Since one of the most controversial elements of "Obamacare" is the individual mandate, I wanted to share T.R. Reid's take on this issue:
Everyone in Japan is required to sign up with a health insurance plan. This is what's known as an "individual mandate," a concept that has sparked furious debate in the United States. But every nation relies on health insurance has that requirement - it's necessary to ensure a viable risk pool for the insurance companies - and in Japan the mandate is not controversial at all. "It's considered an element of personal responsibility, that you insure yourself against health care costs . . . And who can be against personal responsibility?"
An individual mandate to buy insurance raises a corollary question: How do you enforce the mandate? That is an issue America's policy makers have debated time and time again, with no real resolution. Japan has come up with a fairly elegant solution to this common problem. If you don't have an insurance plan, you'll be assigned to one run by your local city government. If you don't pay the premium - about 1 percent of the population fails to pay - you'll get regular dunning letters from the insurance company. But if you get sick, you're required to pay back all the premiums you have missed (up to one year's worth) before the insurance company will pay your bill. The result is that the few people who refuse to pay health insurance premiums tend to make up their arrears when they have an accident or become seriously ill. For the unemployed or those too poor to pay their premiums, local government pays the insurance premium instead, so coverage never lapses.
I also have to include, at this point that Japan spends about 8% of its GDP on health care (more than half of the U.S. 17% of GDP) and the Japanese are the most "prodigious" consumers of health care in the world, visiting a doctor an average of 14.5 times each year, and receiving more CAT scans and MRIs, and taking more prescription drugs that anyone else in the world.
Monday, December 19, 2011
Friday, December 16, 2011
The Healing of America: A Review in Parts (2)
Most shocking fact of the day:
In addition to those who have no health insurance coverage, millions of Americans have coverage so limited that they are not protected against any serious bill from a doctor or a hospital. For those Americans who are uninsured or underinsured, any bout with illness can be terrifying on two levels. In addition to the risk of disability or death due to the disease, there's the risk of financial ruin due to the medical and pharmaceutical bills. This is a uniquely American problem. When I was traveling the world on my quest, I asked the health ministry of each country how many citizens had declared bankruptcy in the past year because of medical bills. Generally the officials responded to this question with a look of astonishment, as if I had asked how many flying saucers from Mars landed in the ministry's parking lot last week. How many people go bankrupt because of medical bills? In Britain, zero. In France, zero. In Japan, Germany, the Netherlands, Canada, Switzerland: zero. In the United States, according to a joint study by Harvard Law School and Harvard Medical School, the annual figure is around 700,000.
- T.R. Reid, The Healing of America
In addition to those who have no health insurance coverage, millions of Americans have coverage so limited that they are not protected against any serious bill from a doctor or a hospital. For those Americans who are uninsured or underinsured, any bout with illness can be terrifying on two levels. In addition to the risk of disability or death due to the disease, there's the risk of financial ruin due to the medical and pharmaceutical bills. This is a uniquely American problem. When I was traveling the world on my quest, I asked the health ministry of each country how many citizens had declared bankruptcy in the past year because of medical bills. Generally the officials responded to this question with a look of astonishment, as if I had asked how many flying saucers from Mars landed in the ministry's parking lot last week. How many people go bankrupt because of medical bills? In Britain, zero. In France, zero. In Japan, Germany, the Netherlands, Canada, Switzerland: zero. In the United States, according to a joint study by Harvard Law School and Harvard Medical School, the annual figure is around 700,000.
- T.R. Reid, The Healing of America
Wednesday, December 14, 2011
The Healing of America by T.R. Reid - A Review in Several Parts
I just started reading this fascinating book today. Since I've worked on healthcare legislation, when my company's new CEO recommended it to me, I dowloaded it immediately. I wanted to share this excerpt to give you an idea of how great this book is going to be:
The thesis of this book is that we can find cost-effective ways to cover every American by borrowing ideas from foreign models of health care . . . The leaders of the health care industry and the medical profession, not to mention the political establishment, have a single all-purpose response they fall back on whenever somebody suggests that the United States might usefully study foreign health care systems: “But it’s socialized medicine.”
This is supposed to end the argument. The contention is that the United States, with its commitment to free markets and low taxes, could never rely on big-government socialism the way other countries do. Americans have learned in school that the private sector can handle things better and more efficiently than government ever could. In U.S. policy debates, the term “socialized medicine” has been a powerful political weapon – even though nobody can quite define what it means. The term was popularized by a public relations firm working for the American Medical Association in 1947 to disparage President Truman’s proposal for a national health care system. It was a label, at the dawn of the cold war, meant to suggest that anybody advocating universal access to health care must be a communist. And the phrase has retained its political power for six decades.
There are two basic flaws, though, in this argument.
1. Most national health care systems are not “socialized”. . . [M]any foreign countries provide universal health care of high quality at reasonable cost using private doctors, private hospitals, and private insurance plans. Some countries offering universal coverage have a smaller government role than the United States does. . . Even where government plays a large role, doctors’ offices are operated as private businesses.
In short, the universal health care systems in developed countries around the world are not as “socialized” as the health insurance industry and the American Medical Association want you to think.
2. “Socialized Medicine” may be a scary term, but in practice, Americans rather like government-run medicine. The U.S. Department of Veterans Affairs is one of the world’s the purest models of socialized medicine at work. In the Medicare system, covering about 44 million elderly or disable Americans, the federal government makes the rules and pays the bills. And yet both of these “socialized” health care systems are enormously popular with the people who use them and consistently rate high in surveys of patient satisfaction. During the debate over “Obamacare,” even those who complained most angrily about a “government takeover of health care” insisted that Medicare and the VA must continue to be government-run systems.
So the problem isn’t “socialism.” The real problem with those foreign healthcare systems is that they’re foreign. That offends the mind-set – sometimes referred to as American exceptionalism – that says our strong, wealthy, and enormously productive country is sui generis and doesn’t need to borrow any ideas from the rest of the world. Anybody who dares to say that other countries do something better than we do is likely to be labeled “unpatriotic” or anti-American. . .
Anyone want to read along with me?
The thesis of this book is that we can find cost-effective ways to cover every American by borrowing ideas from foreign models of health care . . . The leaders of the health care industry and the medical profession, not to mention the political establishment, have a single all-purpose response they fall back on whenever somebody suggests that the United States might usefully study foreign health care systems: “But it’s socialized medicine.”
This is supposed to end the argument. The contention is that the United States, with its commitment to free markets and low taxes, could never rely on big-government socialism the way other countries do. Americans have learned in school that the private sector can handle things better and more efficiently than government ever could. In U.S. policy debates, the term “socialized medicine” has been a powerful political weapon – even though nobody can quite define what it means. The term was popularized by a public relations firm working for the American Medical Association in 1947 to disparage President Truman’s proposal for a national health care system. It was a label, at the dawn of the cold war, meant to suggest that anybody advocating universal access to health care must be a communist. And the phrase has retained its political power for six decades.
There are two basic flaws, though, in this argument.
1. Most national health care systems are not “socialized”. . . [M]any foreign countries provide universal health care of high quality at reasonable cost using private doctors, private hospitals, and private insurance plans. Some countries offering universal coverage have a smaller government role than the United States does. . . Even where government plays a large role, doctors’ offices are operated as private businesses.
In short, the universal health care systems in developed countries around the world are not as “socialized” as the health insurance industry and the American Medical Association want you to think.
2. “Socialized Medicine” may be a scary term, but in practice, Americans rather like government-run medicine. The U.S. Department of Veterans Affairs is one of the world’s the purest models of socialized medicine at work. In the Medicare system, covering about 44 million elderly or disable Americans, the federal government makes the rules and pays the bills. And yet both of these “socialized” health care systems are enormously popular with the people who use them and consistently rate high in surveys of patient satisfaction. During the debate over “Obamacare,” even those who complained most angrily about a “government takeover of health care” insisted that Medicare and the VA must continue to be government-run systems.
So the problem isn’t “socialism.” The real problem with those foreign healthcare systems is that they’re foreign. That offends the mind-set – sometimes referred to as American exceptionalism – that says our strong, wealthy, and enormously productive country is sui generis and doesn’t need to borrow any ideas from the rest of the world. Anybody who dares to say that other countries do something better than we do is likely to be labeled “unpatriotic” or anti-American. . .
Anyone want to read along with me?
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