With so many SZ members across the world, I'm wondering what people think about the current health care debate in the US? Especially interested in people from other countries think about this...



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Bill in Dayton

Well, you asked...

I think it's a shame! Everyone should have, be entitled to and be able to afford it. There's nothing "socialist" about it. Gosh, what a '50ish mindset. I thought McCarthyism was a thing of the past. Doesn't look like it!

Okay, since I am a citizen of Taiwan:


Taiwan Takes Fast Track to Universal Health Care

At the end of the 20th century, Taiwan became a rich country, almost overnight. But it still had a poor country's health care � about half the population had no coverage at all. So Taiwan set out to design a national health care system from scratch. What makes Taiwan unique is the way the country figured out how to cover everyone.

Follow the Oxcart

Hongjen Chang was one of the officials in charge back then. Walking through Taipei's imposing Chiang Kai-shek Memorial Park, he recalls how they did it.

"Taiwan is a small island," he says. "We always look abroad internationally for ideas."

Chang quotes a Chinese saying: "'The track of the previous cart is the teacher of the following cart.'"

In other words, if someone else's oxcart has found a good route to universal health coverage, follow those tracks. "If they were trapped in trouble, avoid that track. Find a new track," Chang says.

The government consulted experts from around the world, like Taiwanese American health economist Tsung-mei Cheng.

"In the end, the program that they finally set up in 1995 really is like a car that was made of different parts, imported from overseas, but manufactured domestically," Cheng says.

A Consolidated System

They wanted a system that gave everybody equal access to health care � free choice of doctors, with no waiting time � and a system that encouraged a lot of competition among medical providers.

To finance the scheme they chose a national insurance system: a single, government-run fund that forces everybody to join in and pay.

The result is a system that works a lot like Canada's, or like the U.S. Medicare system, but with more benefits.

"It has drug benefits, vision care, traditional Chinese medicine, kidney dialysis, inpatient care, outpatient care, just about everything under the sun," Cheng says.

To satisfy the patients in Taiwan, there's no gatekeeper who controls access to specialists and no waiting lines.

If you woke up in Taiwan with shoulder pain, for example, Chang says that you would be able to see an orthopedic specialist the same morning, no recommendation from a general practitioner required.

"Our people don't like the idea of gatekeepers. They want to decide by themselves," Chang says.

Don't Forget Your Smart Card

By consolidating so much � one government plan that covers everybody � Taiwan achieves remarkable efficiency.

Everybody here has to have a smart card to go to the doctor. The doctor puts it in a reader and the patient's history and medications all show up on the screen. The bill goes directly to the government insurance office and is paid automatically.

So Taiwan has the lowest administrative costs in world: less than 2 percent.

They also use that smart card to track patterns of use.

"If a patient goes to see a doctor or hospital over 20 times a month, or 50 times in a three-month period, then the IT picks that person out. The person then gets a visit from the government, the Bureau of National Health Insurance, and they have a little chat. And this works very well," Cheng says.

That may be too much like Big Brother for some people in the United States, but surveys show the Taiwanese are highly satisfied with their health care.

Plus, no one goes bankrupt because of medical bills, Chang says.

So the patients are safe from bankruptcy. But the system itself is under strain. Chang says that Taiwan spends 6.23 percent of its GDP on health care, compared to 16 percent in America.

So the United States spends too much on health care, and doesn't even cover everybody. But the Taiwanese don't bring in enough money to pay for all the services they offer.

"So actually, as we speak, the government is borrowing from banks to pay what there isn't enough to pay the providers," Cheng says.

Taiwan's politicians are reluctant to increase premiums: they're afraid the voters will punish them.

+++So that's the problem here. And frankly, the solution is fairly obvious: increase the spending a little, to maybe 8 percent of GDP.

Of course, if Taiwan did that, it would still be spending less than half of what America spends.

+++The article was written in 2008. Since then there has been a slight premium increase.

To supplement the cash flow Taiwan started the National Lottery along with the NHI. Both were initiated at the same time. Pretty smart since the Taiwanese love to gamble.

So how does this system work? You pay a monthly premium. Your employer pays 60%, you pay 40%. When seeing a doctor you pay a registration fee (usually around $4 to $5). Consultation and drugs are free.

Everyone has to have National Health Insurance in Taiwan. Foreign expacts that live or work here are included.

I actually saw the interview with that official where he talked about following the good tracks, avoiding the bad ones when Taiwan put its system, in place.

American is a frighteningly political country and right now, we're stuck in the muck and the mire of HC reform. I think something will get done this Fall, but nothing very stupendous...

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Bill in Dayton

Australia has nationlized health care. But as I haven't lived there for almost 20 years I can't really comment on it. But the one thing that is obvious is that when health care is controlled by private business as it is here in the USA it is obvious that a large proportion of the money that goes into health care is taken back out as profit and not used for health care at all. Don't tell me that that is in the interest of public health. I don't have any more to say on the subject.

That's why I prefer it to be controlled by the government instead of the private sector. Call it socialist, if you like, but I don't see those making six to seven figure salaries be very concerned about the general population's health. When the small print overpowers the bold print you know that you're in for something that's not on your side.

A couple of years ago I spent three days in a hospital due to a kidney infection. Total cost for hospital stay and medication: $0. In fact, I only had to pay $3 registration fee.

Taike



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Bo pen nyang.

Taike--

No offense intended, but I must interject here.

It is my nation's tax dollars and defense system that enables Taiwan to be able to afford their national healthcare system.

Or to even exist as Taiwan, for that matter.


--Mac

Nigel, I too thought that the greedy bastards at the health insurance companies were just raking in the dough while the country got a crappy return. However, the facts don't support that.

According to Morningstar Financial, a very reputable financal reporting group, the average Health Insurance Co.'s profit margin last year was 3.4% Which ranks them 87th out of the top 215 industries researched, just slightly above the median of 2.2%. The highest profit margins were beverages (25.9%), health care real estate trusts and application based software. Microsoft was 24.9%, Google was 20.6% and Exxon 9%.

If we're looking for a healthcare villain with regard to profits, I say we look at Pharmaceuticals and their profit margin of 16.4% which ranks them 7th out of 215. Others segments of healthcare with margins well above the median include healthcare information (9.4 percent), home healthcare firms (8.5 percent), medical labs (8.2 percent), and generic drugmakers (6.5 percent).

I support scrapping our current system and replacing it with a single payer plan, but that's not going to happen anytime soon.

http://www.usnews.com/money/blogs/flowchart/2009/08/25/why-health-insurers-make-lousy-villains.html



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Bill in Dayton

No offense intended but I'd really like this thread to stay on healthcare reform. What do you think about it?



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Bill in Dayton

We have nationalized health care here in Greece, of course there are private practice doctors and private hospitals, and whoever wants to, can go to them.

If you have an emergency, regardless if it is a serious issue like a heart attack or you simply closed the car door on your finger, you can visit an emergency room in a public hospital, wait your turn (or be rushed in) and be treated on the spot, or hospitalized. Doesn't matter if you are Greek or any other nationality, or a tourist. An ambulance will come and pick you up if you are unable to move yourself.

Of course do not expect what you see in the "ER" in terms of caring professionals, the sheer volume of outpatients exceeds the physical and mental capacity of the doctors and nurses, but usually they do what they can, and more. Couple that with a "Oh my God, I was shaving in the morning and cut my cheek a little, I am in the verge of death" national mentality, and the persons going to the hospital double. Add their close relatives who try to come with them in case the "patient" needs any "assistance", and this becomes the grim picture of Greek public hospitals. and of course everyone tries to get first in the waiting line...

Interestingly, I have no problem with that... maybe I have more patience than the average Greek, but I think I have been treated well in the past, and hope so with the future. I had a vocal cord nodue removed, my father had a pacemaker installed and was treated for prostate something, my mother was hospitalised for cardiac arrythmia (minor), etc, all in a public hospital, and for FREE. (Not exactly free, because every working person or pensioner gives a percentage to the Health fund).

The system of course is not without problems, this being Greece and not a civilized country. Too many to mention. Hoping for the future...

As we go along, for those of you in other countries like Taike and Trident...you almost certainly pay a higher income tax to fund this system of healthcare.

Is that much of an issue in your land? What would the likely reaction be if your leaders said they were going to cut everyone's taxes but unless you're over 64, in the military or very, very, very poor-now you're on your own for health insurance and health care?

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Bill in Dayton