health care reform bill: day 5

I’ve had some great comments about my series this week on the health care reform bill (though not directly to the blog), so I hope you, too, have enjoyed it.  In case you missed any of my previous day’s topics, here’s the recap:

Day 1 featured my main thoughts on the new health care reform bill. (If you haven’t read it yet, it’s the place to start.)
Day 2 contained multiple views and comments on the health care bill via a link to a NY Times article.
Day 3 contained links to Democracy Now! clips relating to the continuation of the for-profit system and palliative care.
Day 4 featured more of my comments in relation to the cost of health care mixed in with articles and other comments on the same topic.

I want to close out this week thinking about the ethics and morality of the United States’ health care system, especially in lieu of what goes on in other “wealthy” countries around the world.

This week I was keyed into a man named T.R. Reid.  In his article for the Washington Post, 5 Myths About Health Care Around the World, he starts out this way:

“As Americans search for the cure to what ails our health-care system, we’ve overlooked an invaluable source of ideas and solutions: the rest of the world. All the other industrialized democracies have faced problems like ours, yet they’ve found ways to cover everybody — and still spend far less than we do.

“I’ve traveled the world from Oslo to Osaka to see how other developed democracies provide health care. Instead of dismissing these models as “socialist,” we could adapt their solutions to fix our problems. To do that, we first have to dispel a few myths about health care abroad:”

He goes on to share some very interesting facts (see below).

Many other countries provide health care to everyone, though the way it is structured and paid for in each country is a little bit different.  Mr. Reid‘s article debunks some of the myths, as he did in an interview for the program Inter Compass (click and scroll down to episode #1011, Healthcare Around the World, to watch or listen) where he explained things a bit more.  He spoke about the ethics of health care, how the systems in other countries differ from that of the U.S., and many other issues I touched on in my first post.  But there was one exchange that I think is so poignant and powerful that I’ve transcribed it here to make sure you hear it (the total interview is 30 minutes, and this quote comes just at the 20 minute mark)(Thanks to Karen Saupe for sharing this):

Host, Shirley Hoogstra: Well, there’s something [referring to a previous statement] that goes against the grain of the American individualism with that, right: this idea that in Canada, well as long as the rich Canadian has to wait as long as the poor Canadian has to wait…

T.R. Reid: They’re into that, yeah.

SH: Yeah, you know, and I think in America, it’s sort of like, “Look: if I’ve earned it, if I’ve got my own wealth, I want to be able to get to the head of the line, I want to be able to buy what I want.  So would that kind’ve have to change? Would that mentality of, you know, “Look I’ve done it, I get it?”

TRR: Well, there are a lot of commodities where we say, “If you’ve worked hard and have the money or inherited the money, you get it.”  The question is whether health care is that kind of commodity, and the economist term for this is the distributional ethic.  What’s your ethic for distributing goods?  Well, we have a distributional ethic for votes: everybody get’s one.

SH: Right.

TRR: Bill Gates gets one, his chauffeur gets one.  Right? Uh, we have a different distributional ethic for yachts.

SH: That’s true.

TRR: If you have money, you can have ten of ’em; if you don’t have money, tough, and we don’t mind that. So here’s the question: do you think health care is more like voting or is it more like yachting.  Well, what I found in my book is all the other countries have said, “No, this is, this is like voting. This is like education.  This is like equal treatment.  Everybody should have the same.” But the U.S. hasn’t made that commitment.

Isn’t it time the U.S. made that commitment?  Should health care be more like education, where the U.S. provides a basic service to all people, or do we want to keep our current system where only those with certain money or connections obtain basic, life-giving health care?  This reform bill claims to accord everyone care while still letting people make money from it, but I think we’re going to see that you can’t do both, and then we’ll have to choose how we want to more forward.

As Mr. Reid notes in his interview, universal health care — which comes in many shapes and forms around the world — would take a massive overhaul of the system, not just attempts to tweak the system that this health care bill tries to accomplish meaningful change with.  Perhaps this is a good first step, but hopefully more and more people will begin to recognize the moral imperative of universal health care and call for a system that no longer discriminates and kills in the way our current system does.  I encourage you to be someone who does just that.

(Reid also has a book, The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care, which I think I’m going to look for myself.)

Some of the more interesting facts I found in Reid’s column:

As for those notorious waiting lists, some countries are indeed plagued by them. Canada makes patients wait weeks or months for nonemergency care, as a way to keep costs down. But studies by the Commonwealth Fund and others report that many nations — Germany, Britain, Austria — outperform the United States on measures such as waiting times for appointments and for elective surgeries.  In Japan, waiting times are so short that most patients don’t bother to make an appointment.

U.S. health insurance companies have the highest administrative costs in the world; they spend roughly 20 cents of every dollar for nonmedical costs, such as paperwork, reviewing claims and marketing. France’s health insurance industry, in contrast, covers everybody and spends about 4 percent on administration. Canada’s universal insurance system, run by government bureaucrats, spends 6 percent on administration. In Taiwan, a leaner version of the Canadian model has administrative costs of 1.5 percent; one year, this figure ballooned to 2 percent, and the opposition parties savaged the government for wasting money.
The world champion at controlling medical costs is Japan, even though its aging population is a profligate consumer of medical care. On average, the Japanese go to the doctor 15 times a year, three times the U.S. rate. They have twice as many MRI scans and X-rays. Quality is high; life expectancy and recovery rates for major diseases are better than in the United States. And yet Japan spends about $3,400 per person annually on health care; the United States spends more than $7,000.

Overseas, strict cost controls actually drive innovation. In the United States, an MRI scan of the neck region costs about $1,500. In Japan, the identical scan costs $98. Under the pressure of cost controls, Japanese researchers found ways to perform the same diagnostic technique for one-fifteenth the American price. (And Japanese labs still make a profit.)

The key difference is that foreign health insurance plans exist only to pay people’s medical bills, not to make a profit. The United States is the only developed country that lets insurance companies profit from basic health coverage.

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