Much has been on the airwaves on Senator Ted Kennedy today. As I was finishing my daily reading on the WSJ, I came across this statement:
Over the course of the third-longest tenure in the history of the Senate, Mr. Kennedy mounted a legislative agenda across a wide range of issues dear to liberal voters and left-leaning Democratic Party constituencies -- school and racial integration in the 1960s, poverty and gender equality in the 1970s, disability in the 1980s and education reform in the 1990s.
I never considered myself liberal or left-leaning before. But by golly, if being left-leaning is to champion the above list please call me a lefty by all means!
Wednesday, August 26, 2009
Sunday, August 02, 2009
Healthy lessons from abroad
This morning Senator McCain observed that while everybody agrees that health care costs are too high, the difference between the parties is that the Republicans believe that the US has the best quality health care in the world. As an aside, this highlights a deeper problem within the Republican Party: the blind devotion to the principle the US is in every way the best country in the world. That leaves comparative analysis to the "America-haters."
Stipulate for the moment that there may or may not be lessons to be learned from foreign health care systems. Put on your agnostic cap and defer any notions you may have about single payer, socialized health care, public options, etc. Meditate if you have to.
Having thus prepared, we can ask the key question: Are there any systems that cost less while delivering more? If there are, we can have a closer look. If not, then we can move on. The following table compares the US with three other countries culled from a Frontline special.
These numbers warrant further interest. Here are three health care systems that provide more coverage for a much cheaper price tag. Not only that, but on the surface they appear to be delivering as good or better health care in terms of infant mortality and life expectancy. Of course these are not perfect indices of health care quality, but they are some of the best metrics available for overall population health, which itself is a function of health care, diet, exercise, air quality and other factors. Indeed, it is reasonable to assume that one of the reasons that the US has lower life expectancy and higher infant mortality is due to the high number of uninsured.
Another way of looking at quality is the degree of access to health care professionals and technology. Japan excels in these ways too. Japanese people go to the doctor three times as often as Americans and they have greater access to medical imaging technology. Although the UK and Taiwan have fewer medical imaging instruments per capita, the UK boasts outstanding preventive care and Taiwan has remarkably low waiting times and other barriers to seeing medical professionals. The US health care meanwhile is characterized by long waiting times and lack of continuity. In one Commonwealth Fund study of patients above a certain sickness threshold, the UK did considerably better in terms of wait times and continuity. This in spite of the fact that socialized health care systems rightly or wrongly carry the stigma of patients waiting in line.
Now that our curiosity is piqued, we may wonder how these other health care systems work. Interestingly, Taiwan, Japan and the UK present a variety of approaches to health care.
The UK is the epitome of much maligned socialized medicine. There are no co-payments, payroll deductions, insurance companies, etc. All health care payments are drawn directly from the national tax revenue.
Japan's health care system looks more familiar on the surface. It is ostensibly a multi-payer system with private insurance companies and premiums that are paid by payroll deductions, employer contributions and co-payments. However, universal coverage is mandated and subsidized to a greater extent. The biggest difference is that the government in effect steps in as the single payer's representative and negotiates with the doctors to determine a schedule of fees which is updated every two years. This causes a dramatic reduction in cost and even led to innovation in medical imaging technology. Actually, the problem with Japan's system is that costs are too low.
Taiwan's current health care system is of recent vintage having been comprehensively engineered based on a study of other countries. All health care coverage is provided through a government insurance agency reminiscent of the 'public option' currently being legislated. As usual, one payer means more market power for the buyer. In addition, each patient carries a smart card with their medical history and payment mechanism. Taiwan boasts the lowest administrative costs in the world.
Clearly there are some lessons to be learned from abroad if we can keep an open mind. We needn't resign ourselves to the notion that health care will be ever more exorbitant. The overhaul would have to take place in several steps and would require non-partisan oversight and steering. If the public option is adopted, lower costs would not be evident until the government insurance agency accumulates enough market power.
Stipulate for the moment that there may or may not be lessons to be learned from foreign health care systems. Put on your agnostic cap and defer any notions you may have about single payer, socialized health care, public options, etc. Meditate if you have to.
Having thus prepared, we can ask the key question: Are there any systems that cost less while delivering more? If there are, we can have a closer look. If not, then we can move on. The following table compares the US with three other countries culled from a Frontline special.
| Country | Cost/GDP | Life expectancy | Infant mortality | Universal? |
| US | 15.3% | 77 | 6.8 | no (83%) |
| Japan | 8% | 82.1 | 2.8 | yes |
| Taiwan | 6.3% | 78 | 5.4 | yes |
| UK | 8.3% | 79 | 5.1 | yes |
These numbers warrant further interest. Here are three health care systems that provide more coverage for a much cheaper price tag. Not only that, but on the surface they appear to be delivering as good or better health care in terms of infant mortality and life expectancy. Of course these are not perfect indices of health care quality, but they are some of the best metrics available for overall population health, which itself is a function of health care, diet, exercise, air quality and other factors. Indeed, it is reasonable to assume that one of the reasons that the US has lower life expectancy and higher infant mortality is due to the high number of uninsured.
Another way of looking at quality is the degree of access to health care professionals and technology. Japan excels in these ways too. Japanese people go to the doctor three times as often as Americans and they have greater access to medical imaging technology. Although the UK and Taiwan have fewer medical imaging instruments per capita, the UK boasts outstanding preventive care and Taiwan has remarkably low waiting times and other barriers to seeing medical professionals. The US health care meanwhile is characterized by long waiting times and lack of continuity. In one Commonwealth Fund study of patients above a certain sickness threshold, the UK did considerably better in terms of wait times and continuity. This in spite of the fact that socialized health care systems rightly or wrongly carry the stigma of patients waiting in line.
Now that our curiosity is piqued, we may wonder how these other health care systems work. Interestingly, Taiwan, Japan and the UK present a variety of approaches to health care.
The UK is the epitome of much maligned socialized medicine. There are no co-payments, payroll deductions, insurance companies, etc. All health care payments are drawn directly from the national tax revenue.
Japan's health care system looks more familiar on the surface. It is ostensibly a multi-payer system with private insurance companies and premiums that are paid by payroll deductions, employer contributions and co-payments. However, universal coverage is mandated and subsidized to a greater extent. The biggest difference is that the government in effect steps in as the single payer's representative and negotiates with the doctors to determine a schedule of fees which is updated every two years. This causes a dramatic reduction in cost and even led to innovation in medical imaging technology. Actually, the problem with Japan's system is that costs are too low.
Taiwan's current health care system is of recent vintage having been comprehensively engineered based on a study of other countries. All health care coverage is provided through a government insurance agency reminiscent of the 'public option' currently being legislated. As usual, one payer means more market power for the buyer. In addition, each patient carries a smart card with their medical history and payment mechanism. Taiwan boasts the lowest administrative costs in the world.
| Country | Funded by | Single payer? |
| US | Private insurance | no |
| Japan | Private insurance | sort of |
| Taiwan | Govt insurance | yes |
| UK | Taxes | yes |
Clearly there are some lessons to be learned from abroad if we can keep an open mind. We needn't resign ourselves to the notion that health care will be ever more exorbitant. The overhaul would have to take place in several steps and would require non-partisan oversight and steering. If the public option is adopted, lower costs would not be evident until the government insurance agency accumulates enough market power.
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