NOTE: The following is for all you BARACK bashers and other racists
and gun-nuts out there ...  have a
semi-educated person read it to you while you pick the dinkleberries
off your sh.t-encrusted hairy a.s.

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"5 Myths About Health Care Around the World"

By T.R. Reid
Sunday, August 23, 2009

AS AMERICANS search for the cure to what ails our health-care system,
we've overlooked an invaluable source of ideas and solutions: the rest
of the world. All the other industrialized democracies have faced
problems like ours, yet they've found ways to cover everybody -- and
still spend far less than we do.

I've traveled the world from Oslo to Osaka to see how other developed
democracies provide health care. Instead of dismissing these models as
"socialist," we could adapt their solutions to fix our problems. To do
that, we first have to dispel a few myths about health care abroad:

1. It's all socialized medicine out there.

Not so. Some countries, such as Britain, New Zealand and Cuba, do
provide health care in government hospitals, with the government
paying the bills. Others -- for instance, Canada and Taiwan -- rely on
private-sector providers, paid for by government-run insurance. But
many wealthy countries -- including Germany, the Netherlands, Japan
and Switzerland -- provide universal coverage using private doctors,
private hospitals and private insurance plans.

In some ways, health care is less "socialized" overseas than in the
United States. Almost all Americans sign up for government insurance
(Medicare) at age 65. In Germany, Switzerland and the Netherlands,
seniors stick with private insurance plans for life. Meanwhile, the
U.S. Department of Veterans Affairs is one of the planet's purest
examples of government-run health care.

2. Overseas, care is rationed through limited choices or long lines.

Generally, no. Germans can sign up for any of the nation's 200 private
health insurance plans -- a broader choice than any American has. If a
German doesn't like her insurance company, she can switch to another,
with no increase in premium. The Swiss, too, can choose any insurance
plan in the country.

In France and Japan, you don't get a choice of insurance provider; you
have to use the one designated for your company or your industry. But
patients can go to any doctor, any hospital, any traditional healer.
There are no U.S.-style limits such as "in-network" lists of doctors
or "pre-authorization" for surgery. You pick any doctor, you get
treatment -- and insurance has to pay.

Canadians have their choice of providers. In Austria and Germany, if a
doctor diagnoses a person as "stressed," medical insurance pays for
weekends at a health spa.

As for those notorious waiting lists, some countries are indeed
plagued by them. Canada makes patients wait weeks or months for
nonemergency care, as a way to keep costs down. But studies by the
Commonwealth Fund and others report that many nations -- Germany,
Britain, Austria -- outperform the United States on measures such as
waiting times for appointments and for elective surgeries.

In Japan, waiting times are so short that most patients don't bother
to make an appointment. One Thursday morning in Tokyo, I called the
prestigious orthopedic clinic at Keio University Hospital to schedule
a consultation about my aching shoulder. "Why don't you just drop by?"
the receptionist said. That same afternoon, I was in the surgeon's
office. Dr. Nakamichi recommended an operation. "When could we do it?"
I asked. The doctor checked his computer and said, "Tomorrow would be
pretty difficult. Perhaps some day next week?"

3. Foreign health-care systems are inefficient, bloated bureaucracies.

Much less so than here. It may seem to Americans that U.S.-style free
enterprise -- private-sector, for-profit health insurance -- is
naturally the most cost-effective way to pay for health care. But in
fact, all the other payment systems are more efficient than ours.

U.S. health insurance companies have the highest administrative costs
in the world; they spend roughly 20 cents of every dollar for
nonmedical costs, such as paperwork, reviewing claims and marketing.
France's health insurance industry, in contrast, covers everybody and
spends about 4 percent on administration. Canada's universal insurance
system, run by government bureaucrats, spends 6 percent on
administration. In Taiwan, a leaner version of the Canadian model has
administrative costs of 1.5 percent; one year, this figure ballooned
to 2 percent, and the opposition parties savaged the government for
wasting money.

The world champion at controlling medical costs is Japan, even though
its aging population is a profligate consumer of medical care. On
average, the Japanese go to the doctor 15 times a year, three times
the U.S. rate. They have twice as many MRI scans and X-rays. Quality
is high; life expectancy and recovery rates for major diseases are
better than in the United States. And yet Japan spends about $3,400
per person annually on health care; the United States spends more than
$7,000.

4. Cost controls stifle innovation.

False. The United States is home to groundbreaking medical research,
but so are other countries with much lower cost structures. Any
American who's had a hip or knee replacement is standing on French
innovation. Deep-brain stimulation to treat depression is a Canadian
breakthrough. Many of the wonder drugs promoted endlessly on American
television, including Viagra, come from British, Swiss or Japanese
labs.

Overseas, strict cost controls actually drive innovation. In the
United States, an MRI scan of the neck region costs about $1,500. In
Japan, the identical scan costs $98. Under the pressure of cost
controls, Japanese researchers found ways to perform the same
diagnostic technique for one-fifteenth the American price. (And
Japanese labs still make a profit.)

5. Health insurance has to be cruel.

Not really. American health insurance companies routinely reject
applicants with a "preexisting condition" -- precisely the people most
likely to need the insurers' service. They employ armies of adjusters
to deny claims. If a customer is hit by a truck and faces big medical
bills, the insurer's "rescission department" digs through the records
looking for grounds to cancel the policy, often while the victim is
still in the hospital. The companies say they have to do this stuff to
survive in a tough business.

Foreign health insurance companies, in contrast, must accept all
applicants, and they can't cancel as long as you pay your premiums.
The plans are required to pay any claim submitted by a doctor or
hospital (or health spa), usually within tight time limits. The big
Swiss insurer Groupe Mutuel promises to pay all claims within five
days. "Our customers love it," the group's chief executive told me.
The corollary is that everyone is mandated to buy insurance, to give
the plans an adequate pool of rate-payers.

The key difference is that foreign health insurance plans exist only
to pay people's medical bills, not to make a profit. The United States
is the only developed country that lets insurance companies profit
from basic health coverage.

In many ways, foreign health-care models are not really "foreign" to
America, because our crazy-quilt health-care system uses elements of
all of them. For Native Americans or veterans, we're Britain: The
government provides health care, funding it through general taxes, and
patients get no bills. For people who get insurance through their
jobs, we're Germany: Premiums are split between workers and employers,
and private insurance plans pay private doctors and hospitals. For
people over 65, we're Canada: Everyone pays premiums for an insurance
plan run by the government, and the public plan pays private doctors
and hospitals according to a set fee schedule. And for the tens of
millions without insurance coverage, we're Burundi or Burma: In the
world's poor nations, sick people pay out of pocket for medical care;
those who can't pay stay sick or die.

This fragmentation is another reason that we spend more than anybody
else and still leave millions without coverage. All the other
developed countries have settled on one model for health-care delivery
and finance; we've blended them all into a costly, confusing
bureaucratic mess.

Which, in turn, punctures the most persistent myth of all: that
America has "the finest health care" in the world. We don't. In terms
of results, almost all advanced countries have better national health
statistics than the United States does. In terms of finance, we force
700,000 Americans into bankruptcy each year because of medical bills.
In France, the number of medical bankruptcies is zero. Britain: zero.
Japan: zero. Germany: zero.

Given our remarkable medical assets -- the best-educated doctors and
nurses, the most advanced hospitals, world-class research -- the
United States could be, and should be, the best in the world. To get
there, though, we have to be willing to learn some lessons about
health-care administration from the other industrialized democracies.

[T.R. Reid, a former Washington Post reporter, is the author of "The
Healing of America: A Global Quest for Better, Cheaper, and Fairer
Health Care," to be published Monday.]

http://www.washingtonpost.com/wp-dyn/content/article/2009/08/21/AR2009082101778.html