This debate has been going on long enough now. For those of us following the debate closely, and have read HR 3200, we know that health care reform is less about reform and more about government control and power.
Everyone is picking apart the health care systems of England, France, and Canada. Those are the systems most in line with the proposed US changes. Though HR 3200 is far more broad and gives far more power to the federal government than that of the aforementioned countries.
For me … the worst part of this whole thing is how people who support HR 3200 haven’t read it, and are literally supporting completely dismantling our health care for a new system of benefits that haven’t been revealed to us yet. If HR 3200 passes, we won’t know what the benefits, coverage, individual cost/responsibility are until a panel of people we didn’t vote for gets together and decides what they’ll cover, and how much money they’ll spend on it.
How can you support a change in your benefits without knowing what those benefits are? Would you blindly buy a private insurance plan that way, or would you research the benefits, covered procedures, co-pays, and deductibles?
Oh, and by the way, it is not a public “option” plan. Page 16 makes it very clear you will only get to keep your private insurance as it is written at the time HR 3200 goes into effect. You will NEVER be allowed to change your coverage … EVER! If you do, you will automatically default to the federal health plan, and you will never be allowed to leave it again. Whether you want that plan or not.
The government will also decide if your private insurance (should you keep it) is adequate. If it isn’t … the federal government will fine you annually on your taxes for the full average cost of a plan they deem adequate. So you’ll pay for your insurance … then pay for insurance you should have had. There is nothing in HR 3200 that says what private insurance plan would be sufficient to avoid the annual fine. There is also nothing in HR 3200 to prevent the government from arbitrarily saying your plan is inadequate. This leaves open the possibility of the government fining you repeatedly until you finally opt into the federal plan. The bill has no protection against this.
With all of that said … why are we looking at a system similar to Britain, France, or Canada. All have major, well documented flaws. They also yield too much liberty to the government than most Americans are willing to give.
All three countries have problems with rationing care … the US doesn’t. You can, and will, be treated in the emergency room any time you want, or need, treatment in the US. A fact that gets ignored in this debate. There is no denying that this method can bankrupt you, but so what … you’ll be alive.
The US also has a much higher survivability rate when you get sick than the other countries. Especially for cancer.
Read the full report here.
This report here highlights in more detail the superior care Americans get compared to Canadians and Europeans.
It is a fact that we get better care when we are sick. That doesn’t mean they get bad care. After all, they do have access to modern medicine.
There’s also been a lot attributed to life expectancy in the US and those countries. Some attribute this to better preemptive care. Most in the medical field I’ve spoken with seem to understand that our lower life expectancy is more correlated to our way of life than preventive care. Especially since it is easier for an American to see a doctor while sick. We eat too much, drink too much, work too much, we sleep very little, take less vacation time, and don’t monitor our diet nearly as well as those countries. Americans also tend to be more thrill seeking than our counterparts.
In spite of all that, our life expectancy in this country just increased. It increased because of a decline in death rates in almost all the leading causes of death according to the CDC … all without government help. Oh yeah, life expectancy did the same thing in 2005 in the US.
Since our health and life expectancy are consistently improving … why change things?
Simply put … there are problems, and the system can be better. Our government simply has chosen to not focus on those things, and instead opted to change everything.
Since Britain, France and Canada aren’t the best places to copy, according to the overwhelming amount of evidence, who is?
According to surveys of citizens in other countries, that I’ve Googled, about their health care … the Netherlands seems to beat everyone. They have the highest percentage of population satisfied with their care, and the lowest percent who want a complete overhaul.
So what’s their system like?
Essentially, it’s private with a federal safety net. I’ve heard a local talk show host here in Vegas, Casey Hendrickson, advocate a similar plan on his show. Though he’s never mentioned the Netherlands, and his plan isn’t exactly like this. I don’t know where he got his ideas from, but it got me thinking.
It is now mandatory for everyone to have at least a base level of insurance (basisverzekering) or run the risk of a warning and fines. However, you are free to choose your own health insurer (zorgvezekeraar) and change companies once a year.
A Dutch insurance company cannot refuse to cover for you for the basic package, regardless of your age or state of health. The standard basic package is pretty much the same from all providers except that costs may vary. If your income is under a fixed minimum level, you can apply for a healthcare allowance (zorgtoeslag) from the tax authorities (belastingdienst).
That’s just an overview. You can visit the link to get the coverage levels.
Right off the bat we have a system of health care in the Netherlands that would be far more accepted by Americans than what is being proposed now. Let’s look at that basic coverage everyone has to have.
The basic insurance covers general medical care (visits to the huisarts, for example), hospital stays, dental care for up to age 22, prescription medicine, and various appliances. Costs start at approximately EUR 100 a month. The government keep tweaking this package.
You will need extra cover for extensive dental treatment, physiotherapy or anything else the government considers to be your own responsibility, and it is in these additional areas where companies compete. You can change the extras each year.
In other words … you can’t be denied for basic coverage, and it all costs about the same. If you want extra coverage … the free market is available for you to shop around. There’s also ways for you to tweak your deductible in favor of lower premiums.
There are some problems with the Dutch system though. You are limited in who you can choose as a doctor. They must be nearby. So you can’t visit a doctor if their office is not within 10 minutes of your home. You can choose any doctor in your area, but you are limited to that area. The same is true of a pharmacy which could be problem if you need a prescription, and you are at work or on vacation.
Overall though … it would be pretty acceptable to most Americans, and would likely sail through Congress. It also eliminates the three primary complaints in the US:
- Can’t get covered because of preexisting conditions
- Insurer drops coverage when sick due to costs
- Cost of prescription drugs
The other complaint about health care in the US is that it is not affordable. That’s bularky, and everyone knows it. How many people claim health insurance is not affordable, but have credit card, or car payments? They didn’t make insurance a priority. Another idea I got from Mr. Hendrickson by the way.
The Dutch system would force you to budget for insurance first so you wouldn’t have the option of buying gadgets and trinkets before insurance. Tah da! Insurance is now affordable!
Ok, so the Dutch system is pretty good, but is there a system that’s better?
How about Singapore’s health care system?
Right about now, some of you are stunned. Who the hell talks about Singapore during a heath care debate? Hear me out before you make your mind up. Americans will love this system.
First, you should know that Singapore’s health system was ranked first in an international comparison study. The World Health Organization ranked it 6th. So why haven’t you heard about it? Good question.
Singapore spends a third of what the US does on health care (GDP), but has better health indicators. Which may still have to do with lifestyle in the US vs Singapore.
So what’s their system like?
- There are mandatory health savings accounts: “Individuals pre-save for medical expenses through mandatory deductions from their paychecks and employer contributions… Only approved categories of medical treatment can be paid for by deducting one’s Medisave account, for oneself, grandparents, parents, spouse or children: consultations with private practitioners for minor ailments must be paid from out-of-pocket cash…”
- “The private healthcare system competes with the public healthcare, which helps contain prices in both directions. Private medical insurance is also available.”
- Private healthcare providers are required to publish price lists to encourage comparison shopping.
- The government pays for “basic healthcare services… subject to tight expenditure control.” Bottom line: The government pays 80% of “basic public healthcare services.”
- Government plays a big role with contagious disease, and adds some paternalism on top: “Preventing diseases such as HIV/AIDS, malaria, and tobacco-related illnesses by ensuring good health conditions takes a high priority.”
- The government provides optional low-cost catatrophic health insurance, plus a safety net “subject to stringent means-testing.”
- Almost all care is subject to significant co-pays.
For those of you who haven’t read HR 3200 you probably think this sounds a lot like what the Democrats are proposing. You’re wrong.
Their system is an actual partnership between public and private insurance. The government mandates that you have a health savings account so you can pay your co-pay, and deductible. Since there is actual cash being used to pay bills, the doctors don’t have to increase rates to cover those who haven’t paid. The HSA funds are tax free as long as used for medical purposes.
You can also get private insurance to have access to better benefits than provided by the government, and go to private hospitals which are more comfortable from what I’ve read. However, you can get low cost catostrophic insurance from the government as a backup plan in case you come down with a serious illness.
The government insurance is strictly regulated, and funded. If there is no money left over … you’re S.O.L. Good thing they mandate you have a HSA huh?
Basically, the government of Singapore requires you to save for you medical bills (like the US does for retirement), and encourages you to use the private sector for insurance because the government doesn’t cover everything. However, they provide a catastrophic safety net for their citizens.
It should be noted that Singapore’s system is said to be a “very difficult system to replicate in many other countries” by Watson Wyatt (a global consulting firm).
While Singapore’s system would likely face more resistance than the Netherlands model … it would be more accepted by Americans than HR 3200.
Since neither system is perfect, but both address the few flaws the current US system has, why not create a hybrid?