SocraticGadfly: Great Frontline on healthcare – Obama should take notes

April 16, 2008

Great Frontline on healthcare – Obama should take notes

We have a lot to learn from other advanced democracies. Yes, anybody who doesn’t have an R after his or her name, and even a few of them, know that. But, it’s not just Britain. Or Germany. Or even the non-visited Canada. Frontline’s T.R. Reid visited five capitalist democracies to see what we can learn.

Beyond Britain, and Germany (which I think holds a lot of insight for the U.S.), he also went to Switzerland, Japan and even Taiwan.

Why should Barack Obama take notes?

All five of these countries, even though Britain and Taiwan are the only “socialist” single-payer systems, require everybody to be signed up for health insurance. In other words, people like Paul Krugman who criticize Obama’s healthcare plans are probably right.

Second, all have some sort of cost controls, with Japan’s being the most rigorous. In Japan, the government negotiates the price of every heath procedure and cost with doctors every two years. In Germany, insurers do it, every year.

Third, insurance companies in the three private-payer examples are non-profits, by law. That said, there’s still an incentive to sign up new customers, as management, within nonprofit structures, can still make more the more people they get enrolled with their particular insurance company.

So, mandated health care, price controls and nonprofit insurance, if you don't have a single-payer system, which I still favor (a private-payer system, that is). Those are the three sine qua nons we need to address.

Finally, although I missed the details on Britain’s NHS, none of the other four countries had longer wait times than the U.S. for either a GP or a specialist! In fact, in most of the countries, the wait time was less, especially for a specialist.

In Taiwan, for example, you can go directly to a specialist without an initial visit to a GP “gatekeeper.”

For insurers and drug companies, obviously, it’s not what they want to see.

And, doctors in all these countries are paid less than in the U.S.

But, the flip side there is lower to much lower administrative costs. Between that and lower costs for med school (a huge issue here, as well), the typical German doctor, for example, is in the same ballpark as a typical U.S. doctor.

And, “tort reform” aside, docs in these countries pay a LOT less on malpractice premiums. In Germany, for example, which has more than a century of centralized healthcare, premiums are about one-tenth of the cost here.

Oh, not from the Frontline story, but a dirty little side note from history:

Some 50-60 years ago, unions were among the main opponents of national health care. They figured they had negotiated their own high-quality health insurance plans through Churchillian blood, sweat, toil and tears, and, in essence, to hell with everybody else. Not the first nor the last time in history that American unions have been short-sighted and self-centered.

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