Have you seen this past week’s Frontline documentary, “Sick Around the World: Can the US Learn Anything From the Rest of the World About How to Run a Health Care System”? If you haven’t, consider yourself urged to go the the PBS website and view it online — click here. Fantastic capsule looks at the health care systems in Britain, Japan, Germany, Taiwan, and Switzerland.
It’s a challenge to many folks on both the right and left in the US. To folks on the right — why is it that other diverse nations can cover everyone for far less cost, use more services, and maintain higher levels of citizen and patient satisfaction? To folks on the left — isn’t it clear there are more ways than just Canada’s and Great Britain’s systems to skin this cat? Yes, both have lots to like, and yes, there are lots of other ways that might actually be more politically doable in the United States.
That’s our take. Watch it and tell us yours.
One way to mitigate peak Emergency Room loads in cities is to have health insurers pay the cab fare required to shuttle non-urgent patients to nearby ERs that aren’t as busy.
The system would require hospitals to be networked (even the internet should suffice), and to maintain a real-time queue of patients.
The cab fare costs should pale in comparison to the costs of slow ER service.
While I thought the show was very interesting, I want to raise the following points that should be considered in assessing the applicability of any of these five countries’ systems to the U.S.:
1. While providing for no exchange of money at the point of service saves on administrative costs, there is a risk that it will lead to overutilization (especially for primary care services) as was alluded to in the UK system.
2. The much more litigious environment in the U.S. suggests much higher costs for malpractice insurance and defensive medicine intended to protect against lawsuits.
3. End of life care is much more conservative (and cheaper) elsewhere. We just don’t seem to know when to stop here.
4. I don’t know how these other countries induce people to undergo the training to become doctors for such low salaries, even if they emerge from medical school with no debt. In the U.S., the drug chains tell me that pharmacists are paid about $80K plus benefits and nurse practitioners earn only slightly less. There is a significant shortage of both nationwide.
5. There are huge regional differences in the cost of medical inputs (mostly wages, real estate and insurance costs for providers) in the U.S. The Japanese system of one price book for the whole country could not work here. Even Medicare uses different conversion factors to reflect these cost differences.
6. I’ve read that people in Japan, if they want to see one of the more popular doctors, often routinely spend three hours in the waiting room for their three minute visit. I don’t think most Americans would tolerate that. The wasted time doesn’t show up in any of the statistics that evaluate healthcare system quality, by the way.
7. Switzerland is a tiny country of 8 million people, while Taiwan has 23 million. In the U.S., we would probably call those laboratories or pilot projects.
8. As was mentioned, the tax burden in the European countries is far higher than here. Americans are unlikely to tolerate that either.
9. The U.S. can certainly do better in such areas as implementation of electronic medical records, reducing the huge regional variations in practice patterns, and using comparative effectiveness research and evidence based medicine to decide what to cover or not cover or, at least, which tier various drugs, devices, services and procedures belong in.
10. If I had to pick one, I think the German system is the closest fit to our values and culture except that I don’t think profit is a dirty word. I don’t see the non-profit Blues, for example, selling health insurance for less than their for profit competitors charge.
From the middle left on marathon monday I took a quick look at the site and found an easy to understand description of of a couple of systems in plain english. Thanks!
Look forward to digging in more, (not really), but meanwhile could some policy wonks*out there tell us which model most resembles the Massachusetts plan? Which model would build on the best parts of our jerry-built private/public national model of employer based/medicare/medicaid/SSDI/SCHIP/vets etc etc etc? In plain english please. Just asking.
*you kinow who you are