Tag Archives: health care costs

German National Health Care Started With Bismarck

According to Alice Cherbonnier, editor of the excellent Baltimore Chronicle, the insurance-based German health care system, launched in 1883 by Chancellor Otto von Bismarck, is suffering from strains not unlike our own. Young people are not paying into it and an increasing number of older people are retiring. There is some thought to cutting the system in two, providing basic guaranteed insurance to everyone, with people who want more coverage buying it. But most Germans don’t want to lose their more egalitarian system. As a report in the Wall Street Journal puts it, they consider health care to be “a basic right.”

OECD figures, Cherbonnier writes, shows that “in Germany, the per-capita annual cost of health care is $3588 per year—10.4% of their GDP. By contrast, Americans are spending 16% of GDP on health care, or $7290 per person per year—the highest of all the OECD countries.’’

Yet unlike the other OECD countries, the U.S. healthcare “system” does not cover all its citizens—not by a long shot. Why is it that the U.S. spends so much more than its peer countries, and still cannot manage to assure that all Americans have decent health care coverage?

In France, Germany, and Japan, universal health care systems are not dependent on socialism, but contain plenty of private enterprise activity, including private insurance companies. What they all include, however, is a form of regulation that makes sure everyone is covered. Prices are set by the government. And the competition among insurance companies is based not on which company can make the most profits or even offer the lowest premiums, but on which company provides the best services. Compare this to the Untied States, where we can’t even imagine “insurance company” and “best service” being used in the same sentence.

The French Do It Better for Half the Cost: Part 2

Here’s a follow-up to yesterday’s post on the superiority of the French health care system, and what we might learn from it. Unfortunately, these are lessons that our policymakers in Washington seem determined to ignore.

This chart was published in the Washington Post last month along with Ezra Klein’s commentary on the French system.  Klein, too, wonders why we’ve “worked extremely hard in this debate” to ignore the success of other countries’ health systems. He writes:

People sometimes ask what the lessons of other country’s health-care systems are. The lessons are twofold. First, they’re better. Second, we’re stubborn.

I think there’s a third lesson, as well: As much as these countries may have market-driven economies and powerful corporations, when it comes to health care, they’ve actually placed the lives of their citizens ahead of corporate interests. That’s something we haven’t yet done in the United States–and nothing will really change until we do.

Source: Washington Post

Source: Washington Post

Note: The Baltimore Chronicle & Sentinel (which alerted me to this graphic), has also assembled a great series of video clips, from PBS and other sources, about health care systems in various other countries–any of which would save us hundreds of billions each year.

Health Care Monopoly

If there is a health care reform bill, it will most likely further entrench the health care monopolies,especially the Blue Cross system and the Big Pharma patent controls. This from Dylan Ratigan at Huffington Post makes that point clear:

Why is health insurance the only business that has an exemption from the Sherman Anti-Trust Act other than Major League Baseball? . . .

Through the governmental negligence that we as voters allowed, a health care system was created in which a single health care company controls at least 30 percent of the insurance market in 95% of the country, including states like the following:

Maine, where Wellpoint controls 71% of the market.
North Dakota, where Blue Cross controls 90% of the market.
Arkansas, where Blue Cross Blue Shield controls 75% of the market.
Alabama, where Blue Cross Blue Shield controls 83% of the market.

This monopoly, combined with the misaligned incentives that trap people in employer-based health care, is causing the skyrocketing health care costs that are hurtling our nation towards bankruptcy.

I don’t know what’s worse: that most Republicans seem to be against ending this unfair legal protection for an entrenched industry that is ruining our country with their non-competitive practices, or that most Democrats seem to be threatening this arrangement only as a bargaining chip to push for a meaningless public option that wouldn’t be accessible to almost 85% of the population?

Instead of improving our country, through creating and enforcing free and fair markets, our politicians are currently engaging in backroom deals, most of which protect the very companies who profit the most from these disastrous outdated systems — industries like health insurance and big Pharma.

Ten Questions on Health Care to Ask at a Town Meeting

This from a buzzflash.com guest blog by Dave Lindorff, based on an idea from one of his readers. Should you go to one of the town hall meetings on health care reform, here are 10 good questions to ask. The questions about Medicare, which I’ve highlighted in boldface, are especially good ones for older people to ask. This is especially important because the media seems to be full of tales of loony geezers claiming the government is going to mess up their Medicare–if it doesn’t euthanize them first.

1. If Canada’s single-payer system is so god-awful, why have repeated Conservative governments at the provincial and national level in Canada never touched it? Canada is a democracy. If Canadians don’t like their health care system, why haven’t they gotten rid of it in 35 years? Since the system there is run by the separate provinces, many of which are very politically conservative, why has not one province ever tried to get rid of single-payer?
2. Why is rationing by income, as we do it here, better than rationing by need, as they do it in Canada?
3. Wouldn’t single-payer mean that companies could no longer threaten working people with the loss of their health insurance? Why is this a bad idea?
4. The bigger the insurance pool, the better. So doesn’t having a national pool, as with single-payer, make the most sense?
5. Why should we be allowing politicians who are taking money from the medical industry to write the new health care legislation?
6. How can the Congress be developing a health system reform scheme and not even invite experts from Canada down to explain their successful system?
7. If Medicare–a single-payer system here in America–is so popular with the elderly, how come it’s no good for the rest of us?
8. Isn’t it true that Medicare currently finances the most costly patient group–the elderly and infirm–so that extending it to the rest of the population–most of whom are young and healthy–would be much cheaper, per person?
9. The AMA, the Pharmaceutical Industry, and the Insurance Industry all bitterly opposed Medicare in 1964-5 when it was being debated in Congress and passed into law, with the right, led by Ronald Reagan, calling it creeping socialism. It became a life-saver for the elderly and didn’t turn the US into a soviet republic. Why should we give a tinker’s damn what those same three industry groups and the Republican right think of expanding single-payer now?
10. The executives of Canadian subsidiaries of US companies all support Canada’s single-payer system, and even lobby collectively to have it expanded and better funded. Why does Congress listen to the executives of the parent companies here at home, and not invite those Canadian execs down to explain why they like single-payer?

Throw Granny from the Train: The Washington Post Gives a Boost to Age-Based Health Care Rationing

Two pieces on the front page of the Washington Post’s Sunday “Outlook” section go a long way toward illustrating what’s wrong with the  terms of current debates around health care costs and health care for the elderly. The juxtaposition of these two commentaries, which appeared side-by-side under a photo of a sunset and the heading “The Dying of the Light,” sends an insidious message about the need for “rationing” treatment to the very old and very sick: To keep health care costs from bankrupting our society, it suggests, we may have no choice but to pull the plug on the geezers.

The Post feature is only the latest of a growing volume of commentary on so-called age-based health care rationing. Even beyond any core ethical questions, the problem with these discussions is what they too often fail to mention: the role of private profits in creating, or at least seriously exacerbating, the supposedly intractable problem of health care costs. Like everything else in the public debate over health care policy, the “dying of the light” has become subject to the lying of the right, where corporate interests trump even questions of life and death.

There’s nothing inherently objectionabale about one of the two pieces, written by doctor at a Minneapolis hospital who cares for “patients struggling through the winter of their lives.” Craig Brown writes:

Today, thanks to myriad medications and interventions that have been created to improve our health and prolong our lives, dying has become a difficult and often excruciatingly slow process.

The author questions the prevailing practice of using extreme measures to prolong the lives of the “threadworn elderly,” when “what’s waiting for them at the end of this illness is just another illness, and another struggle.” Mercy, he says, demands that we change our attitude and our approach toward death. I’ve got no argument with this, which is why I support end-of-life choice for the chronically and terminally ill.

Craig Brown is careful to say that “nothing in my medical training qualifies me to judge what kind of life is satisfying or worth living.” He also states clearly that his position “isn’t about euthanasia. It’s not about spiraling health care costs. It’s about the gift of life–and death. It is about living life and death with dignity, and letting go.”

The same is not true of Post health and science reporter David Brown (also a physician), who wrote the companion piece. He points out that health care costs are growing faster than the economy, due largely to advances in medical care. “Each year, there’s more that can be done and more that’s judged worth doing”–and it’s all terribly expensive. At the same time, life expectancies are lengthening and the population is aging. As a result, he says:

We are on a collision course between our wish to live longer, healthier lives and our capacity to pay for that wish. Whether we can somehow avoid the collision is perhaps the most important domestic issue of this century. From now on, health care costs will be up there with globalization, terrorism and climate change as a force shaping our world.

While David Brown doesn’t blame this all on old people, per se, he does point to the growth in Medicare’s costs, and warns that “unless something changes, in about 75 years, Medicare alone will cost as much as the sum of all our federal income taxes.” And while he says he has no solution to offer that will “rescue us from the Malthusian Spectre of health care spending,” the implicit solution is clear–if not from the article itself, then from its placement alongside Craig Brown’s piece on the tormented lives of the chronically ill elderly. The obvious way to slow our progress toward economic and social destruction is for old folks to stop having all those expensive interventions and just give up the ghost. And if the geezers won’t make the decision to do this voluntarily–well, then, society might have to make it for them.

In blog for the American Prospect, Dean Baker of the Center for Economic and Policy Research lays out why the underlying terms of this debate are fatally flawed. Criticizing David Brown’s Post piece for “telling readers that there is nothing we can do about health care costs,” Baker writes:

Remarkably, this lengthy column never once notes the fact that the United States pays more than twice as much per person for health care than the average of the other wealthy countries, all of whom enjoy longer life expectancies.

This is a hard to overlook piece of evidence suggesting that the United States could do a great deal to lower its health care costs. Among other things, we have a hugely wasteful insurance system (noted in the column), pay close to twice as much for prescription drugs as people in other wealthy countries, and pay our medical specialists close to twice as much as they earn in other wealthy countries.

Overpaying for drug and doctors not only directly wastes money by causing us to pay more for the same services. The huge rents created by these over-payments leads drug companies and specialists to find ways to promote excessive use of their products and services. The result is really bad and really expensive medicine.

Studies comparing health care in the United States and other industrialized countries–including those conducted by the World Health Organization, Congressional Research Service, Kaiser Family Foundation, and Commonwealth Fund–consistently find dramatically higher spending in the U.S. (both per capita and as a percentage of GDP), and poorer performance on a host of important health measures, from life expectancy to infant mortality to medical errors. All of these other countries, of course, have public single-payer health care systems, while we have medicine for profit.

I’m as public spirited as the next person, and I have a Gen-X son. So I’d like to think I’d be willing to give up some expensive, life-prolonging medical treatment if the future of humanity depended upon it. But I’m certainly not going to do it so that some pharmaceutical company executive can take another vacation in Bora-Bora, or so that an elected official can get another big campaign contribution from the insurance industry.

So here’s my advice to anyone who suggests that American geezers should do the right thing and accept age-based health care rationing: Institute a single-payer system, cut our national health care costs in half–and then get back to me.

Bookmark and Share