Cheese-Eating Healthcare
| Mon Jul. 6, 2009 11:06 PM PDT
When I reviewed Jon Cohn's Sick a couple of years ago for CJR, I concluded with this:
The format of Sick almost begs for narratives about overseas health care systems. The book is basically a tour around America, with each of its eight chapters named after the place in which its story unfolds.
So why not include chapters on Manchester, Malmö, and Marseilles, each of them highlighting in narrative form both the good and bad points of the British, Swedish, and French systems?
Naturally, then, I'm delighted that Jon found someone to fund exactly that:
Last year, I had the opportunity to spend time researching two [] countries: France and the Netherlands. Neither country gets the attention that Canada and England do. That might be because English isn’t their language. Or it might be because they don’t fit the negative stereotypes of life in countries where government is more directly involved in medical care.
....In the course of a few dozen lengthy interviews, not once did I encounter an interview subject who wanted to trade places with an American. And it was easy enough to see why. People in these countries were getting precisely what most Americans say they want: Timely, quality care. Physicians felt free to practice medicine the way they wanted; companies got to concentrate on their lines of business, rather than develop expertise in managing health benefits. But, in contrast with the US, everybody had insurance. The papers weren’t filled with stories of people going bankrupt or skipping medical care because they couldn’t afford to pay their bills. And they did all this while paying substantially less, overall, than we do.
Forget Canada and Britain. Neither one is even remotely close to the kind of system we'd ever put in place in the U.S. France's system, however, is surprisingly American in its basic underpinnings. And while no system comes out tops in every single metric, French healthcare, as Jon says, is better than ours on almost all of them and does it for close to half the cost.
Now, the fact that the French spend about half what we do doesn't mean that we'd cut our costs in half if we adopted a French-style system. We wouldn't. There's too much path dependence and too many cultural differences for that. But what it does mean is that if we adopted something close to their system, we could certainly achieve high-quality 100% basic coverage — with the ability to purchase extra coverage for anyone who wants it — for no more than we spend now and possibly a bit less.
We won't, of course, because too many people are still convinced that healthcare in the United States is better than it is in France — or anywhere else. It's not. It's worse and more expensive. Somebody tell Max Baucus.
UPDATE: Matt Yglesias says that Max already knows. I figured as much.
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Comments
Yeah, right.
Submitted by jcricket on Mon Jul. 6, 2009 11:26 PM PDT.
Somebody tell Max Baucus.
Yeah, tell the willfully ignorant anything. Like it matters.
One of my Senators is Maria Cantwell who, I am told, is voting against the public option. Maria's office help is getting an earful from me in the morning. As a matter of fact, Maria's office will be told [truthfully] that if Maria votes against a public option, or supports legislation that specifically omits a public option, then not only is she NOT getting my support should she run for re-election, but I will actively support her opposition in a primary election. Should she make it through a primary, she is on her own without my vote from here on out.
If she supports legislation like a republican, then she can do without my democratic vote from here on out.
I'm a Canadian with many
Submitted by Anonymous (not verified) on Tue Jul. 7, 2009 12:18 AM PDT.
I'm a Canadian with many years experience as both a patient and a health-care IT worker. I couldn't agree with you more when you say to "forget Canada and Britain" and look to other models. Canadian health care is in reality comprised of 13 different administrative units (provincial, territorial, and civil service/military) that are all constrained to run according to federally-legislated rules. Hey, federal mandates that have to be paid for by subsidiary governments ... does that sound familiar?
The only "system" worse than Canada's is Britain. Well, okay, Cuba and North Korea are worse, but let's skip that. Are you sure France is a much better example? The country where 14,000 people, many of them elderly and sick confined to hospitals that lacked air conditioning, died in a heat wave in 2003? If I was going to remodel Canada's health care setup, I'd look to Germany and Sweden. Those countries feature intelligently regulated competition among private and public insurance agencies and hospitals. Unfortunately, that's not so attractive an option for power-hungry politicians.
Canada actual among the best
Submitted by Anonymous (not verified) on Wed Jul. 8, 2009 5:13 AM PDT.
While I agree, as a Canadian, that the Canadian system isn't perfect and the mix of federal and provincial control is inefficient, it is certainly not fair to call it one of the worst.
We need to be careful what we mean by a good and bad system. The measures for a health system are its costs and its results where the results are measured in terms of health outcomes. Those results can be further divided into average and spread of the outcomes. That is, the average can't be good simply because the rich get fantastic care while the poor get terrible care; it needs to treat people equally.
On these measures, the Canadian system is among the best in the world, not the worst, even in comparison to the G8 countries. (See, for instance, http://en.wikipedia.org/wiki/Health_care_in_Canada.)
While it is typical for people to be most critical of their own system because flaws stand out while benefits are taken for granted, it's important to look to objective measures, not personal anecdotal experiences.
Look out! Another cave in coming . . .
Submitted by DevilDog on Tue Jul. 7, 2009 12:36 AM PDT.
Administration officials today said they would be okay with only a "trigger" for a public plan. First, the banks got theirs. Now, it's the insurance companies and Pharma. Is there any member of the oligarchy that this administration will stand up to?
I have often wondered
Submitted by Nancy Irving on Tue Jul. 7, 2009 3:43 AM PDT.
I have often wondered whether opposition to universal healthcare in America does not come from a realization, on the part of the prosperous and selfish, that indeed, money does not buy happiness.
Big houses, fancy vacations, boats, servants--all that riches can buy, do not really secure the rich man from misery.
Conversely, with health, friends and a loving family, even the poor man can be happy.
So it may be that the selfish rich would positively *like* to deprive the rest of us of medical care, so as to assure that at least some of the poor will suffer the misery that they "deserve."
The same goes for helping the poor with food and shelter. Only a very modest amount of both is required for happiness, but some are eager to prevent the provision of even that.
The French don't spend half of what we do
Submitted by Megan McArdle (not verified) on Tue Jul. 7, 2009 4:48 AM PDT.
They spend more like 2/3 or 4/5 of what we do. The more popular systems are also the most expensive--and the systems whose rate of cost inflation most closely mimic ours.
All our Congress knows how
Submitted by Luther on Tue Jul. 7, 2009 6:54 AM PDT.
All our Congress knows how to do is spend money, borrow money, and kowtow to lobbyists. any health-care bill that is passed will be a monstrosity that adds enormous expense to the present system.
McMegan talking out her ass as usual
Submitted by Steve LaBonne (not verified) on Tue Jul. 7, 2009 7:26 AM PDT.
"In 2002 the United States also experienced the highest per capita spending for health care services, spending an average of $5,267 per citizen. (See Figure 7.3.) No other country came close to spending that amount per capita in 2002: Switzerland spent $3,445 per citizen; Norway, $3,083; Luxembourg, $3,065; Canada, $2,931; Germany, $2,817; Iceland, $2,807; and France, $2,736."
http://www.libraryindex.com/pages/1861/International-Comparisons-Health-...
2004 figures: $6102 (US), $3159 (France)
http://digitalcommons.ilr.cornell.edu/cgi/viewcontent.cgi?article=1316&c...
Wrong as usual, McMegan
Submitted by Steve LaBonne (not verified) on Tue Jul. 7, 2009 7:31 AM PDT.
"In 2002 the United States also experienced the highest per capita spending for health care services, spending an average of $5,267 per citizen. (See Figure 7.3.) No other country came close to spending that amount per capita in 2002: Switzerland spent $3,445 per citizen; Norway, $3,083; Luxembourg, $3,065; Canada, $2,931; Germany, $2,817; Iceland, $2,807; and France, $2,736."
http://www.libraryindex.com/pages/1861/International-Comparisons-Health-...
2004 figures: $6102 (US), $3159 (France)
http://digitalcommons.ilr.cornell.edu/cgi/viewcontent.cgi?article=1316&c...
Who cares! America has the most PROFITABLE health care system
Submitted by SecularAnimist (not verified) on Tue Jul. 7, 2009 7:48 AM PDT.
If we want to provide high-quality affordable medical care for the American people, then we need a universal, nonprofit, single-payer medical insurance system under open, transparent, accountable, efficient public administation.
But that's not what "health care" in the USA is about. "Health care" in the USA is about ensuring huge profits for the for-profit medical insurance industry. You know -- the good folks who profit by killing people, by illegitimately denying insurance coverage to their customers, and who bribe our "elected representatives" to make sure that "health reform" in America will have nothing to do with health, and nothing do to with reform, and everything to do with ensuring that billions of dollars keep flowing into the coffers of the for-profit insurance corporations.
Where Ms. McArdle goes wrong
Submitted by mds (not verified) on Tue Jul. 7, 2009 7:54 AM PDT.
Where Ms. McArdle goes wrong is in conflating government expenditures with total expenditures. As of 2006, the French government accounts for approximately 80% of French health care spending, while the US government accounts for approximately 45% of total US health care spending. But the total costs are much lower.
Per-capita government spending on health care:
- US: $3074
- France: $2833
Per-capita total spending on health care:
- US: $6714
- France: $3554
(WHO 2006 figures)
So, the French government spends almost as much per person as we do, but on a system that keeps total expenditures at half of ours. Quelle horreur!
par4 Telling Baucus isn't
Submitted by par4 on Tue Jul. 7, 2009 7:56 AM PDT.
par4 Telling Baucus isn't enough,every Dem that opposes comprehensive change needs to be told that they will be voted out of office.
Cal them and then call them again
Submitted by Anonymous (not verified) on Tue Jul. 7, 2009 8:28 AM PDT.
Each senator has at least two offices. Put the fear of the electorate in them. We have public and private universities. We have Government FHA loans and private mortgage companies. We have government Social Security and 401ks, IRAs, etc. Dozens of countries have public and private health insurance in competition with each other.
Call them and call them again and tell them they are dead politically if they don't pass a strong public option and cover everybody.
France and Canada not too different
Submitted by Wonk (not verified) on Tue Jul. 7, 2009 9:13 AM PDT.
Kevin writes: ******Forget Canada and Britain. Neither one is even remotely close to the kind of system we'd ever put in place in the U.S. France's system, however, is surprisingly American in its basic underpinnings.*******
Actually, France's and Canada's systems are pretty similar, no? Both are relatively expensive, high quality systems. The main difference is that Canada's is run along provincial lines, whereas France's is run directly by the central government. Private insurance for incidentals may play a modestly larger role in France, but in Canada, too, private health insurance is not unknown, playing a peripheral role.
Don't forget Canada.
Submitted by NickB (not verified) on Tue Jul. 7, 2009 9:19 AM PDT.
Don't forget Canada. Remember Canada. Just also remember that the US spends 80% more per person on healthcare than Canada. If Canada is the nightmare dystopia of government healthcare that conservatives warn us about, then it's pretty obvious that even in the worst case, you could provide US level care while spending a lot less.
"Oh, the wait times are so long in Canada!" Spend more money. Train and hire more doctors. Wait times will decrease. "Oh, Canada has so few MRI machines!" Spend more money. Buy more machines. I feel pretty confident that if healthcare spending in Canada were even halfway between its current levels and US levels, every single one of the problems that conservatives point out in the Canadian healthcare system could be fixed. Oh, and they'd still be spending 20% less and providing healthcare to every single person in the country. Sounds like a deal to me.
Cheese-eating
Submitted by SecularAnimist (not verified) on Tue Jul. 7, 2009 9:38 AM PDT.
By the way, the need for costly medical interventions of all kinds would be greatly reduced if we eliminated the epidemics of preventable, debilitating and lethal diseases that arise from a diet heavy in animal products -- meat, dairy and eggs.
Want to do your part to help lower health care costs? Stop eating cheese. And meat. And eggs.
Homo Sapiens wouldn't even
Submitted by Omnivore (not verified) on Tue Jul. 7, 2009 1:24 PM PDT.
Homo Sapiens wouldn't even exist were it not for the introduction of meat and the concentrated protein it provides into the diet of earlier hominids.
Granted, Americans definitely eat too much meat and other animal products, but eliminating them entirely would be detrimental and misguided. If you want to eliminate something from your diet, start with HFCS and other highly processed carbohydrates.
Several epidemiological
Submitted by Artcalight (not verified) on Wed Jul. 8, 2009 6:57 PM PDT.
Several epidemiological studies show strong correlation and possibly causation between eating a whole-food, plant based diet and decreases in incidence of the major diseases such as cancer, CVD, diabetes, etc., etc. The Mediterranean diet, T. Colin Campbell's CHINA STUDY, Arnold Ehret's mucus-less diet, etc. You want a flat belly? Stop eating red meat of all kinds. I won't even go into the dangers of eating meat (beef, pork, chicken, etc., even fish) from factory farms.
Re: Don't Forget Canada
Submitted by Steve LaBonne (not verified) on Tue Jul. 7, 2009 9:45 AM PDT.
Everything NickB says goes double for the UK (which clearly underspends quite a bit by comparative OECD standards). Yet even they have better public health outcomes than the US!
health care in europe
Submitted by rbe1 (not verified) on Tue Jul. 7, 2009 12:11 PM PDT.
I have lived in Germany for some time, where health insurance is mandatory. I have had to make use of the health care system several times. The access to physicians is excellent, with a wide variety of choices of doctors, the insurance I have covers 100% of prescription medication (full reimbursement), and the medical professionals are first rate, doctors right down through receptionists, as well as staff in the pharmacies. I wouldn't trade my insurance for the sorry mess in the USA for all the proverbial tea in China. America, you are being fed a line of pure horseshit.
Republicans can't see past their own mirrors
Submitted by alan (not verified) on Tue Jul. 7, 2009 12:39 PM PDT.
Republicans can't see past their own mirrors.
When they describe the health care in other countries their description is pretty accurately what US healthcare is like.
Horseshit
Submitted by Steve LaBonne (not verified) on Tue Jul. 7, 2009 12:52 PM PDT.
America, you are being fed a line of pure horseshit.
The great majority of Americans are now aware of this (in a way that they were not in 1993); it's our "one dollar, one vote" political system that has held up reform.
The French health care
Submitted by MacGruber on Tue Jul. 7, 2009 2:19 PM PDT.
The French health care system is not the paragon of state-run health care:
http://news.bbc.co.uk/2/hi/europe/3423159.stm
In fact, there is no paragon because government inevitably screws it up.
Of course, those liberals who point out how great - and cheap - the French health care system is fail to mention that the French don't extend health care benefits to any illegal immigrants, or any immigrants who don't hold an E121 or E106 visa.
Here in the U.S., those money-grubbing hospitals and doctors treat immigrants - illegal or not - and pass the bill onto those who do pay.
If you take into account that disparity, you'll probably find the French system isn't as cheap. And those glorious stats will look a little worse as well. That live birth rate statistic? It doesn't take into account the French immigrants who don't get French health care.
America's health care system helps more people than any other socialist health care system in the world.
There's a reason immigrants line up to come to America, much more than France or any other European nation.
MacGruber your link is over 5 ½ years old - written on the eve of a legislative overhaul of the French system. Even with the problems the article identified, the BBC stated that: “The standard of care provided by French doctors is ranked among the best in the world….”
You type that:
“America's health care system helps more people than any other socialist health care system in the world.”
Really? Cool. Show me your stats. And qualify “help” while you are at it.
“There's a reason immigrants line up to come to America, much more than France or any other European nation.”
To get their blood pressure taken? Now, I applaud your patriotic fervor and I hope you can try harder to be more exact.
Apparently it's one of our particular virtues
Submitted by alan (not verified) on Wed Jul. 8, 2009 7:23 AM PDT.
I thought the idea of healthcare for illegal aliens got Republicans all freaked out.
Apparently it's one of our particular virtues.
I've lived in Vienna for 18
Submitted by Anonymous (not verified) on Fri Jul. 10, 2009 10:25 AM PDT.
I've lived in Vienna for 18 years and the same holds for us here as the person in Germany stated and I know for a fact that this insurance extends to people without visas.
Today is different than at any time in the past.
Submitted by MarkH on Tue Jul. 7, 2009 6:11 PM PDT.
The public is better informed by the recent debate. We know the problems, the issues, possible solutions, other country's systems and we know lobbyists are trying to dissuade our politicians.
If we don't get a new law and good results pretty darn quick, then what else can the public do but throw out anyone who gave us crap. Party be damned -- we need results.
If they've got something as good or better than a public option, then I'm all ears. I haven't heard it yet.
The "public option" will be
Submitted by evdebs on Thu Jul. 9, 2009 9:32 AM PDT.
The "public option" will be reduced to Medicare for the "uninsurable", further enhancing health care industry profits at taxpayer expense. There will be no true reform in the US until we outlaw our system of political bribery.
Healthcare costs are
Submitted by CampbellP on Sat Jul. 25, 2009 2:04 AM PDT.
Healthcare costs are increasing at an unsustainable rate, and the national economy will not thrive unless they are reined in. HR 3200 can be a great help during these times. HR 3200 is a health care bill, and what it does is that it will provide affordable health care for all, and curtail medical costs. It also makes it mandatory for all Americans to have health insurance, but creates a government run (taxpayer funded) alternative to private insurance, prohibits exclusion on basis of pre-existing condition, and then (here's the kicker) places a surtax on all households that earn more than $350,000 to pay for it. (To be fair, they don't need sympathy.) The bill HR 3200 is likely to be wildly unpopular, even if it might mean fewer people needing emergency cash loans to see a doctor.
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