In particular, we can learn from the Netherlands, which has a system based entirely on private insurance. According to a survey by the Commonwealth Fund, the Netherlands, which has one of the lowest public costs of all the countries surveyed, has the highest satisfaction by far.
How does the Netherlands system work? Here’s a summary from the Ministry of Health:
The system is a private health insurance with social conditions. The system is operated by private health insurance companies; the insurers are obliged to accept every resident in their area of activity. A system of risk equalisation enables the acceptance obligation and prevents direct or indirect risk selection.
The insured pay a nominal premium to the health insurer. Everyone with the same policy will pay the same insurance premium. The Health Insurance Act also provides for an income-related contribution to be paid by the insured. Employers contribute by making a compulsory payment towards the income-related insurance contribution of their employees.
I’ve been biased towards a single-payer health care system, although that’s largely a moot point because it won’t happen. However, the Netherlands experience makes me more confident that the US can develop a system that cuts costs and improves results, while maintaining a private system.
The little tid-bit that most people miss, that stands out to me, is that in our “private” system, the government pays more for health care than countries that have universal care. The bottom line is that your tax dollars are funding health care anyway, but they are only going to the most high risk and costliest patients so the private insurers can focus on only the most profitable clients. If our tax dollars are already going towards health care at a rate higher than countries that cover everyone with tax dollars, how big of a switch would it be, really?
We have proof positive that single payer is much, much cheaper with better health outcomes. Do not stop beating that drum Jeff. We have proof that a private/public plan will fail. Just look at Massachusetts Romney care.
the dark little secret is that we already have a public plan that is more extensive than any other countries public plan. We just do it in an inefficient way, taking only the most expensive patients, in order to subsidize the insurance companies. Once again we have privatized profit and socialized risk.
Two doctors for single payer were on Bill Moyers,and they made the point that Civil Rights laws were never, ever going to pass, but enough pressure was brought to bear and they passed.
Our citizens deserve health care whether they are rich or not. More pragmatically, if is a waste of money not to provide it.
Do you have anymore input on this issue? I have a report to write on it…
THanks
Great graph.
By spending more on the public side, are we going to tell people that they cannot spend their own out-of-pocket money, or that they can’t include private healthcare as a perk of a comp package?
If we don’t, I’m not seeing where we save money.
If we do…. well, how are Americans going to react to pulling consumer choice away from them?
DtM,
You act as if we have consumer choice now. We do not, unless you are extremely wealthy, or don’t have a family. I choose from the limited providers health partners allow me and then pay an exorbitant amount in co-pays. Right now Dan, 46 million Americans don’t have any choice because they cannot afford any health care. 10’s and probably hundreds of millions of Americans have little choice other than to take the expensive plan their employer offers to partially subsidize. So, which Americans exactly are we taking choice away from? I certainly don’t feel like I have any choices under the commodity system of health care.
Let them have private health care for things like plastic surgery I suppose.
Consumer choice? Is that what we have now?
When my employer switched health plans a few years ago, I had to stop going to the doctor I had seen for 10 years. A year later, when they switched again, I got to go back. Actually, I had to go back because the doctor I had for the year under the other plan was off limits under the newest plan. My favorite is when I get told at the pharmacy that my prescriptions - the drugs that my doctors prescribed for me - were not on the formulary list so I had to try something else recommended by the insurance company. And just to top it off, there are big (and growing) co-pays on those drugs.
We don’t have consumer choice. We have crap. And I’m lucky enough to actually have health insurance. The bogeyman stories about government run health care aren’t going to scare people who actually have to deal with the system we have now.
Sure didn’t take long for the resident bullshit artist/troll to show up. Do you have anything to say that relates to the actual topic? Perhaps all you have is a list of talking points.
The employer based group plan available to my family now costs us over $800 a month. We can’t afford this & are saviing $ by insuring some family members with a high dedcuctible policy (with hopes that are good health continues.) As part of enrolling in the plan I had to listen to the 5 minute disclaimer read to me over the phone, which made it clear to me the broken state of our complicated health care system.
I support single payer and believe there is a role for private inurancers to sell supplementle insurance to the wealthy or those who want to spend 25% of their income on insurance to be quaranteed cadellac coverage for every conceivable treatment.
How is commenting on the exact graph that is shown, with an original question applicable to that graph, a “talking point”?
My question was an honest one. I’m trying to understanding the myriad of approaches to healthcare reform. If anyone cares to answer my question and engage in real dialogue, I’d welcome it.
It just seems like we have answered your question logically a thousand times. We have twice as much or more in administrative expenses as Canada, as a percentage. The real savings comes from cutting administrative costs.
In 1999, and I am sure it is worse now, Canada’s administrative health care costs were $307, compared to $1059 per capita in the U.S. Our admin costs are at least 300% those of Canada. That is where the savings comes from.
I hate to sound shrill, and I am sure I do, but how much more clear can it be: The major savings in single payer is that you dramatically reduce administrative costs. You don’t reduce care. You don’t reduce medical providers. You reduce administrative costs.
Did you know 30%+ of health care workers are in admin? Almost one third of health care workers are not even there to provide you better care. That is the savings.
If we are able to successfully get our administrative costs down to that of, say, Canada, we will still have the most expensive healthcare in the world by alot.
I just don’t buy that it is a magic bullet. I have also tried to make my point a thousand times — changing the financier of healthcare, without changing the system and how we use it, doesn’t fix the problem. At least, not the problem that is cited as the reason for Democratic healthcare reform — runaway costs.
And if you want to introduce a government payer without taking away the option of private insurance, you won’t get rid of the administrative costs. You’ll still have 1,000 separate hospitals billing 500 separate insurances who each have 1,000 different plans.
Call the Democratic healthcare reform what it is — a new taxpayer-funded benefit so the uninsured can have insurance, which will if anything raise the % of GDP we spend on healthcare. That is certainly a valid idea which is worthy of debate. I’m not even opposed to it, not based on the limited details we have today. But let’s not imagine that universal healthcare is going to accomplish more than it really is.
DtM: NOBODY..NOT ONE PERSON in the Obama administration, or in congressional leadership is advocating taking away private insurance. NOBODY. Your bullshit points of conjecture are only that…and not work engaging in debate upon.
Lojasmo,
I think, to be fair, DtM is responding to people like me, who are demanding we get rid of private insurance. DtM seems to be open to Obama’s plan, but I am terrified a half plan or compromise plan will fail just like Romney Care because it doesn’t address the real problem. The problem with health care is the private insurers.
Thanks,
Alec
It would be a huge plus if more Americans were worried about finding an expensive private health care clinic than were dying from lack of affordable healthcare. Do you have instances in countries where private care was unavailable in favor of government health care? I’ve never heard of such a thing.
Dan take a look around the world at how other countries handle health care as both a public and private issue. No where outside of maybe Cuba do these countries forbid the purchase or selling of “extra” healthcare. A good friend of mine works at a private hospital in Canada… that scrupulously takes no funds from the government. They make too much money catering to rich families and their “ill” daughters. There are private options for every medical issue in Canada and it doesn’t really matter in the grand scheme of things.
One final thing - when we compare our healthcare costs against that of other countries, we need to keep in mind two things:
- The USA trains a majority of the world’s doctors. Those doctors are trained, in large part, through government reimbursements to hospitals that occur through additional Medicare payments.
- The USA provides a vast majority of the R&D required for medical devices and pharmaceuticals, in addition to medical technology. The fact that those companies can recoup their costs on those drugs and devices in the USA allows them to provide products for teh entire world.
Perhaps our per capita health expenditure needs to be $4,500 instead of $6,000. But I’d argue that since in the current system we are subsidizing medical training and R&D for the world, Canada’s and the UK’s per capita expenditure shoudl also be $4,500 instead of $3,000.
Also keep in mind that pharmaceutical companies spend nearly twice as much on advertising as they do on R & D.
http://www.sciencedaily.com/releases/2008/01/080105140107.htm
Prescription drug advertising used to be regulated, just like we regulate certain alcohol and tobacco ads. Maybe we need to revisit this. Or maybe big pharma needs to quit telling us that our prescription drug prices are so high because they re-invest so much into R & D.
The typical drug company pumps 20% of its sales right back into R&D.
Pfizer, Merck, and Bristol Myers alone will pump over $10 billion into pharma R&D this year. Are you saying that you want it to go away? Would the government pick up that tab? If so, do we really end up saving money, in the big picture?
$10 billion of R&D. And those are just the first three companies I did a 60-second spot-check on.
Check that, $15 billion, not %10 billion. My error.
As Chuck Schumer says, “few hundred million here, a few billion there, and pretty soon we’re talking about real money”
Well no, I wasn’t suggesting they should cut their R & D budget. Maybe they should cut their advertising budget. If those companies were spending $15b on R & D, then they were spending maybe $28b on advertising. Personally I don’t want to see my co-pays go to produce more Viagra commercials with a bunch of guys sitting around on hay bales singing about how this wonderful pill cures their erectile dysfunction. It would also be interesting to see where the R & D money is going. How much are they spending on finding new antibiotics to combat the “superbugs?” Or are they spending it on drugs that will be taken by patients for years, even decades i.e. anti-depressants and cholesterol lowering drugs (which can lead to e.d., talk about synergy). And truthfully, the government is picking up part of the tab for drug research. My brother-in-law is a immunologist at the Univ. of Colorado and he’s constantly chasing down government grants to do basic research that will eventually lead to new drug therapies. If something marketable does come of his research, I’m sure the U of C will license his intellectual property to get in on the game, just like the U of M has an administrator that keeps track of the licensing of technology that comes from that institution.
Dan I don’t know where you got that stat about the US training a majority of the world’s medical doctors but I don’t see it. I tried to find the stat of graduation numbers per year of medical doctors by country but couldn’t find it.
I did come by an interesting stat on number of doctors per thousand of population… we are 31st in 2002 with 2.3 up from 42nd in 2001 at 2.2. Among the countries ahead of us are Cuba, Russia, Turkey, Bulgaria, Mongolia plus the usual suspects of most of Europe. It is just hard for me to believe that the 31 countries ahead of us in doctors per thousand people are not training their own doctors and are importing them from the US. Canada has 2.1 doctors per thousand and comes in at 35th but I think most of their doctors are homegrown and not imported from the States.
http://www.nationmaster.com/graph/hea_phy_per_1000_peo-physicians-per-1-000-people&date=2002