Weighing in on Health Care

Health Care - at the forefront of American issues

HEALTH CARE. It seems that everything in American political news recently has been about President Obama's (Controversial) Health Care Bill. And before you roll your eyes and say, "Can't you just give me some really cool fisheye picture or a witty comment on some culinary anecdote?" I have a quick thought on the issue... because I'm now a "blogger" and that's what I'm supposed to do. (This isn't solely because my wife comes from Canada!)

WHAT IS THE BIG FUSS ABOUT?

The big debate, for anyone reading this in Europe, is over the role that the American government should play in the modern health care system. This is actually a conversation which might seem silly to explain to people from other nations where the government has always been involved in health care and citizens rarely give it a second thought. However, there are some admitted flaws in the system at this point - such as the role of private insurance companies and its spiraling costs:

FACT: More money per person is spent on health care in the United States than in any other nation in the world, and a greater percentage of total income in the nation is spent on health care in the U.S. than in any United Nations member state except East Timor. In fact, Medical Debt is the principal cause of personal bankruptcy in the United States. Even so, at least 15% of the population (including me and my wife) are completely uninsured.

My personal commentary on this: Can you even imagine someone in Canada going BANKRUPT because they got sick? That is completely ludicrous for any of our Northern, Tim Horton's drinking neighbors. But it seems that in America we have a habit of thinking that our way is the best - in Government (Democracy), in Business (Capitalism), and in Rights (Freedom), and we as Americans are willing to take that risk to have our choice of which doctor or what treatment we want. But when everyone isn't taken care of, bad things can happen. More facts:

According to the Institute of Medicine of the National Academy of Sciences, the United States is the "only wealthy, industrialized nation that does not ensure that all citizens have coverage" (i.e. some kind of insurance). The same Institute of Medicine report notes that "Lack of health insurance causes roughly 18,000 unnecessary deaths every year in the United States." while a 2009 Harvard study published in the American Journal of Public Health found a much higher figure of more than 44,800 excess deaths annually in the United States due to Americans lacking health insurance.

NOW, I DON'T WANT TO TAKE SIDES ON THIS ISSUE - BECAUSE HEY, I'M A MIDDLE CHILD AND THAT'S NOT MY ROLE. HOWEVER, I DO WANT TO SHARE A COUPLE EXPERIENCES AND VIEWPOINTS FROM ABROAD THAT ARE WORTH THINKING ABOUT:

Italy: Gus wasn't the luckiest guy when he broke his leg...

Living in Italy, things don't always go as planned, and the health care system isn't immune to that. (no pun intended) When Gustavo, one of the Catania Elephants linebackers, tore his ACL in a road game, he wasn't given immediate attention at the hospital and flew back home with a cardboard cast on his leg! It took a few days to actually see a doctor, then a few more to get x-rays, and finally a couple more weeks to have surgery. Maybe not the best system...

Austria: Matt was a happy camper with his leg! (Milka not included)

During the EuroBowl, star receiver Matt Epperson broke his leg and suffered a severely dislocated ankle during the first quarter. Austria has a split system - both public and private - and due to the nature of his injury and the Raider's insurance, he was rushed to the private hospital and given IMMEDIATE surgery. By the time the game ended we could visit him, and everything turned out ok - including a MILKA Chocolate! So this obviously works, even though the basic person can get treated as well if he got hurt.

My whole point is that there may be a better way out there... some sort of FUSION, and instead of arguing that "our position" is best, I just want Americans - ESPECIALLY THE ONES WHO HAVE NEVER LEFT OUR COUNTRY - to consider some other viewpoints.

In keeping with this, travel guru Rick Steves published the following reports from Scandinavians regarding their health care systems, which to me don't sound that bad:

Europeans Share Their Health Care Experience, Part 1: Scandinavia

To bring some diverse experience into the discussion on health care reform here in the USA, I've asked my friends in Europe to share how health care works in their lives. In this four-part series, we'll start with the most highly taxed and socialistic part of Europe: Scandinavia.

From Hakan in Sweden:

In Sweden, we have free choice in health care. It means that patients can choose a hospital anywhere in the country.

In 2005, the cost of the health and medical care sector amounted to 8.4 percent of GDP (in the US, it was over 15 percent). This amount includes the cost of pharmaceutical products, dental care, eyeglasses, and patient fees paid by households.

We employ a “high-cost protection scheme” that means that no patient ever needs to pay more than a total of 900 SEK (about $125) over a 12-month period. For pharmaceutical costs, no patient has to pay more than SEK 1,800 (about $250) over a 12-month period for prescription drugs. This way, no citizen will be put into poverty because of health problems.

The fee for visiting a doctor or hospital varies from 100-300 SEK (about $14-32), but once you have paid 900 SEK in a 12-month period, the rest of the care is totally free — no matter what kind of treatment you need. Private-care providers are also “clients” of the government. A patient can choose a private doctor or hospital, pay the small fee, and the government pays the difference.

The health and medical services have an obligation to strengthen the situation of the patient, for example, by providing individually tailored information, freedom to choose between treatment options, and the right to a second opinion in cases of life-threatening or other particularly serious diseases or injuries.

Having lived here all my life and raised my family here in Stockholm, I honestly do not see anything bad with our health care system.

From Richard in Demark:

I have lived and worked in Denmark for 24 years and have had numerous encounters with the health care system. In all cases I was satisfied or impressed with the quality of service and the low cost (apart from the tax system — more about that later).

The health care system in Denmark is free to all who live here. Even visiting tourists will be treated free of charge in case of an emergency. A non-Danish friend of mine who sprained her ankle during a recent visit was X-rayed, bandaged, treated by a doctor, and even given a pair of crutches to use — and was not charged anything. She was only asked to return the crutches when she left Denmark.

The quality of Danish health care — which is not run on a profit motive — is very good, though there is a waiting time for some non-life-threatening operations like a hip replacement. But everyone will eventually get the operation they need. Hospitals are free, doctor visits are free, and medicine is highly subsidized so that those who need a lot of medicine get it at a greatly reduced charge. Dentistry is subsidized.

This is paid for through our tax system, which — at 52 percent — is perhaps the highest in the world. None of the 10 political parties in Denmark has ever wanted to change that, because they know that they would not get any votes. The vast majority of Danes are agreeable to pay these high taxes; they know that they get about 50 percent of the money back each year in a vast array of benefits. Seven out of 10 Danes are willing to pay even more taxes, if necessary, to maintain the health care system we expect.

Danes have the mature and realistic understanding that you cannot give everyone a quality health care system, good schools, and the elements that help to make for a good quality of life, without paying for it. Freedom does not mean not paying taxes. For us, freedom is paying taxes. By taking care of each other, and the weaker elements in our society, we all have a better quality of life with very low crime rates, few prisons, and a sense of security that it is not “me against the world.” That is part of what it means to be Danish.

From Hanne and Trond in Norway:

In Norway, everyone has, in principle, equal rights to health care. Norwegian hospitals are “free” for patients (being financed with taxes) and everyone is entitled to treatment, irrespective of income and insurance. However, many things are not always working well here.

When hospitalized, no one asks for insurance coverage. You can stay for as long as it takes without having to worry about costs. At the hospital, every part of the treatment is free, indefinitely. At home, people with chronic illnesses get medicine and necessary medical equipment almost for free, save for a limited, annual base payment.

But some parts of the system don't function well. Depending on the illness, you could wait a long time for necessary hospital treatment (typically non-emergency surgery). For instance, you have to go through your family doctor in order to be referred to a specialist. When the family doctors have way too many patients and limited opening hours (and limited telephone hours!), this is often an obstacle. Of course, any emergency treatment is exempt from “queuing.”

As for the cost, the hospitals operate with a combined budget of approximately NOK 75 billion ($13 billion). Our health care is not free — we pay for it in our taxes: Our corporations pay a flat tax rate of 28 percent on their profits. Wage income is taxed under a progressive structure, from almost zero (very low, part-time wages) to a maximum marginal tax rate of 54 percent. The average “industrial worker” has a tax rate of 30 to 35 percent.

Posted by Rick Steves on November 04, 2009