People who favor nationalized health care often say that Canadians (for example) don't face cost barriers to receiving medical treatment like Americans do. People who oppose it say that Canadians face long waits to get the care they want, unlike Americans (who have shorter waits). According to the Commonwealth Fund International Health Policy Survey of 2002, both are right. As I mentioned in my last post, this was a cross-national telephone survey of adults with health problems. The countries included were Canada (CA), New Zealand (NZ), United Kingdom (UK), the United States (US), and Australia.
Here is a Powerpoint presentation from which I selected two tables showing that sick adults face longer waits for medical care in Canada compared to the US:
And here is a table showing that Americans more often forgo medical care because of cost:
What I don't know is how often Americans did not get medical treatment because they were advised to get an expensive procedure (or an expensive drug) that (a) would not even be avaialble in the other countries and (b) insurance companies refused to cover. I believe that is a real issue with respect to new cancer drugs (which tend to be outrageously expensive and also tend to be available in the US before they are available in other countries), but I don't yet know if that issue generalizes to other forms of medical treatment. I also don't yet have a complete picture of how much of this cost/access problem is due to Americans who are uninsured.
18 comments:
Engram,
thank you for providing this information, including both sides of the issue for our consideration.
It is not until I read your posting that I realized how one-sided and agenda-driven all of the other media articles on this topic have been.
Keep up the good work,
A regular reader
Sensible people understand that everything has its costs.
The cost of not stopping terrorism in its tracks was 9/11
The cost of liberating 25 million Iraqis is that tens of thousands of innocents are killed.
As is the cost of not liberating 25million Iraqis.
The cost of denigrating the business class is reduced entrepreneurship and fewer jobs.
The cost of higher taxes is reduced economic activity and higher unemployment.
The cost of deficit financing is higher interest rates, more inflation and higher taxes.
The cost of a media monoploy is mediocrity and the election of unvetted candidates.
The cost of pandering is loss of respect.
As is the cost of claiming you didn't bow, when you clearly did.
"You get what you pay for."
I guess that many others do not agree. Or else they are willing to go with a lower quality.
The difference really comes down to the free market lets you decide if you want to sacrifice to get what you need and socialism gives you no choice. I guess you are supposed to not mind because everybody gets screwed equally.
I do some volunteer work with low-income middle school kids in Lawrence, MA: low-income being defined as those who qualify for free food at school (among other things.) I am not longer surprised, but still saddened, that parents choose to send their children to school for food, while at the same time choosing to buy "bling", ipods, what-have you.
That health care is (too) expensive - at least at the personal level, and outside of major catastropic illness such as cancer - seems to me to be as much a societal issue as a real dollar issue.
What is dental care worth compared to status coming from having gold teeth, for example? If you place value on the latter, any kind of dental care at all is expensive. How you would statistically pose this as a hypothesis is unfortunately beyond me: I do think that attitudes are important, and are not being taken into account in the current health care debate.
As long as there is a private alternative to socialized medicine, and it is allowed to compete on price, quality, availability etc. things will stay pretty much status quo. There will be longer waits for people who choose to have medical care from the Post Office.
The problem is, politicians will not be able to resist trying to crowd out private care because they know they will not be able to compete with it on access etc, and because they will not be able to avoid costly adverse selection.
Engram,
Thats for pointing some basic differences in health care delivery. I am a small town business owner from rural Minnesota who has had the unusual experience of being both a consumer/payer and hospital board member. I can guarantee that anyone who serves on a hospital board for any substantial length of time will come away with a very different view of health care. I served for nine years, which is long enough to obtain a understanding of the workings of health care, but not so long as to become totally jaded by the whole experience.
If you want to truly have a discussion about American health care there are several major points that will help people understand how we got to where we are.
1. We are a wealthy country with an abundance of cheap resources, steady population growth and a large pool of talented health care workers. This is a important difference between the US and all other countries and should not be overlooked in any such discussion. It is the wealth of our country that has allowed Americans to spend 15% of GDP on health care, unlike other countries that simply cannot afford it.
2.Until recently Americans have been pretty insulated from having to pay directly for health care costs because either employers or the goverment paid. The result of this is that most consumers have no idea what health care costs. But we are all finding out. As odd as it may seem this is probably the best thing to happen to health care in a long long time. We are finally getting the health care consumer and the health care providers to come to the table and have open discussions about costs.
3.Health care providers such as nurses unions, physicians, administrators and virtually everyone else who collects a paycheck has not had to ever deal with declining income. That situation has changed. This will without doubt cause all sorts of dire predictions on the part of these groups, which all translate in to demands for more subsidys, insurance cost increases etc. It is the prudent among us who will insist on health care organizations reforming their own systems plus letting consumers see the true costs involved.
One last thought. I believe the only true health care reform that will be successful will come from within individual health care providers, such as hospitals, clinics and drug manufacters. Anything else would ultimately end up looking like Canada's system. Also, unlike some conservative commentators I do not believe that a single payer system is a bad thing just because it is a single payer versus multiple payers. Our Medicare system is a single payer system and has served us well.
I hope this adds useful information to this very timely topic. Thank you for reading my lengthly comment.
Anon:
Wonderful comments based on unique experience.
I would take exception to the last notion that Medicare works pretty well. It only works because it is currently subsidized by non-Medicare payers. If your hospital had to rely solely on Medicare reimbursement( which would almost certainly be the case under a single payer system), I suspect it would either close, or look radically different with most loss leading services such as obstetrics no longer offered.
You are right that the level of affluence in this country has allowed levels of service that no other country can match.
SR. My comment about Medicare was not a statement on cost effectiveness or cost shifting for that matter. The fact is that Medicare has been a very successful single payer system, generally offering health care providers reasonable reimbursment rates. The primary complaint I have is with certain network commentators who equate Medicare with the post office. Nothing could be further from the truth. Please remember when comparing health care systems that Medicare is a payer only. Medicare as it exists today does not actually provide health care, it only pays for it. It is highly unlikely that the USA would ever be able to manage a national health care system such as Canada's or the UK. Health care here is simply too big and diverse for any goverment agency to manage. Period.
On to the subject of actual reimbursment to providers. Sigh..This is a subject far too complex to address in this format, but suffice it to say that the devil is in the details. In this case details that are provided to us courtesy of Congress. Let me repeat that...Congress writes the rules...Need I say more? It is very easy to say that Medicare underpays providers, however this is more an issue of the health care providers operating costs, not the rate of reimbursement. There are a thousand factors ranging from which state you are located in to the particular mix of patients to try and declare that private insurance is somehow superior to Medicare. It is just not that easy.
Let me give you a quick example on one of the differences between Medicare and private insurance. Medicare will pay claims quickly and make adjustments later if needed. In my hospitals situation we quite often had private insurers who would not pay at all until everyone agreed on the final amount for each patients bill after discounts etc. This would take 90 to 180 days to resolve in most cases. This meant a carrying cost to the hospital of around 5% on each claim. In the case of Medicare, even though the reimbursements might be less, there were virtually no carrying costs associated with it. With hospital bottom lines running in the 2-3% range it is hard to make the arguement that private insurers pay better.
The issue for consumers should come down to cost effectiveness. Which system of payment is more cost effective for the consumer? This is why I advocate a open discussion of costs between health care providers and consumers. You don't go to a car dealership and buy a car without knowing what the cost will be. Hospitals are no different, they all have cost schedules for each proceedure, the problem for consumers is finding out what those costs are!
As to your comment about my local hospital, its more complicated than meets the eye. Being a rural hospital with under 25 beds allows the facility to be designated a Critical Access Hospital. CAH designation means that facility is reimbursed based on cost plus 1%. When you compare this to the net income of the hospital overall its pretty comparable to what private insurers pay, given that small hospitals don't usually have more than a 2-3% bottom line. You need to recognize of course that this varies widely because of factors such as depreciation on capital expenditures and other fixed operating costs.
Confused yet?
I am dissatisfied with the fact that I can't Email my doctors due to HIPAA. I wish I could waive every privacy right I ever had under that law.
Sensible people understand that everything has its costs.
The cost of not stopping terrorism in its tracks was 9/11
So have we stopped this terrorism thing now?
The cost of liberating 25 million Iraqis is that tens of thousands of innocents are killed.
Tens of thousands, try a million, by some estimates, 100s of thousands by conservative estimates. Also who said they were free, they are getting blown up to this day, and we still don't know who's going to wind up in charge.
As is the cost of not liberating 25million Iraqis.
There would be way more Iraq's alive today, if not for Operation Iraqi Liberation (OIL).
The cost of denigrating the business class is reduced entrepreneurship and fewer jobs.
Really, where have you seen this take place?
The cost of higher taxes is reduced economic activity and higher unemployment.Taxes have been lower for the last 8 years or so, and there are lot of jobs going bye-bye, right now!
The cost of deficit financing is higher interest rates, more inflation and higher taxes.Yes like that deficit financing of Operation Iraqi Liberation, what was that, 2 trillion?
The cost of a media monoploy is mediocrity and the election of unvetted candidates.Yes, but now that GWB is gone, we have hope again.
The cost of pandering is loss of respect.
As is the cost of claiming you didn't bow, when you clearly did.Yes like the kind of respect associated with being the major opposition party, and coming in third place behind people who claim to be independent.
America has a new president, if you don't like it, perhaps you should leave. America, LOVE IT OR LEAVE IT, that's what I say!
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