Building a New US Healthcare System: A Look at Best Practices in Western Europe

Aug 1, 2008 by

HealthcareLast month, the Democratic party encouraged ordinary people all across America to hold Platform Meetings in their own communities for input into the document that states what the Democrats stand for in this election. The outcome of these meetings will be reviewed by party’s Drafting Committee as it creates the final Platform.

At the recent BlogHer conference in San Francisco, the MOMocrats held a Platform meeting of our own, at the brunch we co-hosted with the Silicon Valley Moms Bloggers. Ours was a different kind of event, as it included about 40 mothers from all over the country – and not all of us in attendance were Democrats. We had input from a fair number of Republican and Independent women, too.

It’s probably not surprising that the one issue the entire room of mothers agreed upon was the need to improve our nation’s health care system. We may not all see it evolving in the same manner – but we are all dismayed at the rising cost of keeping our own families healthy and the number of families and individuals who do not have access to affordable medical care in our country.

The discussion was led by founding MOMocrat Glennia Campbell, who urged us to think outside the box and to look at what’s been successful elsewhere. By opening our eyes and seeing what’s working in other countries, we might adapt some of the best practices to the unique culture and needs of the United States.

That’s why I’ve been so fascinated by Health Care for All: NPR’s series of in-depth reports on the state of health care in western Europe. If you think (as I did) that it’s all about socialized medicine and higher taxes, you would be wrong (as I was).

Take Germany.

According to NPR, the Germans have enjoyed universal health benefits for over 100 years. Their system sounds actually sounds a lot like ours, as it health coverage is provided by insurance companies, with employers and employees splitting the cost of the premiums. But there is one big difference with the German system: It works.

One reason is that few people opt out of the system. Workers and employers both pay a percentage of their salary. The cost is higher for higher paid workers, but lower for those on the bottom of the economic scale.

For the average worker, this comes to about 8% of salary – which is comparable to what is paid by US workers with employer-provided insurance. However, German employers also pay just 8% of their workers’ salaries into healthcare, while American companies pay an average of 18% per worker.

Germans have a choice of over 200 different nonprofit healthcare companies to choose from. And they receive a very high level of benefits. They have no deductibles. There’s little or no wait for procedures such as MRI’s.

Self-employed citizens must buy private insurance. Most do, and the level of coverage can be even higher.

Costs are kept down through government regulation. Physicians are put on collective annual budgets which amount to a limited pool of money per quarter per region. “Once doctors collectively use up that money, that’s it — there’s no more until the next quarter.”

Administrative costs are also kept low – just 50% of what is paid in the US.

France is a country known for its gastronomic pleasures and haute couture. But in 2000, a World Health Organization survey named its health care system number one. (The United States ranked at #37). It came out on top a few years later in a second survey of 19 industrialized nations. The US was mired right at the bottom.

So what’s so great about the French approach to health care?

For one thing, it’s truly universal. No one in France goes without medical insurance – even non-citizen residents.

The system is made up of several quasi-public health insurance networks, paid for through income and payroll taxes.

Insurance companies and medical unions set doctors’ fees. Hospital charges are regulated by the government.

The national program pays 70% of individuals’ medical expenses. Most French citizens also carry private insurance for the remaining 30% of their health bills. These private policies are usually funded by employers.

Coverage is also needs-based: Residents who contract very serious diseases may find their treatment paid for 100% by the French government.

French coverage is not cheap: French workers pay 21% of their income into the system (however, half of that is subsidized by their employers).

Even though Americans pay far less in taxes, they end up paying more out of pocket for health care expenses. ($6400 per person, compared with $3,300 in France).

If you develop cancer in France, you are eligible to receive any treatment you and your doctor decide upon – even if it’s highly expensive or experimental.

The French take pregnancy and motherhood very seriously. New mothers receive months of paid leave and there are an abundance of free pre-natal and pediatric health clinics, at-home visits, and subsidized day care.

The French health care system is facing some of the same financial problems as other industrialized nations. Their debt last year was $9 billion. Services will likely be cut in the future as the nation figures out how to pay for rising medical costs and aging populations.

Health care costs are low in the Netherlands, partly because of Dutch cultural resistance to treating illnesses with pharmaceuticals. (I find this kind of ironic, given the reputation of cities like Amsterdam, but I suppose their attitude is different when it comes to recreational drugs.)

According to NPR, the Dutch consider it “preferable to endure aches and pains without resorting to medication.” The philosophy there is that most ailments will eventually just go away. This is one reason why Dutch citizens spend half as much on medication per person as Americans.

This extends to pregnancy. The majority of Dutch women have natural childbirths and it is difficult to get an epidural, even if you want one.

The Dutch system is organized like our HMO’s – except that everyone is a member. All Dutch citizens have access to primary health care, 24/7. They must get permission from their primary providers before seeing specialists.

There are still some citizens that do not have access to health care – but in the Netherlands, that figure is just 2% (as opposed to 16% in the US).

NPR reports that “Republican policymakers are abuzz over Swiss-style, universal health care; it comes closest to what they could imagine emerging in the United States.”

Switzerland’s system is a lot like the one in Massachusetts: The country mandates that everyone buy private health insurance, with the government providing a subsidy for those who cannot afford it.

And like our country, there is a confusing multitude of companies and plans to choose from.

The Swiss government restricts private insurers from making a profit on basic comprehensive plans. They do, however, earn profits from plans sold to supplement the basic coverage.

Unlike France and Germany, health insurance premiums are not calculated by income, so everyone pays the same amount. This makes health care costs a bigger burden on lower income families who do not qualify for government help.

The system has been working well, but like those of other countries, is plagued by rising costs – as much as 50% in the last decade. This is reflected both for individuals who are paying for their insurance, and for the government, which subsidizes insurance for the poor.

The final country in NPR’s survey of western European health care systems is the United Kingdom.

When Americans talk about countries with universal health care, the model they are most familiar with is that of Britain’s National Health Service, which insures all citizens and legal residents to a minimum level of coverage. The NHS is an arm of the government, funded entirely by taxes, and it is what has been described as “socialized medicine.” It runs the hospitals and pays the doctors, and treatments must be approved by an NHS council.

Average annual per-person spending: $4,504 (about $2,000 less per person than in the United States). About 75% of this is paid by the government, with an additional 25% coming from  supplemental private insurance, OTC drugs, and direct payments to doctors.
Financing: 95% of funding comes from taxes; 5% comes from user charges, such as co-payments for prescription drugs.

According to NPR, on the the biggest challenges facing the NHS is the fact that the “government doesn’t cover care that it deems cost-ineffective,” and “maintaining a steady source of government funding in the face of increasingly expensive treatments and drugs.”

The following information is personal and purely anecdotal, as I actually do have some experience with the NHS. Both my husband and daughter are dual US/UK citizens, and we visit the family in Wales as often as we can. We’ve interacted with the NHS a few times when our daughter (who was prone to ear infections when she was little) developed a fever while there.

I was afraid the first time this happened – what kind of care would she receive? I should not have worried. We took her to the neighborhood “surgery” (the offices of the general practitioners that serve the area, which was in walking distance of my in-laws’ house) – without an appointment. The wait time to see a doctor was shorter than what I experience at our own pediatrician’s office.

I dug out our passports, my insurance information, my credit cards — for nothing. They never asked us for it, never cared that my daughter and I were obviously not from around there (and when other Brits hear my husband speak after 25 years in the US, they don’t think he’s a native, either) and laughed when I tried to pay them.

Over the years, I’ve observed the kind of care my husband’s elderly parents received under NHS. On my first visit to meet them, BOTH his father and mother ended up going to the hospital (for different reasons). The socialized system of treatment is definitely different from what we are used to in this country. In some ways, it’s better. In other ways, it’s not.

I remember one time when my father-in-law was diagnosed with an anuerism and he had to wait quite a long time for his surgery because there were no beds available at the hospital. But he did eventually get his operation and it was successful.

My father-in-law suffered the first of many strokes a few years later. After the first one, he remained in the hospital for weeks, in a drug-induced coma. My friends and family here in the US were shocked at how long he remained in the hospital; such a stay would have bankrupted most of us, even with the best insurance plan. I remember thinking it was no wonder there was such a problem obtaining a hospital bed… but he emerged from that event with nary a symptom. The care he received no doubt gave him several productive years (he passed away in 2005).

But then there was the time my mother-in-law needed an adjustment in the medication she takes for a chronic condition and the family could not get an appointment with her doctor until her situation became life-threatening. That was frightening and is the kind of scenario that makes Americans wary of a British-style government run health care system.

Yet, according to NPR, “the British say they would riot in the streets if they were asked to adopt an American-style system.”

I urge those who want to learn more about these health care systems to see for themselves here on the NPR website, where you can link to both transcripts and the actual radio reports. They have also summarized a comparison of the systems on a chart here.

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Hannah Montana and the Politics of Desensitizing America

May 7, 2008 by

Last week, while the Momocrats were here celebrating our no small victory of getting a substantive blog-terview with Senator Obama, the rest of the interwebs were a twitter with the latest incident of inappropriate celebehavior, namely Miley Cyrus disrobing for Annie Lebowitz in Vanity Fair.

Now, I’m as avid a participant (though closeted, must maintain my brainy Clark Kent disguise) in the celeb-culture as the next gal. Though I would not dream of filling my home or my daily commute with any of the dozens of celeb-rags that cover newsstands in techni-colored rainbow splendor, let’s face it, there’s little as satisfying as doing the treadmill or the elliptical while voraciously snarfing down a Star or an Ok! or even a Life & Style (you can pretend to workout, and get some culture too!) So I know about Hannah Montana and Heidi Montag (except for why she’s famous?) and Gossip Girls and of course Ms. Brittney.

So when the Miley Cyrus brouhaha erupted, I was tempted to dismiss it with the usual sleight of hand that I reserve for news that isn’t news. But then this most appalling thought stopped me short: how could I, a mother of two girls, be so non-plussed about a 15 year old “role model” cavorting half-naked in a theoretically “reputable” general interest magazine? When did I become so desensitized that it no longer phased me that a girl that I could imagine my own daughters emulating was basically set up to seduce the entire world with her tousled hair, lacquered lips and bedroom eyes?

Because every day, in this life we lead, our values are getting chipped away, one little nick at a time, by those who profit by doing so.

In this case, a magazine that I believe(d) to be of substantial quality, Vanity Fair, decided to profit by profiling the teen superstar, in a way that was inevitably going to draw ire and controversy. And controversy = $cha-ching$. As a profit-dependent corporation, Vanity Fair has simply decided to take its cut. It follows a long progression of for-profit corporations chipping away at our sense of modesty and sexual responsibility: from the topless models in Abercrombie and Fitch, to the sexually precocious high-schoolers on Gossip Girl and the OC, to Bratz dolls with their bare navels and crotch skimmers.

A few days ago, Lawyer Mama made an impassioned plea on behalf of single payer universal health care. She too drew some ire and controversy (though, as far as I know, not for profit) in particular from one reader who believed that such a system would be antithetical to a bottom-up solution of realigning morals and re-establishing community. And to some extent, the reader is right.

The problem of 47 million Americans being uninsured should not, in an ideal world, be the problem of the government, which is, in the end, a soulless entity, and, just like any other soulless entity, flawed by bureaucracy. The fact that there are 47 million Americans who could be wiped out by a single health incident should appeal to the other 253 million American’s sense of humanity and collective responsibility.

Except, (chip, chip, chip) here comes the for-profit corporations, in this case, the insurance companies and HMOs, to chip away at our values, to desensitize us from the things happening around us.

Because my first reaction to Miley Cyrus’s photo was: she’s a star, she’s not my life, I can keep my children away from that kind of undue influence. In other words, the message being conveyed by Miley to millions of American children is not my problem because my children in particular would not be exposed to it. In exactly the same way that the 47 million uninsured Americans will not burden my particular wealthy and supportive community.

Just as we have now been conditioned to think that the sexualization of adolescents is alright as long as it is artfully done, done to a celebrity, or done to someone who, though visually underage, is factually over 18, we have also become conditioned to think that it’s ok for health services to cost 30-50% more for the uninsured compared to the insured, for a person to be denied preventative health care because they are uninsured, or, even worse, that it a person is uninsured, they probably deserve it.

Desensitized. Just look around. How many ways have we been desensitized by corporations?

  • We have allowed corporations to subsidize our school sport fields, our school lunches, our school field trips.
  • We have allowed mortgage brokers to convince us that we can afford to buy houses with no down payment and on an adjustable rate mortgage that will reset in five years.
  • We have replaced voluntary military service with contracted security.
  • We have allowed credit card companies to rewrite the bankruptcy law so that it is harder to enter bankruptcy and harder to discharge debt.
  • Billion with a “b” has become the millennium’s million and we don’t even blink until the letter (and number) turns into trillion with a “t”.

We have basically entrusted our country to a few people whose net-worths are directly tied to the short term profits that they can generate. Short term profits, long term catastrophe.

The problem is, I am a capitalist. I *heart* capitalism and I don’t want it to go away. I have no interest in tearing down the man. I embrace the man. I recognize that as a shareholder in these corporations, whether directly or indirectly through my retirement savings, I am sharing in the upside of their corporate decisions. These decisions have made America as a whole, and me in particular, more wealthy. And it is the spirit of competition that keeps America (and, apparently, *snark* the Democratic primary *roll eyes*) strong.

With the boom of capitalism, even in the non-democratic reaches of the world, we have to recognize that there has been an ancillary effect of decentralizing community. We don’t work and live the way we used to. We are much more mobile, we connect with people (such as this pan-America political cooperative) across the world more than those down the road, we are multi-cultural and multi-faith. All of which present barriers to community based solutions.

When I took a mediation class in law school (by fluke, not by interest), the first thing we were taught was to look beyond the specific demands of the two parties and at the underlying desires. We forget how often people who appear to disagree in fact share the same intentions. Democrats want a strong country, a safe country, a country that will give their children a future. I’m pretty sure Republicans want the same thing.

I have even voiced my personal admiration for John McCain, or the McCain he used to be until he started to pander to the very voices that he used to disdain. Remember that McCain? The one of fiscal responsibility and small government?

And don’t forget that when McCain used to talk about small government, he was talking about taking away government intervention in capitalism. He was talking about doing away with pork barrels (which, admittedly, after doing some research, is not apparently as big a problem as some make it out to be) and PACs (which are, in fact, bigger problems than many make it out to be).

Because we have a system of capitalism run amok. The market forces that so many Republicans are so eager to subject our education, health care and social security systems to are the very same market forces that apparently required the government’s intervention after 9/11, the internet bubble burst, and the most recent credit crunch. If the government can step in to save companies in need, why did it become a crime to step in to save citizens in need?

Without a strong citizenry, we can have none of the things that we all want: a strong country, a safe country, and a country that offers a future for our children.

(photo courtesy of Disney)

Kady is sorry this post is so out of date, but she’s pretty out of date too on her personal blog at Loaded Dice.

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