Wednesday, August 29, 2012

Four countries that already meet the Republican Platform's health-care goals

Health care in the Netherlands, 17th century
(Jan Steen: "The Doctor's Visit)
Friday evening we were having supper with friends who make frequent trips to Israel. One of them commented that Israeli doctors don't have a lot of administrative expenses. To arrange for payment, to transfer records, or to prescribe or check medications, all they have to do is swipe a patient's health-care card. "We could learn a lot from them," she said.

Saturday evening we were having supper with friends whose families live in Canada. One of them commented that Canada's health-care system gets a bad rap in the U.S., and that nearly all the complaints are nothing more than political propaganda. "Most Canadians are satisfied with their health care most of the time," he said. "The only complaint you hear is that sometimes the waits are too long."

I just read the Republican Platform section on health care (it starts here) in which they promise to repeal the loathly Affordable Care Act and replace it with something magnificent (as yet undefined). "Our goal," they say, "is to encourage the development of a healthcare system that provides higher quality care at a lower cost to all Americans while protecting the patient-physician relationship based on mutual trust, informed consent, and privileged patient confidentiality." Now there's a goal I can agree with 100%.

Interestingly, it well describes health care in Israel and Canada, which are single-payer, tax-financed systems--what Americans correctly call "socialized medicine." It also is a perfect description of health care in, for example, Germany and the Netherlands, which are multi-payer systems that combine some government funds with funding from competing private insurers--what many Americans also call "socialized medicine" because they don't know any better.

Let's look at how these countries measure up to the Republicans' wish list. (All information unless otherwise attributed is from the World Health Organization's data tables.)

Higher quality care. Mothers and infants in Canada, Germany, Israel, and the Netherlands are less likely than American mothers and infants to die in childbirth. People in those four countries live two or three years longer than people in the United States. Interestingly, this may not be due to better health habits: Only Canada has fewer smokers than the U.S.

In addition, Germans, Israelis, and the Dutch have many more doctors per 10,000 population than we do (Canadians have fewer, which may explain their long waits). All four of the other countries have a higher ratio of hospital beds than we do.

Lower cost. Somehow these four countries have figured out how to deliver good quality health care without paying astronomical costs--their total health-care costs per capita range from 24 to 58% of ours. Oddly, our government actually paid more per capita than the governments of Canada, Israel, and Germany; the Dutch government paid about the same as we did.

Subtract the government contribution from the total bill, and you get what you and I are paying out of pocket. Americans, of course, are paying vastly more than citizens of the other four countries: $3074 per capita in 2006, the last year for which WHO has comparative data. (Canadians paid $1158, Germans paid $860, the Dutch paid $687, and Israelis paid $562.)

All Americans. Canada, Germany, Israel, and the Netherlands, like all other developed nations with the exception of the United States, have universal health care. That means that every citizen is covered. In the United States, by contrast, "nearly half (44%) of U.S. adults—81 million people—were either underinsured or uninsured in 2010." So says the Commonwealth Fund, who note that among low-income families, that figure rises to 78%.

Protecting the patient-physician relationship based on mutual trust, informed consent, and privilege patient confidentiality. Yes, of course. That is also the goal of every other developed nation. Contrary to public misinformation, by the way, Europeans do get to choose their own doctors--and they have more to choose from than we do.

So, Republicans, we have a long way to go in order to achieve those excellent health-care goals. The Affordable Care Act moves us slightly--not nearly far enough--in the right direction. How are you planning to improve on it?

If you were smart, you'd study countries that already have higher quality care at a lower cost that covers all citizens. That happens to be true of every other developed nation, so it shouldn't be too hard to find resources. But what you'd learn is that their health-care efficiency comes from price controls, strict government regulation of private insurers, and an adequate tax base.



Marcia Z. Nelson said...

Mme Neff: Stop bothering them with facts.

Anonymous said...