That's convenient since you keep making pronouncements which I then prove wrong. I usually let them go since I'm fairly sure you know that you lost those arguments but you need to pay attention and stop twisting what I said and then getting upset about it.
Moving forward....
There are many types of systems that work for industrialized countries such as ours. None of them are perfect and they all need to stay flexible to account for changing demographics, medical science, etc. They all rely on two things:
- universal health care coverage. No one goes bankrupt from medical bills, everyone is covered. Health care is treated as a right, not an option or a luxury.
- the government regulates the industry quite heavily whether or not it pays for all services directly.
Two systems that are interesting are Taiwan's because it is new and based on reforming a system that was becoming too expensive. They did what we can do, look at other systems (they rejected ours) and see which pieces of others would work for our particular situation:
"Taiwan established a compulsory national health insurance program that provided universal coverage and a comprehensive benefit package to all of its residents. Besides providing more equal access to health care and financial risk protection, the single-payer NHI also provides tools to manage health spending increases. Our data show that Taiwan was able to adopt the NHI without using measurably more resources than what it would have spent without the program. It seems that the additional resources that had to be spent to cover the uninsured were largely offset by the savings resulting from reduced overcharges, duplication and overuse of health services and tests, transaction costs, and other costs. The total increase in national health spending between 1995 and 2000 was not more than the amount that Taiwan would have spent, based on historical trends.
Additionally, Taiwan did not experience any reported increase in queues or waiting time under the NHI. Meanwhile, the government has taken regular public opinion polls every three months to gauge the public’s satisfaction with the NHI. It continuously enjoys a public satisfaction rate of around 70 percent, one of the highest for Taiwanese public programs.
One notable result that should interest Americans is that Taiwan’s universal insurance single-payer system greatly reduced transaction costs and also offered the information and tools to manage health care costs. Alex Preker, a leading health economist at the World Bank, came to a similar conclusion from his research of OECD countries. He concluded that universal health care led to cost containment, not cost explosion.26 Equally important, a single-payer system can gather comprehensive information on patients and providers, which can be used to monitor and improve clinical quality and health outcomes."
content.healthaffairs.org
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France's gets a lot of attention these days so it is worth looking into as well.
"The Health Care System I Want Is in France
French Health Care: C'est Magnifique
By MARY CLINE
PARIS April 15, 2008 —
Shortly after we moved to Paris, my son, Luke, cut his lip in a fall at school. I rushed him to the emergency room of a suburban Paris hospital, where a nurse asked my name and address and a doctor quickly stitched up his cut. When I tried to pay, the cashier asked me to call the following week because the "computer is slow." A bill eventually arrived in the mail for the equivalent of $60.
The same week I took Luke to have his stitches removed at a clinic where a doctor spent nearly an hour with him first softening a scab on the cut. This time, the clerk was apologetic as she handed me the bill, explaining she was sure my American health insurance would reimburse some of the cost. The total bill: $7.50.
As presidential candidates hammer out proposals to deal with the increasing millions of uninsured Americans, I know which health plan I'll choose: the French one.
The World Health Organization has named the French health care system the best in the world. (The U.S. ranked 37th). It's physician-rich, boasting one doctor for approximately every 430 people, compared with a doctor for every1,230 residents in the U.S. (and French docs tend to charge significantly less). The average life expectancy is two years longer than the U.S. And while the system is one of the most expensive in the world, costing $3,500 per person, it's far less than the $6,100 spend per capita in the U.S.
I've had a unique opportunity to see both systems up close and personal: I had breast cancer in California nine years ago and a recurrence in Paris this year. I received excellent care in both places, though looking back now my California oncologist's office was a bit of a meat market always packed with patients, from the seemingly not-so-sick to some a step from the grave a time-consuming disadvantage of living in a much larger country with a lower doctor-to-patient ratio.
My French doctors and nurses have been sensitive, skillful, caring and not so harried.
But the biggest difference has been money.
My top-level health insurance paid for most of my U.S. care, but it was often a struggle to shake loose the money. I was frequently stuck in the middle of disputes between the company and my hospital and doctors over "agreed to fees."
Continually dunned by the hospital for fees and facing multiple complaining phone calls to my insurance company, I sometimes simply caved in and wrote checks to cover bills that I knew were the insurance company's responsibility part of a wearing-down strategy I was convinced was deliberate.
Here in France I have a green carte vitale literally a "life card" or social security card that provides entree to the system. It's funded by worker contributions and other taxes. My husband (and our family) is covered through his work with a French subsidiary of a U.S. company, and so is everyone else; coverage is universal. The French are responsible for co-pays, but some 80% of them have supplemental private insurance to cover the co-pay. People least able to pay and those with chronic or serious illnesses often have the best coverage. Because I'm being treated for cancer, I'm cent pour cent 100%covered.
The effect of a system where hospitals and doctors don't worry about getting stiffed by a patient or an insurance company seems to be a far more relaxed, generous system. When my surgeon discussed breast surgery here, he suggested that I stay in the hospital five days. "Of course I can do it the American way, kind of an outpatient situation," he told me, apparently not wanting to sound unsophisticated. "But I don't like pain."
Maternity stays for a normal delivery are a minimum of five days, not the 48 hours mandated by U.S. federal legislation in 1998 after many insurance companies insisted stays be even shorter.
I've always had health insurance in the U.S. And yet the few times I'd had to walk into an American emergency room I've always felt a thief who seems to be expected to sign over all worldly goods before any medical care can begin, regardless of the state of agony someone might be in. French doctors address problems immediately and aren't constrained by approvals from some medical decision maker in a distant insurance office.
Years ago, my husband had to wait several hours in Manhattan emergency room as administrators tracked down someone in our out-of-state insurance company who would approve (and therefore agree to cover the bill for) antibiotic treatment for a horrifying infection in his face that doctors were concerned could have been flesh-eating strep.
There's no question you'll be treated in France. Everyone is. The nation pays the bills and the hospitals don't get stiffed. It's an all-encompassing cradle-to-grave system. My fear now is that I won't be able to even get insurance when and if I return to the states, much less be able to afford it.
"The French health care system has a lot of lessons for the U.S.," said Northern Arizona University Professor Paul V. Dutton, who has studied both extensively for his book "Differential Diagnoses: A Comparative History of Health Care Problems and Solutions in the U.S. and France."
"There seems to be a feeling that Britain's socialized health system is the only one we can look at because it's English, it's the mother country. But in fact, the French share many of the same values that American consumers seek, like choice of physician and freedom from insurance company authorization of medical decisions. The French system is already far more similar to the American ideal," Dutton said.
Except it works.
Mary Cline is a freelance writer and editor in Paris. She's using her married name for a change because of fears that she won't be able to obtain U.S. health insurance when she returns to the states if insurers track down this article."
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