How 5 Capitalist Democracies actually tackle health care

DanteAugustusGermanicus · #1 (**permalink**) 06-19-2008, 06:46 AM

It is about as unbiased a collection of stories as I've seen. It is biased in that it approaches the conversation from the point of view that Americans are unhappy with their own system...a bias I share.

read it and see if you consider it fair and balanced and if you think it adds to your understanding of the issue.
here are the program's results for the United Kingdom:

UNITED KINGDOM

Quote:

Percentage of Gross Domestic Product (GDP) spent on health care: 8.3

Average family premium: None; funded by taxation.

Co-payments: None for most services; some co-pays for dental care, eyeglasses and 5 percent of prescriptions. Young people and the elderly are exempt from all drug co-pays.

What is it? The British system is "socialized medicine" because the government both provides and pays for health care. Britons pay taxes for health care, and the government-run National Health Service (NHS) distributes those funds to health care providers. Hospital doctors are paid salaries. General practitioners (GPs), who run private practices, are paid based on the number of patients they see. A small number of specialists work outside the NHS and see private-pay patients.

How does it work? Because the system is funded through taxes, administrative costs are low; there are no bills to collect or claims to review. Patients have a "medical home" in their GP, who also serves as a gatekeeper to the rest of the system; patients must see their GP before going to a specialist. GPs, who are paid extra for keeping their patients healthy, are instrumental in preventive care, an area in which Britain is a world leader.

What are the concerns? The stereotype of socialized medicine -- long waits and limited choice -- still has some truth. In response, the British government has instituted reforms to help make care more competitive and give patients more choice. Hospitals now compete for NHS funds distributed by local Primary Care Trusts, and starting in April 2008 patients are able to choose where they want to be treated for many procedures.

interview with Nigel Hawkes who ...is health editor for The Times of London and a longtime observer of Britain's National Health Service (NHS), a government-run service that covers everyone's health care and is paid for out of tax revenue. Here Hawkes discusses the NHS's advantages and shortcomings, and recent initiatives to bring some market efficiencies into the 60-year-old socialized system. This is an edited transcript of an interview conducted Nov. 1, 2007.

DanteAugustusGermanicus · #2 (**permalink**) 06-19-2008, 06:48 AM

here are the program's results for the Japan:

JAPAN

Quote:

Percentage of GDP spent on health care: 8

Average family premium: $280 per month, with employers paying more than half.

Co-payments: 30 percent of the cost of a procedure, but the total amount paid in a month is capped according to income.

What is it? Japan uses a "social insurance" system in which all citizens are required to have health insurance, either through their work or purchased from a nonprofit, community-based plan. Those who can't afford the premiums receive public assistance. Most health insurance is private; doctors and almost all hospitals are in the private sector.

How does it work? Japan boasts some of the best health statistics in the world, no doubt due in part to the Japanese diet and lifestyle. Unlike the U.K., there are no gatekeepers; the Japanese can go to any specialist when and as often as they like. Every two years the Ministry of Health negotiates with physicians to set the price for every procedure. This helps keeps costs down.

What are the concerns? In fact, Japan has been so successful at keeping costs down that Japan now spends too little on health care; half of the hospitals in Japan are operating in the red. Having no gatekeepers means there's no check on how often the Japanese use health care, and patients may lack a medical home.

interview with Naoki Ikegami, chair of the Department of Health Policy and Management at the Keio University School of Medicine, is widely regarded as Japan's top health economist. In this interview, he explains how Japan's health care system is able to produce some of the best health statistics in the world while costing less than health care in most other developed nations. This is an edited transcript of an interview conducted Oct. 15, 2007.

DanteAugustusGermanicus · #3 (**permalink**) 06-19-2008, 06:52 AM

here are the program's results for the Germany:

GERMANY

Quote:

Percentage of GDP spent on health care: 10.7

Average family premium: $750 per month; premiums are pegged to patients' income.

Co-payments: 10 euros ($15) every three months; some patients, like pregnant women, are exempt.

What is it? Germany, like Japan, uses a social insurance model. In fact, Germany is the birthplace of social insurance, which dates back to Chancellor Otto von Bismarck. But unlike the Japanese, who get insurance from work or are assigned to a community fund, Germans are free to buy their insurance from one of more than 200 private, nonprofit "sickness funds." As in Japan, the poor receive public assistance to pay their premiums.

How does it work? Sickness funds are nonprofit and cannot deny coverage based on preexisting conditions; they compete with each other for members, and fund managers are paid based on the size of their enrollments. Like Japan, Germany is a single-payment system, but instead of the government negotiating the prices, the sickness funds bargain with doctors as a group. Germans can go straight to a specialist without first seeing a gatekeeper doctor, but they may pay a higher co-pay if they do.

What are the concerns? The single-payment system leaves some German doctors feeling underpaid. A family doctor in Germany makes about two-thirds as much as he or she would in America. (Then again, German doctors pay much less for malpractice insurance, and many attend medical school for free.) Germany also lets the richest 10 percent opt out of the sickness funds in favor of U.S.-style for-profit insurance. These patients are generally seen more quickly by doctors, because the for-profit insurers pay doctors more than the sickness funds.

AN INTERVIEW WITH KARL Lauterbach, one of Germany's foremost experts on health policy, is a professor of health economics and epidemiology at the University of Cologne and a member of the German parliament. Here he discusses the German system of social insurance, developed by Chancellor Otto von Bismarck in the 19th century, and what lessons America could learn from it. This is an edited transcript of an interview conducted Oct. 25, 2007.

DanteAugustusGermanicus · #4 (**permalink**) 06-19-2008, 06:56 AM

here are the program's results for the Taiwan:

TAIWAN

Quote:

Percentage GDP spent on health care: 6.3

Average family premium: $650 per year for a family for four.

Co-payments: 20 percent of the cost of drugs, up to $6.50; up to $7 for outpatient care; $1.80 for dental and traditional Chinese medicine. There are exemptions for major diseases, childbirth, preventive services, and for the poor, veterans, and children.

What is it? Taiwan adopted a "National Health Insurance" model in 1995 after studying other countries' systems. Like Japan and Germany, all citizens must have insurance, but there is only one, government-run insurer. Working people pay premiums split with their employers; others pay flat rates with government help; and some groups, like the poor and veterans, are fully subsidized. The resulting system is similar to Canada's -- and the U.S. Medicare program.

How does it work? Taiwan's new health system extended insurance to the 40 percent of the population that lacked it while actually decreasing the growth of health care spending. The Taiwanese can see any doctor without a referral. Every citizen has a smart card, which is used to store his or her medical history and bill the national insurer. The system also helps public health officials monitor standards and effect policy changes nationwide. Thanks to this use of technology and the country's single insurer, Taiwan's health care system has the lowest administrative costs in the world.

What are the concerns? Like Japan, Taiwan's system is not taking in enough money to cover the medical care it provides. The problem is compounded by politics, because it is up to Taiwan's parliament to approve an increase in insurance premiums, which it has only done once since the program was enacted.

an interview with...Husband-and-wife health policy experts Reinhardt and Cheng (who is referred to as May Reinhardt at times in this interview) are based at Princeton University, where he is the James Madison Professor of Political Economy and she is a co-founder of the annual Princeton Conference on health policy. Here they discuss the U.S. health care system's problems and analyze other countries' approaches, including that of Cheng's native Taiwan, which studied health systems around the world before reforming its own. This an edited transcript of an interview conducted Nov. 10, 2007.

DanteAugustusGermanicus · #5 (**permalink**) 06-19-2008, 06:59 AM

here are the program's results for the Switzerland:

SWITZERLAND

Quote:

Percentage of GDP spent on health care: 11.6

Average monthly family premium: $750, paid entirely by consumers; there are government subsidies for low-income citizens.

Co-payments: 10 percent of the cost of services, up to $420 per year.

What is it? The Swiss system is social insurance like in Japan and Germany, voted in by a national referendum in 1994. Switzerland didn't have far to go to achieve universal coverage; 95 percent of the population already had voluntary insurance when the law was passed. All citizens are required to have coverage; those not covered were automatically assigned to a company. The government provides assistance to those who can't afford the premiums.

How does it work? The Swiss example shows that universal coverage is possible, even in a highly capitalist nation with powerful insurance and pharmaceutical industries. Insurance companies are not allowed to make a profit on basic care and are prohibited from cherry-picking only young and healthy applicants. They can make money on supplemental insurance, however. As in Germany, the insurers negotiate with providers to set standard prices for services, but drug prices are set by the government.

What are the concerns? The Swiss system is the second most expensive in the world -- but it's still far cheaper than U.S. health care. Drug prices are still slightly higher than in other European nations, and even then the discounts may be subsidized by the more expensive U.S. market, where some Swiss drug companies make one-third of their profits. In general, the Swiss do not have gatekeeper doctors, although some insurance plans require them or give a discount to consumers who use them.

an interview with Pascal Couchepin who is the current president of Switzerland. He also heads the Federal Department of Home Affairs, where he oversees the implementation of LAMal, a law passed in 1994 requiring all citizens to buy health insurance -- with the state paying for the poor. In return, the new law guarantees a comprehensive package of medical care for all. At the time the law was passed, Switzerland's health care system resembled America's: Medical insurance was voluntary and generally linked to employment. Losing your job meant you could lose coverage -- and many did. This is an edited transcript of an interview conducted Oct. 30, 2007.

Craigers · #6 (**permalink**) 06-19-2008, 07:45 AM

Quote:

Originally Posted by DanteAugustusGermanicus

It is about as unbiased a collection of stories as I've seen. It is biased in that it approaches the conversation from the point of view that Americans are unhappy with their own system...a bias I share.

read it and see if you consider it fair and balanced and if you think it adds to your understanding of the issue.
here are the program's results for the United Kingdom:

UNITED KINGDOM

interview with Nigel Hawkes who ...is health editor for The Times of London and a longtime observer of Britain's National Health Service (NHS), a government-run service that covers everyone's health care and is paid for out of tax revenue. Here Hawkes discusses the NHS's advantages and shortcomings, and recent initiatives to bring some market efficiencies into the 60-year-old socialized system. This is an edited transcript of an interview conducted Nov. 1, 2007.

http://www.liberty-page.com/issues/h...d.html#britain

Yeah I guess I am just scared...

Craigers · #7 (**permalink**) 06-19-2008, 07:56 AM

Here was another post of mine in response to your statement:
"But to ignore the great success of most great society and FDR policies as many conservatives do is idiocy masquerading as informed opinion."

This is also the reason why I will never trust our politicians with a mandated healthcare system. They screw everything up:

Quote:

Originally Posted by Craigers

In 2007, Medicare Part A benefit payments began to exceed the program’s tax revenue.

In 2011, the Medicare Part A Trust Fund begins to decline as benefits exceed payroll taxes and trust fund interest.

In 2017, Social Security benefit payments will begin to exceed the program’s tax revenue.

In 2019, Medicare Part A Trust Fund assets will not be enough to pay full benefits. Under current law, benefits would be reduced to 79 percent of scheduled benefits in 2019, declining to 29 percent by 2081.

In 2027, Social Security Trust Funds begin to decline as benefits exceed tax revenue and trust fund interest.

In 2040, federal debt held by the public will exceed the historical high of 109 percent of GDP.

In 2041, Social Security Trust Funds’ assets will not be enough to pay full benefits. Under current law, benefits for all retirees would be reduced to 75 percent of scheduled benefits in 2041, declining to 70 percent by 2081.

In 2080, total government cost will be more than three times revenue.

http://www.fms.treas.gov/frsummary/frsummary2007.pdf

You consider this great success?

What's even better, if I where to invest the amount I lost to SS last year (not including the amount my employer pays) into my company matched 401(k) and continue to do so until I retire and NOT account for any pay raises, I will have $1.5 Million in the account. How much will SS give me when I retire if it is even around? A few thousand a year?

Lets not forget the 'reform' we've gotten on SS over the years:

> Franklin Roosevelt, a Democrat, introduced the Social Security (FICA)
> Program. He promised:
>
> 1.) That participation in the Program would be Completely voluntary,
>
> 2.) That the participants would only have to pay 1% of the first $1,400
> of their annual incomes into the Program,
>
> 3.) That the money the participants elected to put into the Program
> would be deductible from Their income for tax purposes each year,
>
> 4.) That the money the participants put into the independent "Trust Fund"
> rather than into the General Operating Fund, and therefore, would only
> be used to fund the Social Security Retirement Program, and no other
> government program, and,
>
> 5.) That the annuity payments to the retirees would never be taxed as
> income. Since many of us have paid into FICA for years and are now
> receiving a Social Security check every month -- and then finding that
> we are getting taxed on 85% of the money we paid to the Federal
> Government to put away for our use upon retirement -- you may be
> interested in the
> following:
>
>
> Q: Which Political Party took Social Security from the independent
> "Trust Fund" and put it into the General Fund so that Congress could spend it?
>
> A: It was Lyndon Johnson and the democratically Controlled House and
> Senate.
>
> Q: Which Political Party eliminated the income tax deduction for
> Social Security (FICA) withholding?
>
> A: The Democratic Party.
>
> Q: Which Political Party started taxing Social Security annuities?
>
> A: The Democratic Party, with Al Gore casting the "tie-breaking"
> deciding vote as President of the Senate, while he was Vice President of the US.
>
> Q: Which Political Party decided to start giving annuity payments to
> immigrants?
>
> A: That's right! Jimmy Carter and the Democratic Party. Immigrants
> move into this country, and at age 65, began to receive Social
> Security payments! The Democratic Party gave these payments to them,
> even though they never paid a dime into it!
>
> Then, after violating the original contract (FICA), the Democrats
> turn around and tell you that the Republicans want to take your Social
> Security away! And the worst part about it is, uninformed citizens believe it!

Why on earth would I want these people running my healthcare?

Do you even live in the US?

DanteAugustusGermanicus · #8 (**permalink**) 06-19-2008, 08:02 AM

Quote:

Originally Posted by Craigers

http://www.liberty-page.com/issues/h...d.html#britain

Yeah I guess I am just scared...

so is this part of your straw man argument class? why single out the United Kingdom with absolutely NO reasonable or rational discussion?

twist and shout, that is all you are doing.

can you Craigers, discuss health care intelligently? I have my doubts

DanteAugustusGermanicus · #9 (**permalink**) 06-19-2008, 08:17 AM

note: Under Reagan my income tax was cut but my FICA was what? I ended up paying a few dollars more. I did not complain because it was part of teh social contract I agree with, but I always resented that Reagan fans used the cut as a way of implying I got money back. I did not.

George Herbert Waker Bush was right about one thing: calling it all Reaganomics

---

you have not debated or challenged FDR's great society program as you have made a list of 'maybes' about what might happen in the future if the GOP keep throwing crap into the process of fixing things. you've also listed a group of complaints as I find conservatives usually do.

you are of the attitude that politicians screw everything up. What would you have perfection where none exists? if you were around in 1776 and had any leverage we'd be singing God Bless the Queen. Politicians try hard, but ideologues (like you?) get in the way.

nothing disturbs the mind of a partisan ideologue as much as success, no matter how worthy that success be, if that success benefits their opponent.

should I address your laundry list?

in another post
"... the great success of most great society and FDR policies..."

Quote:

Originally Posted by Craigers

Here was another post of mine in response to your statement:

"But to ignore the great success of most great society and FDR policies as many conservatives do is idiocy masquerading as informed opinion."

This is also the reason why I will never trust our politicians with a mandated healthcare system. They screw everything up:

Quote:

Originally Posted by Craigers

In 2007, Medicare Part A benefit payments began to exceed the program’s tax revenue.

In 2011, the Medicare Part A Trust Fund begins to decline as benefits exceed payroll taxes and trust fund interest.

In 2017, Social Security benefit payments will begin to exceed the program’s tax revenue.

In 2019, Medicare Part A Trust Fund assets will not be enough to pay full benefits. Under current law, benefits would be reduced to 79 percent of scheduled benefits in 2019, declining to 29 percent by 2081.

In 2027, Social Security Trust Funds begin to decline as benefits exceed tax revenue and trust fund interest.

In 2040, federal debt held by the public will exceed the historical high of 109 percent of GDP.

In 2041, Social Security Trust Funds’ assets will not be enough to pay full benefits. Under current law, benefits for all retirees would be reduced to 75 percent of scheduled benefits in 2041, declining to 70 percent by 2081.

In 2080, total government cost will be more than three times revenue.

http://www.fms.treas.gov/frsummary/frsummary2007.pdf

You consider this great success?

What's even better, if I where to invest the amount I lost to SS last year (not including the amount my employer pays) into my company matched 401(k) and continue to do so until I retire and NOT account for any pay raises, I will have $1.5 Million in the account. How much will SS give me when I retire if it is even around? A few thousand a year?

Lets not forget the 'reform' we've gotten on SS over the years:

> Franklin Roosevelt, a Democrat, introduced the Social Security (FICA)
> Program. He promised:
>
> 1.) That participation in the Program would be Completely voluntary,
>
> 2.) That the participants would only have to pay 1% of the first $1,400
> of their annual incomes into the Program,
>
> 3.) That the money the participants elected to put into the Program
> would be deductible from Their income for tax purposes each year,
>
> 4.) That the money the participants put into the independent "Trust Fund"
> rather than into the General Operating Fund, and therefore, would only
> be used to fund the Social Security Retirement Program, and no other
> government program, and,
>
> 5.) That the annuity payments to the retirees would never be taxed as
> income. Since many of us have paid into FICA for years and are now
> receiving a Social Security check every month -- and then finding that
> we are getting taxed on 85% of the money we paid to the Federal
> Government to put away for our use upon retirement -- you may be
> interested in the
> following:
>
>
> Q: Which Political Party took Social Security from the independent
> "Trust Fund" and put it into the General Fund so that Congress could spend it?
>
> A: It was Lyndon Johnson and the democratically Controlled House and
> Senate.
>
> Q: Which Political Party eliminated the income tax deduction for
> Social Security (FICA) withholding?
>
> A: The Democratic Party.
>
> Q: Which Political Party started taxing Social Security annuities?
>
> A: The Democratic Party, with Al Gore casting the "tie-breaking"
> deciding vote as President of the Senate, while he was Vice President of the US.
>
> Q: Which Political Party decided to start giving annuity payments to
> immigrants?
>
> A: That's right! Jimmy Carter and the Democratic Party. Immigrants
> move into this country, and at age 65, began to receive Social
> Security payments! The Democratic Party gave these payments to them,
> even though they never paid a dime into it!
>
> Then, after violating the original contract (FICA), the Democrats
> turn around and tell you that the Republicans want to take your Social
> Security away! And the worst part about it is, uninformed citizens believe it!

Why on earth would I want these people running my healthcare?

Do you even live in the US?

DanteAugustusGermanicus · #10 (**permalink**) 06-19-2008, 08:21 AM

I list 5 substantive posts. what will I get in return from the misanthropic misfit wing of the conservative class?

watch and learn...

5 substantive posts on health care. what will they offer? on topic discussion? rational debate? a fair hearing for the work done on the program I profile?

head in the sand resistance to the issue at hand is more likely.

we'll see

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