Setting aside all of the absurd claims about the impending health care reform legislation (such as death panels), there are some other problems with the discussion as well. Terms like "socialized medicine" get tossed around, and the health care systems in other countries all get lumped together as if they are all the same. They are not; they are very different. So today, our effort is to clarify the language and terms we use when discussing health care systems.
I'll confess that I got the idea for this from an interview I heard on NPR Mon night. Author T.R. Reid was discussing a book he has written called "The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care", in which he describes the various health care systems in the world and compares them to ours. He also summarized some of that information in an excellent column in the Washington Post
, which I will use as source for some information below.
First, let's look at the term "Socialized Medicine
". It was actually coined over 100 years, and was not a pejorative. It only became a negative in the 1930s when opponents of FDR wanted to smear his New Deal proposals. The smear came forward again during the McCarthy era as a response to communism, and again during the Reagan presidency. So the idea of any kind of government involvement in health care being referred to as "socialized medicine" is not really new. In fact, it's starting to get a little tired.
What is "socialized medicine" really? To be honest to the term, it is a system where the government owns the hospitals, and the doctors work directly for the government. That is really only the case in a small handful of countries like England. So let's look at what other countries have for health care systems:
- The British Model: The British NHS is truly socialized medicine, with the doctors working for the government. For British citizens, it is looked upon as a government service paid for with taxes, like fire services, police services, and garbage pickup. Most neighborhoods have a family doctor (who will make house calls!), and patients never have to pay anything out of pocket. There is still some private insurance for things like plastic surgery.
- Avg Health care costs per person: $2815
- percentage of cost for administration: 5%
- avg life expectancy: 79.1
- The French Model: The French system can be referred to as "single payer", where there is a mix of private and public doctors and hospitals, and doctors are reimbursed directly by the federal government. There is still some private insurance for things like plastic surgery.
- Avg Health care costs per person: $3,449
- percentage cost for administration: 4%
- avg life expectancy: 80.9
- The Canadian Model: Their model is not actually single payer. It is publicly funded and regulated, but the funds are collected and administered at the local/provincial level. There is still some private insurance for things like plastic surgery, and to cover copay costs .
- Avg Health care costs per person: $3,678
- percentage cost for administration: 6%
- avg life expectancy: 80.4
- The German Model: This may end up being closer to what the current U.S. bills are proposing. It's a mix of private and public insurance. People below certain income levels are required to use the public system. Public system insurance coverage is not as good as private coverage, so there is some private insurance available to cover the gaps. Insurers must all offer the same coverage, cannot turn anyone down, and the insurance is bought directly by the consumer.
- Avg Health care costs per person: $3,371
- percentage cost for administration: N/A (couldn't find by the deadline)
- avg life expectancy: 79.8
- United States: We all know what we have here... It's a hodgepodge of private insurance, and government care for older people. In most cases, insurance is provided by your employer, rather than purchased directly by the individual. This creates a situation where people feel tied to their jobs over fears of losing their insurance. Approximately 15% of Americans have no health insurance coverage.
- Avg Health care costs per person: $6719+
- percentage cost for administration: 20% for ins. companies
- avg life expectancy: 77.8
Here is a chart (based on 2006 data) that provides some comparisons on costs and availability of health care (this chart is a screen shot from the Canadian Health care link):
For some other comparisons, you can look at this report
; appendix B (pg 59) is where the information is summarized.
So how else do these countries and their systems compare to the U.S.?
- Everyone in all of these countries is covered.
- The coverage provided is cheaper overall there than here. This is mainly due to efficiency and lower costs for malpractice insurance.
- They have approx the same number of doctors and nurses per person as we do (in some cases more), so availability under a different system would be no different than it is now.
- Private health insurance exists, but their companies must be not-for-profit. The United States is the only industrialized country where health insurance companies are allowed to make a profit.
- Our VA system is actually socialized medicine; it is a microcosm of the British system.
- Medicare is not socialized medicine, it is single-payer. It is a microcosm of the French system.
One thing that the U.S. "system" (if something so disjointed could be referred to as a "system") is good at is being a boogieman for other countries. In those countries, the best way to silence critics of their health care systems is to ask "would you rather have the American system?".
wow... doesn't that make you proud?
Postscript: As I was finalizing this blog entry, I saw the news about the passing of Teddy Kennedy. Besides being a champion of liberal causes, he was an advocate for health care reform. Let's make this happen for Teddy...