The health care debate-5: How other countries health systems compare to the US


(For previous posts on the issue of health care, see here.)

The advantages of single-payer systems over the current US system are becoming increasingly obvious. Another pro-business publication BusinessWeek concedes the advantages of the single payer system as is practiced in France.

In fact, the French system is similar enough to the U.S. model that reforms based on France’s experience might work in America. The French can choose their doctors and see any specialist they want. Doctors in France, many of whom are self-employed, are free to prescribe any care they deem medically necessary. “The French approach suggests it is possible to solve the problem of financing universal coverage…[without] reorganizing the entire system,” says Victor G. Rodwin, professor of health policy and management at New York University.

France also demonstrates that you can deliver stellar results with this mix of public and private financing. In a recent World Health Organization health-care ranking, France came in first, while the U.S. scored 37th, slightly better than Cuba and one notch above Slovenia. France’s infant death rate is 3.9 per 1,000 live births, compared with 7 in the U.S., and average life expectancy is 79.4 years, two years more than in the U.S. The country has far more hospital beds and doctors per capita than America, and far lower rates of death from diabetes and heart disease. The difference in deaths from respiratory disease, an often preventable form of mortality, is particularly striking: 31.2 per 100,000 people in France, vs. 61.5 per 100,000 in the U.S. (my italics)

PBS’s Frontline had a program Sick Around the World that looked at the health care systems in England, Taiwan, Germany, Switzerland, and Japan.

The private, profit-seeking health industry knows that their system is terrible compared to what single payer or socialized systems can offer and so they have to obscure and confuse things as much as possible. What has been amusing to watch has been the logical knots that the health industry has been tying itself up in to avoid even the minimal public option that has been proposed, saying that it would drive them out of business. Of course, if their claims that the government cannot run anything properly, that the private sector is far more efficient and will provide better health care at lower cost, then they should not have anything to fear from a public option. Even president Obama, who has been trying to placate the private health insurance industry, found this argument a bit much, saying, “Why would it drive private insurers out of business? If private insurers say that the marketplace provides the best quality healthcare, if they tell us that they’re offering a good deal, then why is it that the government — which they say can’t run anything — suddenly is going to drive them out of business? That’s not logical.”

The fact that they are trying to prevent a public option shows that the opposite is true. What they really fear is that once you take the profits, the huge salaries and bonuses of their top executives, and their exorbitant bureaucratic costs out of the system, the public system will be cheaper and more efficient and people will flock to it. Because of this fear, they and their lobbyists will first try to prevent any discussion at all of a meaningful public option, such as single payer.

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If forced to concede one, they will try to hobble it by either limiting access to it or put in a lot of restrictions and rules in order to make is as inefficient and expensive and callous as the private system. “Opponents say private insurers could not compete with a public plan that didn’t have to make a profit. They argue that private health plans would end up going out of business, leaving only an entirely government-run health care system.”

I sincerely hope that this is true. Profit-making entities have no business being in the position of making health care decisions.

What the industry would really like is for the government to mandate that everyone have private insurance and pay for it, and at the same time reserve the right to deny coverage so that they make more profits. Because of this, we should be aware that the public plan that finally emerges from Congress may not be that good because of the amount of money that the health industry funnels to members of Congress. They may try to fob off on us some lousy system that they label the ‘public option’ that is designed to fail.

We should keep pushing for a single-payer, Medicare-for-all type system. The group Physicians for a National Health Program (PNHP) has done wonderful work in pushing for single payer and has created a comparison chart of public option vs. single payer. Single Payer Action Network in Ohio (SPAN Ohio) has come up with a plan just for the state that has the following features:

  • Patients get free choice of health care providers and hospitals.
  • When you go to your own personal physician for visits, there are NO premiums, NO co-payments, NO deductibles, NO one excluded. You pay nothing.
  • When you get your prescription filled by your pharmacist, there are NO premiums, NO co-payments, NO deductibles, NO one excluded. You pay nothing.
  • If you need hospitalization, there are NO premiums, NO co-payments, NO deductibles, NO one excluded. You pay nothing.

It beats me why anyone would prefer the current bureaucratic, service denying nightmare of the private, employer-based, profit-seeking system over such a plan.

POST SCRIPT: Tom Tomorrow on health care

One of my favorite cartoonists has been on a tear recently with three strips on health care: one, two, and three.

Comments

  1. says

    In the UK we have a free health service but the inefficiency is atrocious. There are hospitals with 2 year waiting lists which have their operating theaters perform two operations a day when they could do five – and then they say they need more operating theaters – what they need is efficiency. The surgeons think they are Gods and no manager can tell them what to do. Managers are self serving and get bigger salaries the more staff they have which starves the operational end of cash. We have MRSA running rife because cleaning is scant – the hospitals cannot afford decent cleaners!

    The answer?

    Give the patients FOC treatment at the point of delivery but let the private sector provide it on a competitive basis.

    Say a private hospital has to tender for 1000 hip operations, the Government pays, but it gets the work done for a lower price than paying inefficient bureaucrats, unionized non-medical staff and consultants with a God complex.

    Nurses and anesthetists would have to take their lunch breach at the same time (so the op theatre only closes for one hour instead of two) and surgeon would not be able to nip off for a round of golf on a Friday afternoon, Anesthetists would have to start an hour BEFORE the operating theater opened (yes the whole operating team waits an hour doing nothing whilst the anesthetist goes to work) all this inefficiency would be wiped out if the private sector had to compete on price for a specified quality of service that the Government would then pay for.

    It happens in other areas of public service, private contractors providing services on a competitive basis which are FOC at the point of delivery to the customer – the tax payer – why not in the health service?

    After all why should we trust the Government to be efficient with our money? they never are!

    Competition will force efficiency.

    At the end of the day health care has to be paid for and the more efficiency we have the better off we will all be.

  2. says

    In the UK we have a free health service but the inefficiency is atrocious. There are hospitals with 2 year waiting lists which have their operating theaters perform two operations a day when they could do five – and then they say they need more operating theaters – what they need is efficiency. The surgeons think they are Gods and no manager can tell them what to do. Managers are self serving and get bigger salaries the more staff they have which starves the operational end of cash. We have MRSA running rife because cleaning is scant – the hospitals cannot afford decent cleaners! The answer? Give the patients FOC treatment at the point of delivery but let the private sector provide it on a competitive basis. Say a private hospital has to tender for 1000 hip operations, the Government pays, but it gets the work done for a lower price than paying inefficient bureaucrats, unionized non-medical staff and consultants with a God complex. Nurses and anesthetists would have to take their lunch breach at the same time (so the op theatre only closes for one hour instead of two) and surgeon would not be able to nip off for a round of golf on a Friday afternoon, Anesthetists would have to start an hour BEFORE the operating theater opened (yes the whole operating team waits an hour doing nothing whilst the anesthetist goes to work) all this inefficiency would be wiped out if the private sector had to compete on price for a specified quality of service that the Government would then pay for. It happens in other areas of public service, private contractors providing services on a competitive basis which are FOC at the point of delivery to the customer – the tax payer – why not in the health service? After all why should we trust the Government to be efficient with our money? they never are! Competition will force efficiency.

  3. says

    Getting health right is not always about all that though is it? Sometimes I find it’s more of a state of mind than anything else, where you need to be in total control of what you are trying to achieve. That probably sounds a bit voodoo, but you know what I mean.

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