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View Full Version : Fixing Health Care, Int'l Edition



KC
08-29-2012, 11:14 AM
Health care needs to be fixed if we are ever going to get our fiscal house in order. That's just an inescapable fact as we worry about the cost of medicare, medicaid and prescription drug programs. The best way to fix health care is up for debate, but we can learn a lot from learning from other countries. In TR Reid's The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care, Reid outline's how other countries have solved the problem of insuring a large population. He summarizes them into four models (http://www.pnhp.org/single_payer_resources/health_care_systems_four_basic_models.php): The Beveridge Model (UK), The Bismarck Model (Germany, Japan), The Nat'l Insurance Model and the Out of Pocket "Model" (Pretty much most of the less developed world).

The US is pretty similar to the Bismarck model as it is.


Named for the Prussian Chancellor Otto von Bismarck, who invented the welfare state as part of the unification of Germany in the 19th century. Despite its European heritage, this system of providing health care would look fairly familiar to Americans. It uses an insurance system — the insurers are called “sickness funds” — usually financed jointly by employers and employees through payroll deduction.
Unlike the U.S. insurance industry, though, Bismarck-type health insurance plans have to cover everybody, and they don’t make a profit. Doctors and hospitals tend to be private in Bismarck countries; Japan has more private hospitals than the U.S. Although this is a multi-payer model — Germany has about 240 different funds — tight regulation gives government much of the cost-control clout that the single-payer Beveridge Model provides.
The Bismarck model is found in Germany, of course, and France, Belgium, the Netherlands, Japan, Switzerland, and, to a degree, in Latin America.


What that quote from Physicians for a National Health Program doesn't tell you is that German "sickness funds" are private, non profit entities. The absence of the profit motive might make you expect this model to be highly costly and inefficient, but according to the OECD data, Germany spent only about 11% of their GDP on health care in 2009, while the US spent about 17.4%. Out of that 17.4%, the US spent from 3-4% on medicare alone. With an aging population, that number is going to grow.

We gotta fix health care in a way that actually targets costs instead of just shifting the payers. I think the German model is a pretty good place to start from. Switzerland followed the German model in the '90s at no significant shift of expense, but instead of of covering only the middle and upper classes, Switzerland now covers everyone. The US should follow suit, IMO.

Peter1469
08-29-2012, 12:08 PM
Health care needs to be fixed if we are ever going to get our fiscal house in order. That's just an inescapable fact as we worry about the cost of medicare, medicaid and prescription drug programs. The best way to fix health care is up for debate, but we can learn a lot from learning from other countries. In TR Reid's The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care, Reid outline's how other countries have solved the problem of insuring a large population. He summarizes them into four models (http://www.pnhp.org/single_payer_resources/health_care_systems_four_basic_models.php): The Beveridge Model (UK), The Bismarck Model (Germany, Japan), The Nat'l Insurance Model and the Out of Pocket "Model" (Pretty much most of the less developed world).

The US is pretty similar to the Bismarck model as it is.



What that quote from Physicians for a National Health Program doesn't tell you is that German "sickness funds" are private, non profit entities. The absence of the profit motive might make you expect this model to be highly costly and inefficient, but according to the OECD data, Germany spent only about 11% of their GDP on health care in 2009, while the US spent about 17.4%. Out of that 17.4%, the US spent from 3-4% on medicare alone. With an aging population, that number is going to grow.

We gotta fix health care in a way that actually targets costs instead of just shifting the payers. I think the German model is a pretty good place to start from. Switzerland followed the German model in the '90s at no significant shift of expense, but instead of of covering only the middle and upper classes, Switzerland now covers everyone. The US should follow suit, IMO.

The US can do a lot to reduce health care costs. We need to introduce the free market as much as possible. Look at how costs have dropped in medical areas traditionally not covered by insurance or government handouts.

Insurance should be insurance: to cover against unexpected costs and catastrophic costs. Insurance shouldn't cover routine medical care for those who can afford it. That would be a major cost control.

For those who can't afford insurance, they should be covered by society. We have effective and cheap models to follow. http://www.ramusa.org/about/stanbrock.htm

Captain Obvious
08-29-2012, 04:56 PM
Outcomes based healthcare is the future of healthcare reform - or should be.

"Pay for performance", "quality-based initiatives", whatever you want to call it, rewarding providers for efficient and effective delivery of healthcare is the only way we can sustain effective and efficient healthcare delivery.

And, healthcare is already on that path. The US is lagging in this industry, but the roadwork is already in place.

Savitri Devi
09-05-2012, 06:46 AM
So I must admit I'm not a huge fan of the medical establishment period. It tends to be founded on the exploitation of animals in many ways (the scientific validity of which is of serious concern, but I digress).

That being said, if such an establishment exists, I firmly believe it should NOT be publicly funding.

To me, a publicly funded health care system allows people to do whatever stupid things they want (eat unhealthily and excessively, not exercise, smoke, drink, etc.) and then basically get a free pass. It gives this "everybody wins" mentality, that actually weakens society as a whole. We will just end up nursing countless invalids. I mean most of the common ailments affecting western society are diseases of excess: cancers, diabetes, obesity, cardiovascular disease, cognitive deterioration, etc. These all have causes rooted in dietary and lifestyle factors.

Either we live in a capitalist society or we don't. People need to pay for their own mistakes, or they need to accept regulation of their own actions. Ban unhealthy activities/foods and promote healthy ones.

I'm from Canada, and our health care system sickens me.

KC
09-05-2012, 01:54 PM
So I must admit I'm not a huge fan of the medical establishment period. It tends to be founded on the exploitation of animals in many ways (the scientific validity of which is of serious concern, but I digress).

That being said, if such an establishment exists, I firmly believe it should NOT be publicly funding.

To me, a publicly funded health care system allows people to do whatever stupid things they want (eat unhealthily and excessively, not exercise, smoke, drink, etc.) and then basically get a free pass. It gives this "everybody wins" mentality, that actually weakens society as a whole. We will just end up nursing countless invalids. I mean most of the common ailments affecting western society are diseases of excess: cancers, diabetes, obesity, cardiovascular disease, cognitive deterioration, etc. These all have causes rooted in dietary and lifestyle factors.

Either we live in a capitalist society or we don't. People need to pay for their own mistakes, or they need to accept regulation of their own actions. Ban unhealthy activities/foods and promote healthy ones.

I'm from Canada, and our health care system sickens me.


You raise an extremely important point. The countries with the most successful health care systems put a great deal of emphasis both on preventive medicine as well as better public health. That is certainly true of some of the much larger "nanny state" governments of the EU, but I wouldn't be surprised if it was also true of certain provinces of Canada, which to my best understanding manage health care on somewhat local/ somewhat centralized basis. What part of Canada are you from?

Savitri Devi
09-06-2012, 06:18 AM
You raise an extremely important point. The countries with the most successful health care systems put a great deal of emphasis both on preventive medicine as well as better public health. That is certainly true of some of the much larger "nanny state" governments of the EU, but I wouldn't be surprised if it was also true of certain provinces of Canada, which to my best understanding manage health care on somewhat local/ somewhat centralized basis. What part of Canada are you from?

I'm from New Brunswick. Health care here is supposed to be more locally managed, but it receives a lot of national funding so there is a lot of debate about that.

And you're absolutely right. The old adage, "an ounce of prevention is worth a pound of cure," is true of the economic situation of health care as well.

RollingWave
09-06-2012, 11:05 AM
The US can do a lot to reduce health care costs. We need to introduce the free market as much as possible. Look at how costs have dropped in medical areas traditionally not covered by insurance or government handouts.

Insurance should be insurance: to cover against unexpected costs and catastrophic costs. Insurance shouldn't cover routine medical care for those who can afford it. That would be a major cost control.

For those who can't afford insurance, they should be covered by society. We have effective and cheap models to follow. http://www.ramusa.org/about/stanbrock.htm
It would also help if the US either through education or some other social effort (doesn't have to be public) push harder for a general healthier life style... I mean if you have a bunch of really unhealthy people, cost isn't going to come down regardless of the system. the reverse of course is also true, if your system is crap, but your citizens were healthy to begin with, you'll probably still do just fine.