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Michele Swenson

Michele Swenson

Posted January 17, 2009 | 02:00 PM (EST)

'Sick Around the World': Contrasting U.S. Health Care with 5 Other Capitalist Countries


U.S. Taxpayers rightfully question the insanity of shoveling $700 billion (more accurately, several trillion) of corporate welfare to the high-rollers on Wall St., when true health care reform for all could contribute significantly to U.S. economic recovery and provide immediate relief to those very same taxpayers.

The ability to access health care would alleviate a huge burden for those reeling under the weight of home foreclosures and job losses. Naysayers who project stratospheric costs for health care reform (still less than corporate bailouts) remain willfully ignorant about numerous federal and state studies (now more than 20) that have demonstrated billions of dollars of savings with a single-payer model of health care reform that could provide comprehensive coverage for all.

The lament of "free-market" conservatives like Morton Kondracke is the feared "disappearance of private health insurance." It is that very insurance industry that has sucked the U.S. health care system dry by placing profits before health care, and gaming the system with tactics of bait-and-switch, denial and abrupt cancellation of coverage, inadequate disclosure, deceptive marketing, promotion of evermore limited benefit policies at increasing cost, restricted choice of providers, while creating the accelerating annual $20 billion industry of "Denial Management," writes Dr. John Geyman (Do Not Resuscitate: Why the Health Insurance Industry is Dying, and How We Must Replace It).

The fact that people in the U.S. cannot access needed health care, or that 50% of U.S. personal bankruptcies are due to medical bills "would be a huge scandal" in Switzerland, the conservative Swiss president, Pascal Couchepin tells journalist T.R. Reid in his documentary Sick Around the World. Couchepin echoes the overriding sentiment heard in all five of the capitalist countries visited by Reid: "Everybody has a right to health care."

Last week Reid brought his documentary to the Colorado legislature, and answered questions from members of the House and Senate Health & Human Services Committees. The film draws a sharp contrast between five other capitalist countries where everyone receives needed health care without risking bankruptcy and the fragmented non-system of U.S. financing and health care delivery where many fall between the cracks.

When Taiwan designed a new health care system in 1995 after studying health care in 15 other countries, they discounted the U.S. model as a "market-not-a-system." They created a national insurance with no opt out, no gatekeepers and no wait lines. Information technology plus a smart card with each person's medical history facilitate health care. Taiwan has the least administrative costs of all countries (2%), as providers bill the government directly.

A key difference between the U.S. and others, notes Reid, is that you will not find anything resembling the U.S. "army of underwriters practicing risk selection" in these other countries. Insurance for needed health care is not-for-profit. Only supplemental policies (e.g., for private hospital rooms, etc.) are sold for a profit.

The national insurance of most of these countries is covered by a sliding-scale tax or social insurance payment. The poor are subsidized. All five of these countries -- Great Britain, Japan, Taiwan, Switzerland and Germany -- spend roughly half as much on health care as the U.S. spends, and have better outcomes. In all of the countries except Britain, medical education is free. In other countries claims are paid quickly, within 2 weeks, by contrast to U.S. insurance denial of 30% of first-time claims. Great Britain has a public entity that makes decisions about coverage, e.g., cutoff for some procedures, such as kidney dialysis for the terminally ill. "They cover everybody, not everything."

Reid reports that most capitalist countries don't trust the unfettered free market and, thus, create serious controls. He notes that universal care could begin at the state or federal level. If one state created a model, others would likely follow, as in Canada, where national health care started in one province (Saskatchewan, where insurers declined to insure rural folks), financed by taxes. One by one, other provinces demanded the same.

Health care systems in all of five of the countries visited by Reid share the following characteristics:

1) Insurance companies accept everyone (no exclusions) and do not profit from basic necessary coverage -- even when coverage is accomplished through a number of private insurers. E.g., Germany has over 200 private insurers, who make an end-of-year financial report. To equalize risk among insurances, those that end the year in the black, share their income with those who end the year in the red.

2) There is a mandate for all to buy into the system, and government subsidizes the poor.

3) Doctors and hospitals negotiate annually for fixed-rate payment, whether they negotiate with a quasi-government or government entity, or with private insurers, as in Germany.

4) Bankruptcy due to medical bills is unheard of in these countries.

5) Most utilize some form of IT, electronic medical records, and individual smart cards with medical history.

Reid also reports a very good personal experience of health care while living in both Japan and Great Britain. In Great Britain, he relates that his family received very good care from a doctor who lived on the block and made house calls. Oh, how far the U.S. has fallen!