickly concluded that the US represents how NOT to deliver healthcare, they DID manage to take the best pieces from all of the other different systems and integrate them into an approach that avoids the issues those others face.

 

Taiwan is my vote. Fahreed seems to agree: http://globalpublicsquare.blogs.cnn.com/2012/03/17/zakaria-how-to-fix-u-s-health-care/

[JustinW]

OK, this thread is for those who agree that the US system is among the worst in the "first" world.

I guess this excludes me?

[iNow]

I guess this excludes me?

Not necessarily. For purposes of discussion, let's assume we WERE going to replace the US system. Let's just take that as a given. If you do, which other country would you like to model?

[john5746]

Taiwan is my vote. Fahreed seems to agree: http://globalpublicsquare.blogs.cnn.com/2012/03/17/zakaria-how-to-fix-u-s-health-care/

 

Thanks, I found your posts in the other thread very informative by the way.

 

I just wonder if the Swiss system, with more choice in regards to insurance, would fit better or be more likely to get approved with our country of many states. I probably shouldn't worry at this point as to what system can be approved, as long as we have morons in the highest judicial branch who think broccoli is a good analogy for health care.

[JustinW]

iNow,

 

Not necessarily. For purposes of discussion, let's assume we WERE going to replace the US system. Let's just take that as a given. If you do, which other country would you like to model?

Okay, I'll play along. Assuming that we were going to replace the US system for another countries model I wouldn't like to model any ONE country. I think that would be asking for the same troubles already implied by the OP in various different countries. But that being said, instead of nit-picking through the pros and cons of each individual countries healthcare system, I would probably choose the Swiss' system. If only we could get over the fact that people think a wealthier nation shouldn't spend more on their healthcare than less wealthier nations.

 

I think this article covers most of why I would find it appealing in this scenario. http://www.forbes.co...th-care-system/

 

 

 

Sorry, cross posted with John5746

Edited April 4, 2012 by JustinW

[CharonY]

But, they rely on the asian work ethic to provide great care at low cost. Their doctors work their a$$ off.

 

From anecdotal conversations the work hours are not too different from the US (In an Uni-clinic the average hours were 60ish in Taiwan and the US). A large difference is the number of patients that they see in that time frame. This has (again, based on anecdotes) at least two reason. One is that the number of patients has an direct effect on their income. Thus they tend to squeeze in as many as possible. A second thing is that traditionally in Taiwan many see doctors for preventive care or minor ailments (especially for those enrolled in NHI) which arguably takes less time. Plus, if they visit a doctor often, he/she becomes more familiar with them and it may (together with the medical database) cut down on overhead time.

[iNow]

The problem I have with the Swiss system is that while, yes... Choice is still there... it does a much poorer job of managing costs.

 

 

http://www.nytimes.com/2009/08/17/opinion/17krugman.html?_r=1

 

[in the Swiss model,] costs are running higher than expected, but the reform has greatly reduced the number of uninsured. And the most common form of health insurance in America, employment-based coverage, actually has some “Swiss” aspects: to avoid making benefits taxable, employers have to follow rules that effectively rule out discrimination based on medical history and subsidize care for lower-wage workers.

 

So where does Obamacare fit into all this? Basically, it’s a plan to Swissify America, using regulation and subsidies to ensure universal coverage.

 

If we were starting from scratch we probably wouldn’t have chosen this route. True “socialized medicine” would undoubtedly cost less, and a straightforward extension of Medicare-type coverage to all Americans would probably be cheaper than a Swiss-style system. That’s why I and others believe that a true public option competing with private insurers is extremely important: otherwise, rising costs could all too easily undermine the whole effort.

 

But a Swiss-style system of universal coverage would be a vast improvement on what we have now. And we already know that such systems work.

 

That was from BEFORE the passing of "Obamacare."

 

Thanks, I found your posts in the other thread very informative by the way.

Thank you, too. I've realized a lot of benefit by finding sources of information that I can trust to present the actual information regardless of ideology or worldview. Zakaria is definitely one of those sources, and I'm a subscriber to his pages and a regular watcher of his show GPS.

 

I would probably choose the Swiss' system.

So, basically... Obamacare.

[iNow]

---

 

More here (watch the ~50 minute special if you're able):

 

http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries/

 

What is it? The Swiss system is social insurance like in Japan and Germany, voted in by a national referendum in 1994. Switzerland didn't have far to go to achieve universal coverage; 95 percent of the population already had voluntary insurance when the law was passed. All citizens are required to have coverage; those not covered were automatically assigned to a company. The government provides assistance to those who can't afford the premiums.

 

How does it work? The Swiss example shows that universal coverage is possible, even in a highly capitalist nation with powerful insurance and pharmaceutical industries. Insurance companies are not allowed to make a profit on basic care and are prohibited from cherry-picking only young and healthy applicants. They can make money on supplemental insurance, however. As in Germany, the insurers negotiate with providers to set standard prices for services, but drug prices are set by the government.

 

What are the concerns? The Swiss system is the second most expensive in the world -- but it's still far cheaper than U.S. health care. Drug prices are still slightly higher than in other European nations, and even then the discounts may be subsidized by the more expensive U.S. market, where some Swiss drug companies make one-third of their profits. In general, the Swiss do not have gatekeeper doctors, although some insurance plans require them or give a discount to consumers who use them.

[JustinW]

iNow,

 

So, basically... Obamacare.

Yep. And price doesn't conscern me as much as a surpression of cost with the regulating of procedures and medicines that are allowed to be used.

I am under the assumption that the major factor of this thread is to talk about systems that coverage encompasses everyone?

[iNow]

Yep. And price doesn't conscern me as much as a surpression of cost with the regulating of procedures and medicines that are allowed to be used.

I am under the assumption that the major factor of this thread is to talk about systems that coverage encompasses everyone?

I didn't realize it was a confusing topic. The OP explicitly said:

 

So, what system would be best for the US or if you live in another country, perhaps one of those mentioned, how good/bad is your system?

 

I imagine that part of the question asks, "Why do you support that," and then perhaps they also accept that we might discuss the relative merits and faults of each. Do you disagree?

 

My own opinion on this is that it is silly to argue that higher costs are worth saving a one-dimensional idea (and IMO rather ignorant version) of freedom.

 

Let me also preempt your likely response... No, I am not saying we need to sacrifice freedoms. I am saying your definition of freedom is somewhat myopic relative to mine. I will also note that this "what does freedom mean" topic is tangential, and I apologize for introducing it. I welcome further discussion in another thread.

[JustinW]

iNow,

 

I imagine that part of the question asks, "Why do you support that," and then perhaps they also accept that we might discuss the relative merits and faults of each. Do you disagree?

Okay, the Swiss might spend more than most, but they are still privvy to all the advancements in technology and latest innovations. I think for the minimal restraint on choices that they and their doctors are allowed to make, the cost is worth it considering their economic output and availability.

 

 

So, please refrain from preempting my responses since I have already agreed to look at this thread with a certain amount of objectivity.

 

 

 

Also I would be happy to debate freedom with you. Just say the word.

[iNow]

Okay, the Swiss might spend more than most, but they are still privvy to all the advancements in technology and latest innovations.

Implicit in this comment is the suggestion that publically funded systems are not privy to these same advancements and innovations. Why would you suggest this?

 

Also, to return is closer to the originally intended topic, perhaps some non-US members can comment on the systems with which they have experience, and perhaps share some anecdotal experiences of the relative merits and faults?

[JustinW]

Implicit in this comment is the suggestion that publically funded systems are not privy to these same advancements and innovations. Why would you suggest this?

Maybe they are to some point, but not at the same level as the more wealthy nations. Most publicly funded systems try to control costs and that has to have effects in availability of expensive medicines, equipment, and resources.

[iNow]

Maybe they are to some point, but not at the same level as the more wealthy nations. Most publicly funded systems try to control costs and that has to have effects in availability of expensive medicines, equipment, and resources.

Instead of providing assumptions, maybe you can start providing evidence in support of your conjectures?

[JustinW]

Instead of providing assumptions, maybe you can start providing evidence in support of your conjectures?

Do you deny that governments ration care to cut costs in those types of systems? Why do you think they do so? To control costs of course. I could look up a bunch of links to support this, but as some people say, it's painfully obvious.(pun intended)

 

Quick definition: http://en.wikipedia.org/wiki/Health_care_rationing

[John Cuthber]

I thought all health insurers rationed payouts.

There's a link to this page

http://en.wikipedia.org/wiki/Health_care_rationing_in_the_United_States

on the page Justin cited.

If they all ration then the question is who can pay more before they run out of cash, a government or an insurance company?

If you want indsurance for anything you are better off with a large company that can stand a big payout. The biggest company is the government.

Edited April 5, 2012 by John Cuthber

[JustinW]

John,

 

If they all ration then the question is who can pay more before they run out of cash, a government or an insurance company?

If you want indsurance for anything you are better off with a large company that can stand a big payout. The biggest company is the government.

In private insurance a person has the option to switch to another provider that does fit their needs. With a government provided system there is no option. And to stay in the context of this thread, this is another reason I would prefer the Swiss system. Because it provides more option and availability.

[John Cuthber]

How well does that work?

For example, if I had diabetes and a dodgy heart and my current insurer decided they couldn't afford to treat me in the way I thought was right, could I really move to another one who would happily foot the bill?

Remind me not to buy shares in the second one- they are idiots.

[Phi for All]

How well does that work?

Choice is a marketer's panacea. If I have only one version of my product, no matter how efficient it is at what it does or how well it's priced, your decision on whether to buy is always yes or no. But if I give you an array of versions (which increases costs and therefore price), you're much more likely to choose one of them. Your decision on whether to buy is almost automatically yes, followed by your secondary decision of which version to choose.

 

It works really well for the seller, and the buyer is happier at the point of purchase and feels empowered because he got to choose. But much of the time, choice can actually make us unhappier in the long run. Here's a very eye-opening TED talk about The Paradox of Choice.

[iNow]

I find the whole question of choice to be a red herring anyway. Let's say that insurer A can offer you coverage at $400 per month, and insurer B can offer you coverage at $360 per month. The coverages are essentially equal... maybe a $5 difference in copay, or a different deductible... but for all intents and purposes it's an equivalent product across both insurers covering the same services and offering access to the same doctors.

 

Then, let's say we pool our risk together as a nation, and get coverage from the government with effectively the same exact coverage, and even sometimes better (especially for those with high deductibles and next to nothing covered)... for only $170 per month... How is this even an open question which is the best approach for anyone with a rational mind?

 

 

 

Ugh... Sorry... Still off-topic. We spend so much time battling back silliness that the meat of the thread gets forgotten. Justin prioritizes the ability to stick with private insurers and make his own choice over lower costs for everyone. That is his opinion, and that is okay, even though many of us disagree or find that approach illogical, it's still his opinion and that's all the OP requested.

[Phi for All]

It's still on-topic. I responded to John's question about how well choice works. If the Swiss system is being chosen strictly because it offers more choices, I wanted to show how choice is often used to make people think something is better when it really isn't.

 

The top two best selling ice cream flavors at Baskin-Robbins are still vanilla and chocolate. You just pay more for all of it because they have to stock all 31 flavors in every store all the time.

[John Cuthber]

I don't really know a lot about this and that might be why I wasn't clear.

 

What happens if I choose a company, scheme, and premium that I feel suits me, and then I fall prey to some (expensive) condition that's not covered?

 

I don't believe I will suddenly be able to transfer to another deal which does cover it, because the premiums would be higher than the cost of treatment.

So, since I know I'm always going to be at risk of finding that the insurer won't pay out enough, what do I do?

No company can honestly guarantee indefinite payout (to be fair, not can a government, but they can get closer).

So my choice is to pay all the money I can afford and hope that I'm lucky.

That's not much of a choice

[Phi for All]

I don't really know a lot about this and that might be why I wasn't clear.

 

What happens if I choose a company, scheme, and premium that I feel suits me, and then I fall prey to some (expensive) condition that's not covered?

 

I don't believe I will suddenly be able to transfer to another deal which does cover it, because the premiums would be higher than the cost of treatment.

So, since I know I'm always going to be at risk of finding that the insurer won't pay out enough, what do I do?

No company can honestly guarantee indefinite payout (to be fair, not can a government, but they can get closer).

So my choice is to pay all the money I can afford and hope that I'm lucky.

That's not much of a choice

Part of the Patient Protection and Affordable Care Act of 2010 would protect you from being rejected for a pre-existing condition. Prior to that (or if it's overturned), you'd either be denied coverage, be charged higher premiums or have a waiting period before your coverage kicks in. Waiting periods are typically six to eighteen months.

 

Just another reason why healthcare doesn't fit the for-profit business model, imo. How much more difficult and costly is it going to be to treat you after letting your condition go untreated during the waiting period?

[JustinW]

I thought we were supposed to be talking about the pros and cons of other systems for a hypothetical replacement of the US model?