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Our Health Depends On It

There are too many “facts” being thrown around in the healthcare debate, and not enough information for me to figure out which ones are true. This is made worse by “facts” that I know are false. For example, I keep hearing opponents of health care reform claim that if health insurance was provided by the government, then you will not be able to pick your own doctor. Not only is this not true in every plan being proposed in the US, it is not even true in any country I know of that has single payer health insurance.

But other “facts” are more difficult to evaluate. For example, I keep hearing about long waiting lines in Canada for certain treatments, or to see specialists. Or about people crossing the border from Canada to the US to take advantage of our “superior” health care. It shouldn’t be difficult to actually find out if either of these things are true. How many people come to the US for medical procedures? How does this compare to the number of people in the US who travel to other countries to get medical procedures? Where are these numbers?

What we are left with — which is better than nothing — is anecdotal evidence. For example, a posting today in Reddit from a Canadian, giving what looks to be a fairly balanced view of the Canadian health care system — largely positive, but not afraid to point out things that could be better.

A better researched example, but still anecdotal, is this excellent article in The New Yorker that argues that “Costlier care is often worse care” in the US.

So I guess I will throw in my anecdotal evidence too. I am actually in a fairly good position to provide anecdotal evidence for and against health care reform. I have mainly lived in the US, but I have also lived — and more importantly had interactions with the health care system — in three other countries: England, Canada, and New Zealand. In addition, I have good friends in all of those countries, including friends who have lived both in the US and those countries, and we have had discussions about the relative merits of the various systems. This is what I’ve found:

  • Nobody I know prefers the system in the US. Not even close. I know people who will no longer travel to the US, just because they have had bad experiences with the US health care system.
  • I have talked to more people who have traveled to other countries to get health care they either could not get here (because it was not yet approved) or could not afford (because it was cheaper to fly to another country and get a treatment than it was to get it here), than people who have traveled from other countries to the US to get treatment.
  • You cannot talk about single payer systems in other countries as if they were all alike. There are many variations.

This last point is important. I lived in England during the Thatcher era, which is many ways was similar to some of our recent conservative administrations. Prime Minister Thatcher spent a lot of time trying to destroy the social programs created by the previous left-wing Labour governments, including the single payer health care system. As a result, I would say that England had the worst single payer system I have had to deal with. Still better than the current US system.

Canada, where I have lived multiple times, comes in second. Better than the British system, and far better than the US, but could definitely use some improvements. One thing I specifically don’t like about the Canadian system is that you cannot buy extra private insurance if you want it. You are locked into their system, period.

The best system I have had personal experience with is in New Zealand. In NZ, doctors and hospitals are privately run, but the government pays for basic preventative care and for major medical problems. There is an emphasis on keeping everyone healthy through regular check-ups and early detection of serious problems, and the government also pays for big things (the kind that usually bankrupts people in the US). Supplemental private health insurance is available, if you want and can pay for it, and is relatively inexpensive (since it doesn’t have to pay for basic preventative care, nor for hugely expensive problems).

One thing that surprised me was that automobile insurance was also far cheaper than equivalent insurance in the US, because it did not need to cover medical expenses. So you saved a ton of money: no out-of-pocket health insurance costs other than what you paid in taxes to cover that insurance, which was far less than paying for an equivalent health insurance policy in the US; and far cheaper car insurance.

As for long waits, when I needed to see a doctor in NZ, I called a doctor who was located within walking distance of where I lived, and got an appointment for the next morning. I showed up with all my private information — ready to fill out a bunch of forms — and was surprised to find out that I did not need to fill out anything. From the time I showed up, until I was sitting in front of the doctor, was less than 5 minutes. And the doctor didn’t feel any need to practice defensive medicine. She mentioned some tests that I could get if I wanted them, but said she didn’t think they were warranted. Since I had already had similar tests in the US, I didn’t get them. It was a completely pleasant experience, and I felt like the doctor was not rushed, was willing to answer all of my questions, and discuss all of my options. The whole thing cost me $35 (if I had been a resident of New Zealand, rather than a visitor, it would have been free).

Likewise, I had to refill some prescriptions while I was there, and the total I had to pay (and I was paying the full price, since I was a visitor) was less than the deductible amount I was paying for the same prescriptions in the US. So it was cheaper to pay full price for drugs in NZ than to get them with health insurance supposedly paying for them in the US. And the full price of the drugs in the US (if I had not had an expensive insurance plan that covered prescriptions) was over four times what they cost in NZ. And of course, if I was a resident of NZ, they would have been free.

I had a similar experience when a friend had an allergic reaction and was having problems breathing. We called the nearest hospital, and they said to bring her in. When we arrived, they had already prepared a room for her in advance (I have never had that happen in the US) and again, she was talking to a doctor within minutes of arriving. Their treatment worked, and she was breathing normally again, but they asked her to stay for a few hours so they could make sure everything was alright before they released her. While we were waiting, I started wondering how much this was going to cost (since she was also a visitor and not covered by the NZ health plan), but when we went to leave, we were not charged anything. Also, the total amount of paperwork she had to fill out was her name and address, and a couple of questions about any drugs to which she might be allergic.

A few month after that, back in the US, I had to go to an urgent care center for a minor emergency, and the paperwork they had me fill out took 45 minutes to finish, and then I had to wait over an hour before I got to see a doctor who was obviously rushed. The experiences were like night and day. And even not counting my expensive health insurance plan I had to pay for in the US, my emergency in the US cost me far more than a more serious emergency in NZ.

So the point of all this is that it is not just important that we get health insurance reform, it is very important what system we end up with. There are powerful forces in the US who want health care reform to fail, just like Thatcher wanted it to fail in the UK. If we let these people influence the new system, we will end up with a poor system. Then they will be able to shout “I told you so” about government-run health care.

Don’t let them do it. We need facts. We need to look objectively at the health care systems in other countries, and pick the parts that will work for us, and get rid of those things that don’t work. We can’t figure out a good health care system based on lies and deceptions, or on misleading labels like “socialist” or “government takeovers”.

Our health depends on it.

UPDATE: Another good article about health care reform in the New York Times, with more information about the Canadian system.

UPDATE 2: An editorial in Newsweek by Tom Daschele, “A public plan will reduce costs and improve access” makes the point that a public plan will offer “a far greater choice of docitors than private plans do.”

UPDATE 3: More information from Canada — with evidence that Canadians love their health care system.

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26 Comments

  1. JM wrote:

    My own experiences attest to the authenticity and accuracy of this article. I particularly strongly agree with the sentiment that no-one who has experienced other health care systems prefers the US system.

    Friday, June 12, 2009 at 12:53 am | Permalink
  2. CS wrote:

    Thank you for pointing out the car insurance connection. Every time I write the obscenely high checks for car insurance I think the same thing… I wouldn’t need to pay this if everyone had health insurance.

    Friday, June 12, 2009 at 6:04 am | Permalink
  3. Eva wrote:

    1966-Working OB at Alta Bates Hospital in Berkeley, I listened to a Dr. tell of his and his wife’s visit to Austrailia where she needed a D&C for bleeding. He was so impressed by the treatment she got and the lack of cost for the treatment. 1966. Most Drs I’ve heard want Universal Health care. The Doctors want it.

    Friday, June 12, 2009 at 6:32 am | Permalink
  4. starluna wrote:

    Great post. I always laugh when I hear people say that “you won’t be able to choose your doctor.” I never have been able to choose my doctor. In California, I had Kaiser. You could only use Kaiser facilities. Here in Massachusetts we have “regular” insurance where I could choose any doctor, but if it’s the wrong doctor, I’ll pay a higher co-pay. When we had no insurance, well, I wouldn’t really call going to the local urgent care center a real choice.

    One thing that no one seems to be mentioning in this debate is that we can’t have universal access to health care unless we start to control the costs and ration the care that is available. Every country that has any kind of universal system of access controls the costs – which also means controlling what doctors can and can’t do. Personally, I think this is the biggest ideological hurdle to getting health care reform.

    Friday, June 12, 2009 at 7:06 am | Permalink
  5. Pkam wrote:

    I don’t have much to add, but I wanted to commend you on the piece. Fantastic, and the auto insurance connection is something I’ve never thought of or heard anyone else mention.

    It irritates me that the main rationale of the right against a gov’t system is that it will limit ‘choice.’ To me, the important choices in health care are in the procedures and care you get, not who pays for them. In a private system (like we have now), those important choices are lost in favor of the false choice of what corporation you get to make richer for the privilege of limiting your care.

    Friday, June 12, 2009 at 8:01 am | Permalink
  6. Mike wrote:

    I just spent 3 months driving a van around N-Zed, and had a similar experience. After getting chronic diarrhea in Thailand, we wanted to get tested cause all of the cheap over the counter meds there didn’t work. When we asked people where to go for a test in Takaka, a woman told us of a clinic, but warned us that it was really expensive: $70NZ/$40US!!! We just laughed.

    We were shown in about an hour after our appointment, but once in the doctor took his time and did a great job.

    Friday, June 12, 2009 at 8:07 am | Permalink
  7. JM wrote:

    Want to go one better with Auto insurance? More places than I realized (I knew about Australia) have mandatory 3rd party (liability) insurance that is purchased as part of a vehicle’s annual license fee. If your tags are out of date, so is your insurance. This makes it vastly easier to ensure that most people have some form of insurance and would negate the requirement we have is the US to carry un and under insured coverage.

    http://en.wikipedia.org/wiki/Vehicle_insurance#Australia

    Friday, June 12, 2009 at 8:48 am | Permalink
  8. *applause*

    I have worked as a temp at a medical equipment manufacturing site (pacemakers) back in the day (80’s weekend college work).

    Marble stairways, glassed in atrium in the lobby, the whole deal. I was there as a temp to stuff envelops (not allowed to read the letter): the letter was about how the pacemakers were faulty, dangerously so, and it was being sent confidentially to the doctors–not the patients.

    Given my other extrememly limited experience with the medical professions, my impression is that the corporate side is the bulk of the problem. Greed is *not* always good.

    Oh, and have you thought about why Americans might buy this load of malarkey about having access to the best health care in the world? We would have access to that health care only if we were rich enough to afford it, of course. But I gather there’s a mindset among some Americans that they will get that rich someday, and so such people are wanting to protect their future benefits (same sort of logic may apply to not taxing the rich heavily–if a person sees him/herself as a future rich person, that person may be motivated to argue against such high taxes).

    Not everyone is falling into this trap, of course. But I am reminded of the skit from the musical 1776, where the good gentlemen of the Congress sing about being “rational men.”

    Friday, June 12, 2009 at 9:02 am | Permalink
  9. Iron Knee wrote:

    The New Yorker article referenced in the post makes a good case that money doesn’t necessarily buy good care, or better health. I recommend everyone read it.

    So the idea that the US health care system will work for you “once you get rich” is not really true either. I could probably afford almost any medical treatment I needed, but I would still far prefer the system in NZ.

    Friday, June 12, 2009 at 9:56 am | Permalink
  10. Sammy wrote:

    I’m somewhere wildly on the fence regarding this issue. One thing your analysis (very good, by the way) does not include, is what the income tax rate is in the aforementioned countries to cover this cost. So their car insurance is much less expensive, but are those citizens paying an effective income tax rate of 35%? I’m not talking about tax brackets, but actual income tax paid divided by gross income.

    This is not meant as an argument against your position, but just another question added to the mix.

    I believe that the answer lies somewhere between our system and a government-run system. I help run a small business, and the next government-run system I see that is not full of bureaucratic waste and autopilot brain dead employees will be the first.

    Friday, June 12, 2009 at 10:35 am | Permalink
  11. Iron Knee wrote:

    Sammy, you make an excellent point, and one that backs up the main point of my post — that the devil is in the details. It is not good enough to get something that some politician calls a “public option”, we need to make sure it works and reduces costs. After all, Bush managed to push through things like “no child left behind” and “clear skys” and even a “prescription drug benefit” that caused more problems than they solved. Never underestimate the ability of politicians to jerk us around. I still believe that Obama will do better than Bush (such a low bar…) but with the health industry doing everything they can to sabotage health care reform, the only person you can trust to make sure we get real reform is yourself.

    Friday, June 12, 2009 at 12:14 pm | Permalink
  12. Sammy wrote:

    I have an excellent health plan (and I’m lucky to have negotiated total family coverage into my total compensation), but I’m a male, so ya know I only go to the doctor when I’m three minutes from death’s door. ;)

    But I’m married to a female and have two kids, so there’s plenty of family utilization to make up for my male stubbornness.

    Friday, June 12, 2009 at 12:27 pm | Permalink
  13. As a former Property and Casualty Insurance agent I’ll throw in some numbers that are about 90% accurate and 100% confusing.
    Bodily Injury Insurance is the bulk of your liability part of your Auto Insurance Policy most of this goes to covering hospital bills (about 60%) the rest covers you under wrongful death (If you kill someone with your car you are responsible for the lost earnings that the family could expect to receive).
    Most states also have some form of PIP (Personal Injury Protection) to cover your emergency room bills.
    I’ll give a quick rundown of what I would save off my $333 premium.
    If we had a single payer system you could take out the PIP (In my case that is $77.23) 60% of the Bodily Injury (about $77) and 60% of Un/Under Insured ($18) so I would save roughly $173 every 6 months on car insurance. Getting my premium down to $26 per month.
    At that rate their would be less excuse for someone not to have car insurance which would make my uninsured motorist coverage drop even more.
    Add in the $5 a month I pay for Workman’s Comp and you could raise my taxes a couple percent and I’d never notice.

    Friday, June 12, 2009 at 12:40 pm | Permalink
  14. starluna wrote:

    Sammy makes a really good point that the efficiency of any system depends entirely on the operations and the quality of the staff. A single payer system isn’t a panacea.

    I heard Himmelstein and Wolfe on the Bill Moyers show claim that getting rid of insurance companies would create such efficiencies that doctors could continue to make very costly care decisions and there would still be enough money to provide access to everyone. I think they are delusional. At best they would be trading the hours they spend negotiating with a private plan with hours spent negotiating with public payers. Unless there is a clear system of what will be paid for and what will not be paid for and other cost controls.

    I’m all for single payer but I’m not crazy enough to think that somehow there still won’t be problems for some people. If we do it right, the doctors will be pissed because their reimbursements will likely be lower.

    Friday, June 12, 2009 at 12:57 pm | Permalink
  15. Sammy wrote:

    Here is an example of my concern:

    When I’ve used UPS, a private company, for next day services, they have stated the package WILL be received the next day (or two days, depending on service paid for). And they’ve rarely failed me.

    When I was at the Post Office the other day, someone was paying for next day service, and the clerk stated that it MIGHT be there next day, but it might be there in two or three.

    For me, that is the epitome of private companies vs. government services. Hence my concern.

    Friday, June 12, 2009 at 1:02 pm | Permalink
  16. Iron Knee wrote:

    Actually, the largest expense for providers is that they have to deal with hundreds of insurance companies, each with their own rules, forms, procedures, and names for different procedures. That’s why I’m in favor of single payer — only one government bureaucracy to deal with, rather than hundreds of health insurance company bureaucracies. In fact, they already have to deal with Medicare, so they aren’t gaining any bureaucracy they have to deal with.

    And doctors would be free to pass on any charges beyond what the government would pay to the patient, as they do now. That’s what supplemental health insurance in NZ takes care of.

    Friday, June 12, 2009 at 1:04 pm | Permalink
  17. Iron Knee wrote:

    Sammy — you have a choice of using UPS or USPS.

    And I’m not sure what you overheard at the Post Office. The USPS definitely offers guaranteed delivery. See http://www.usps.com/shipping/expressmail.htm

    I used to be the CEO of a company whose business involved shipping hundreds of packages every day (thousands around Christmas) to 60 different countries. We monitored everything and could tell you which shipping service was more likely to deliver a package on time, and — even more importantly — less likely to lose the package entirely. We were surprised that the US Post Office was often more reliable than many private services. Some of the (big name) private services were terrible at losing packages — I don’t want to name names because this was a few years ago. But I will say that the top two shipping services we used to destinations in the US (depending on service requested) were UPS and the USPS.

    Friday, June 12, 2009 at 1:30 pm | Permalink
  18. Scott wrote:

    Earlier today, saw one of the fur-unbalanced guys at F**KsNooze Channel interviewing someone who was mostly in favor of the new health ideas. Interviewer’s brilliant contribution: “Have you ever been to your DMV?” Hey, why have an intelligent discussion, replete with facts and needed information, when we can toss out one little sarcastic communications stopper like that?

    Friday, June 12, 2009 at 1:40 pm | Permalink
  19. starluna wrote:

    Sammy, I think your point about UPS actually illustrates my primary reason for wanting a public option in whatever reform comes about. In my current neighborhood, we have a regular UPS driver who knows everyone in the neighborhood, just like our regular USPS delivery guy. I’ve never had a problem with deliveries. If no one is home, they leave a note and actually come to the house within the time frame specified on the tag.

    In most of the other neighborhoods that I’ve lived in, the postal service was the only reliable delivery service. It was always a battle to get UPS to actually come on time – when they actually came. There was never a regular delivery person. They would sometimes leave a package on the stoop where they could/did get stolen.

    The difference between the neighborhoods is that we now live in a moderately middle-class, more home owner occupied, mixed race (but largely white) neighborhood. Our previous homes were in low income, predominantly non-white areas.

    As with postal delivery, so goes health care. Depending on who you are and where you live, you are going to get different service from the private sector. It’s been well documented that the poor and non-whites (in part because they are more likely to be poor) receive worse care in the private sector, when they receive it at all.

    And the last time I was at the DMV to renew my driver’s license, I was in and out in 15 minutes. I didn’t even get to the second page of the article I brought with me.

    Friday, June 12, 2009 at 2:25 pm | Permalink
  20. Sammy wrote:

    Good points all. What I got most out of Iron’s article is what I think is the most important aspect of this debate. In reality, it’s not really a “debate” at all, with each side presenting facts from unbiased sources (i.e., those who would benefit from a certain finding). It’s one side making sweeping, anecdotal generalizations, usually negatively about the opposition, without backing up the argument with facts.

    How about each side say to the other, “Prove it”?

    The problem is that one loudmouth with a microphone will say, “The English flock here for health coverage” and 5 million people believe it without question, and tell 10 million others. Someone from the other side says, “3 million people lost their homes last year due to unpaid medical bills” and 5 million people believe it without question, and tell 10 million others.

    Iron’s first sentence is the most important and really, until the REAL facts (isn’t that a redundancy?) are presented, neither side has an iron clad case.

    Friday, June 12, 2009 at 2:47 pm | Permalink
  21. David wrote:

    Here is a link to a study which might help shed some light on the true facts.

    http://www.pnhp.org/news/2006/may/study_shows_us_res.php

    Also, here is some more interesting information:

    http://www.commonwealthfund.org/Content/Publications/In-the-Literature/2009/Apr/Differences-in-Control-of-Cardiovascular-Disease.aspx

    Friday, June 12, 2009 at 4:10 pm | Permalink
  22. Sammy wrote:

    Wow. Debate. Civil discourse. Back and forth points made. Concession. And not one personal attack or thrown out line of rhetoric. Who knew?

    Friday, June 12, 2009 at 4:23 pm | Permalink
  23. Gene wrote:

    Why do they always indicate problems with other systems and presume that those same problems will be in ours. If they can identify the problems, couldn’t they do something about them? They usually claim they can if they want to make a change…

    Friday, June 12, 2009 at 4:55 pm | Permalink
  24. Bubblehead wrote:

    Outstanding post!

    Being retired Navy, and therefore a victim of the system frequently held up by advocates of universal healthcare as the shining example “how well” a government-run healthcare program can perform here in America, I approach this concept with non-trivial misgivings. That said, I’m not necessarily irretrievably opposed to the idea … but I do have major reservations.

    My primary concerns on the subject are as follows:
    1 – Liberty (which is pretty much always my first reaction anyway). If the government is “responsible” for everyone’s healthcare, then the government has a ready-made excuse to create nanny-istic intrusions into virtually every aspect of our lives. I wear my seat belt because I believe it makes me safer, but I am vehemently opposed to the existence of seat belt LAWS. This has the potential to magnify that intrusiveness on an epic scale.
    2- The fundamental problem with the American system in its current form, as I see it, is government money. Healthcare costs have risen at roughly twice the general rate of inflation over the past three decades; higher education costs have risen roughly twice as fast as healthcare costs over the same period. These are the two sectors of the marketplace into which virtually limitless streams of taxpayer money have been pumped since the advent of the Great Society, and those costs have merely been responding to the influx of money. I am hesitant to accept what appears to be a prima facia absurdity – that even more of what broke the system will magically fix it.
    3- The excess capacity and overlap present in the American system due to the very inefficiencies and ineffective competition mechanisms its critics complain about provide the “surge capacity” to handle disasters such as the aid we sent to Asia after the tsunami a couple years ago, and the disaster relief centers we set up after hurricanes. An “efficient”, centrally-managed system wouldn’t have that slack available when the next earthquake or hurricane or tsunami hits.
    4- Once we jump off this bridge, there’s no easy way back if we decide we’ve made a mistake.

    Friday, June 12, 2009 at 10:00 pm | Permalink
  25. Steve wrote:

    Coming from New Zealand, I’ve always found descriptions of America’s health care system to be incredible… Health care is such a basic necessity, its management shouldn’t be left to companies whose primary goal is to extract as much money from its customers as possible. For the same reason that it is preferable to have socialised water supplies and fire services, health care should be socialised so that it can be focussed on its end goal: helping those most vulnerable in society, not turning a profit.

    Hospitals in NZ, by the way, are by-and-large publicly run. There are a few private hospitals in each city, but these are the exception. Although on the whole they are better (I believe), public hospitals do have their pitfalls: the wait in line can be massive (think 6 hours or so at the busiest times to get looked at in the A&E (Accident and Emergency) ward early on a Saturday morning), though I don’t know how this compares to private systems. Also, procedures which are not absolutely necessary can have massive waiting times. Grommet surgery is an example. Lots of kids have ear infections which require minor operations (grommet surgery) to fix, but these kids can be waiting at public hospitals for month to be treated, as the condition is far from life threatening. Varicose veins are another example of a condition which will require a huge wait, as the condition isn’t life threatening but aesthetically displeasing, although I hear it can cause a lot of pain.

    As I’ve said though, on the whole I would consider public healthcare to be fair superior to private.

    Saturday, June 13, 2009 at 4:47 am | Permalink
  26. Eva wrote:

    Re: Seat Belt Laws. People drive on public highways. My tax dollars pay for that highway. People have accidents on public highways. People not wearing seat belts have more injuries in these accidents which causes more medical costs which causes my health insurance to go up. I pay $608 a month now before the $3000 a year in meds. I don’t want people raising my health insurance by not wearing seat belts. (whether we have private or Universal health insurance)

    Saturday, June 13, 2009 at 10:34 am | Permalink

2 Trackbacks/Pingbacks

  1. [...] Instead of a “healthy” debate, the arguments against health care reform are becoming more and more bizarre. I’ve already talked about the fact that even though most people are in favor of single-payer health insurance, our representatives are so owned by the insurance companies (who are paying off politicians with the money they have been ripping off from us) that they are not allowed to even mention single-payer as a possibility. [...]

  2. [...] to pay more. This is how it should be with health insurance (and is how it works in countries like New Zealand). The government provides universal coverage for a basic price, while private health insurance [...]