Gov: Sick Around the World 2


Sick Around the World 3
Five capitalist democracies around the world – Japan, Taiwan, Switzerland, Great Britain, and Germany – all have health care systems that provide health  care for everyone. They have higher life expectancies, lower infant mortality  rates, and spend less money than the U.S. for health care. At any given time, at least 45 million Americans do not have health insurance. What lessons can the U.S. learn about health care from other countries?

In the 1990s, Taiwan researched many health care systems before settling on one where the government collects the money and pays providers. But the delivery of health care is left to the market. Taiwan adopted a National Health Insurance model in 1995 after studying other countries’ systems. Like Japan and Germany, all citizens must have insurance, but there is only one government-run insurer. Working people pay premiums split with their employers; others pay flat rates with government help; and some groups, like the poor and veterans, are fully subsidized. The resulting system is similar to Canada’s and the U.S. Medicare program. Taiwan’s new health system extended insurance to the 40 percent of the population that lacked it while actually decreasing the growth of health care spending. The Taiwanese can see any doctor without a referral. Every citizen in Taiwan has a smart card, which is used to store his or her relevant health information, medical history and bills the national insurer automatically. The system also helps public health officials monitor standards and effect policy changes nationwide. Thanks to this use of technology and the country’s single insurer, Taiwan’s health care system has the lowest administrative costs in the world. But the Taiwanese are spending too little to sustain their health care system and the government is borrowing from banks to pay what there isn’t enough to pay the providers. The problem is compounded by politics, because it is up to Taiwan’s parliament to approve an increase in insurance premiums, which it has only done once since the program was enacted.

Switzerland, a country which, like Taiwan, set out to reform a system that did not cover all its citizens. In 1994, a national referendum approved a law called LAMal or the sickness, which set up a universal health care system. Switzerland didn’t have far to go to achieve universal coverage as 95 percent of the population already had voluntary insurance when the law was passed. Today, Swiss politicians from the right and left enthusiastically support universal health care. The Swiss system is social insurance like in Japan and Germany. All citizens are required to have coverage and those not covered are automatically assigned to a company. The government provides assistance to those who cannot afford the premiums. The Swiss shows health care reform is possible, even in a highly capitalist country with powerful insurance and pharmaceutical companies. Insurance companies are not allowed to make a profit on basic care and are prohibited from cherry-picking only young and healthy applicants. However, they can make money on supplemental insurance. Like Germany, the insurers negotiate with providers to set standard prices for services, but drug prices are set by the government. The Swiss system is the second most expensive in the world, but it is still cheaper than U.S. health care. Drug prices are higher than in other European nations and are subsidized by the more expensive U.S. market, where some Swiss drug companies make one-third of their profits. The Swiss do not have gatekeeper doctors, although some insurance plans require them or give a discount to consumers who use them.

American health insurance companies routinely reject applicants with a preexisting condition, precisely the people most likely to need the insurers’ service. Insurance companies employ armies of adjusters to deny claims. If a customer is hit by a truck and faces big medical bills, the insurer’s rescission department digs through the records looking for grounds to cancel the policy, often while the victim is still in the hospital. The companies say they have to do this to survive in a tough business. Foreign health insurance companies, in contrast, must accept all applicants, and they can’t cancel as long as you pay your premiums. The plans are required to pay any claim submitted by a doctor or hospital, usually within tight time limits. 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. Foreign health care models are not really foreign to America, because our health care system uses elements of all of them. For Native Americans or veterans, we are like Britain or Cuba. The government provides health care, funding it through general taxes, and patients get no bills. For people who get insurance through their jobs, we are like Japan or Germany. Premiums are split between workers and employers, and private insurance plans pay private doctors and hospitals. For people over 65, we are like Taiwan or Canada. Everyone pays premiums for an insurance plan run by the government and the public plan pays private doctors and hospitals according to a set fee schedule. And for the tens of millions without insurance coverage, we are like Cambodia, Burkina Faso, Burundi, Burma, or rural India. In the world’s poor nations, sick people pay out of pocket for medical care and those who cannot pay stay sick or die. This fragmentation is another reason that we spend more than anybody else and still leave millions without coverage. All the other developed countries have settled on one model for health-care delivery and finance. The United States is unlike every other country because it maintains so many separate systems for separate classes of people. We have blended them all into a costly, confusing bureaucratic mess. Which, in turn, punctures the most persistent myth of all: that America has “the finest health care” in the world. In terms of results, almost all advanced countries have better national health statistics than the United States does. In terms of finance, we force 700,000 Americans into bankruptcy each year because of medical bills. In France, the number of medical bankruptcies is zero. Britain: zero. Japan: zero. Germany: zero. Given our remarkable medical assets, the best-educated doctors and nurses, the most advanced hospitals, and world-class research; the United States could be and should be the best in the world.

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