Posts Tagged ‘US Medical System’

American Health Insurance … revisited

Wednesday, April 18th, 2012

– We’ve been here before, readers.   But I feel like I need to revisit the subject again for the edification and amazement of my U.S. readers.

– I just bought New Zealand Health Insurance to cover myself when I’m in the USA for 78 days from July 8th to September 23rd this year.

– Cost in New Zealand dollars was $386.55 which is currently about $302.00 in U.S. dollars.

– And this policy is much more than just simple healthcare coverage.   It’s also travel insurance for lost baggage, the consequences of cancelled flights and other things.  

– If I was to get seriously sick in the USA (a potentially very expensive thing to do), the New Zealand insurance folks will fly me home to New Zealand on their dime and I’ll be treated here.

– When I was still in the U.S., married and running a business, we paid each about $425.00 a month for our medical coverage.   There was a $2500 deductible on the policy so we had to spend that amount each up front before we ever got a dime back from the insurance company for medical expenses.   And, even then, when they did begin to pay, it was only 80% of our costs.

– So, in the U.S., I had to play $20.82 per day (see Note 1) to get 80% coverage and with this New Zealand policy, which is covering me on the other side of the planet, I’m paying $3.87 per day (see Note 2) for 100% coverage.   Interesting, eh?

– Some months ago, I had a small heart attack here in New Zealand.   You can read about it here:    

– The long and the short of it is I went to an emergency clinic, I had a ride in an ambulance, I spent two nights in the hospital, I had an angioplasty and I had a stent inserted into one of my coronary arteries.   My total cost was less than $200 dollars ($164.00 U.S.).

– Many in the U.S. have a hard time believing that the country has been so thoroughly captured by corporations.   And many still believe the country is a fully functional representative democracy.  But both assumptions are seriously flawed.  

– The outrageously high cost of medical care in the U.S. is because enormous profits are being taken from the system by the medical corporations.  

– And our representative democracy has been deeply corrupted by big money.  Money that pays to keep the country’s laws arranged so that the looting can continue.

– Don’t believe it?   Then ask yourself how the richest country in the world is also the only major western democracy in which this sort of stuff goes on?

– Dennis


Note 1 – that’s $425/month * 12 = $5100.00/year and if I divide that by 365, it is $13.97/day.  But then in order to get any thing paid to me, I also have to spend the $2500 deductible which is another $6.85/day so the total I have to spend per day in the U.S. to get to the 80% coverage point is $13.97 + $6.85 = $20.82/day.

Note 2 – I’m paying $302.00 (in U.S. dollars) for 78 days so I’m paying $3.87/day to get to the 100% coverage point.

A real life experience with Socialized Medicine

Wednesday, June 15th, 2011

– One of my favorite themes to write about is the U.S. medical system vs. the socialized medical systems in use in many of the western democracies.

– In the last few days, I’ve had a personal and very real experience of how Socialized Medicine works here in New Zealand.

– I had a heart attack.

The suspect

The suspect

The Event

– Last Thursday, I rode my bicycle into work.   I’m not sure how far it is but I’m a fit and  fast rider and it takes me 20+ minutes to make the journey through the city.  When I finished work Thursday, I decided to see how quickly I could make the journey home so I rode hard all the way and arrived home in 15 minutes – a little out of breath but feeling fine.

– 20 minutes later, as I was sitting and talking to Colette as she prepared the evening meal, I began to feel quite odd.  My upper spine, neck and jaw began to ache and I began to feel a bit queasy.   I told her about this  and went and lay down on the sofa to see if it would pass off.   After a few minutes, it seemed like it was getting better so I got up and we ate the meal she’d prepared.   But, as we got to the end of the meal, I began to feel poorly again and went and lay down on the sofa a second time.   The symptoms were the same with the spine and the neck and jaws but getting stronger.

– After a few minutes, it came to an intensity where I thought, “I need to go into a medical center and see what this is all about.“, and I asked Colette to take me in.

– At this point, thinking back we should have called an ambulance, but I wasn’t thinking heart attack yet.  I was just thinking that I was having some sort of weird event and should go find out what it was.   It was around 6.15 PM when we took off.

– A 20 minute drive took us across the city to the 24 hour Emergency Clinic on Bealey Avenue.

–  The medical authorities here in New Zealand prefer that most folks report to either their own doctor or the 24 Hour Clinic first, rather than going straight into the Public Hospital’s Emergency Room.   But, just as in the U.S., many folks will take their kids with sniffles straight into the main hospital’s emergency room because it is free, rather than taking them into the 24 Hour Clinic,  where there’s a charge to be paid.

– There are some very different pricing structures here in New Zealand for medical care compared to the U.S. but we’ll look into the details of all of that later.

– When I entered the clinic, just above the check-in desk was a sign that said, “If you are experiencing chest pain, please let the desk staff know and you will be seen immediately”.   I did this and I was taken into a treatment room right away and was seen by a nurse who asked me a series of questions.   In less than 10 minutes, a doctor was looking at me and an ECG was taken.   It showed some abnormal descending strokes in the graph that are, apparently, indicative of a possible heart attack.  The doctor decided that my symptoms and assessment results were serious enough to admit me to the hospital, and an ambulance was called to transport me.

– Meanwhile, the pain I’d been experiencing had moved from the jaw and upper spine to the more classic just-to-the-left of center chest.   I never experienced the pain radiating down the left arm that I’ve heard is also a classic symptom of heart attack.   But, by now I was beginning to believe that what  I was experiencing was, indeed, a heart attack.

– And that was an amazing thought.   I’ve always been fit, ate healthily and am a bit of an exercise aficionado.  And, here in New Zealand, over the last year and a half, I’d lost a fair bit of weight (205  to 187 lb) which I didn’t think was too bad for a 5′ 11″ 63 year old male.

– But, be that as it may, the signs were getting stronger that I was having a heart attack as I lay there waiting for an ambulance to come.   My pain was increasing and they gave me a morphine shot and  I believe they also gave me something to prevent my blood from clotting.    In five minutes, the pain was completely gone due to the shot.  If I hadn’t experienced all that had gone before, it would have been hard to believe that anything was wrong with me.   But, then the ambulance arrived to carry us to the hospital and it dispelled that notion.

– At every step, everyone was relaxed and yet entirely professional.   I never felt like a number or like an object being shuffled through the ‘system’.   Eye contact and human warmth were evident in each person I encountered along the way.

– Once at the hospital, I was wheeled directly into the emergency room and my chart from the 24 hour clinic was scrutinized and I was asked many questions – many of them repeats of earlier ones.   Blood that had been drawn at the 24 hour clinic was sent with me in the ambulance. It was explained to me that by analyzing this blood, they would look for enzymes that would  indicate if my heart muscle had sustained damage.

– If they didn’t find the enzymes, then I would be scheduled for treadmill tests to see what was wrong with me.

– But, if enzymes were found, then it would strongly indicate that I’d had a heart attack and I would be scheduled for an angiogram.   An angiogram is an X-ray test that uses a special dye and camera  to take pictures of the blood flow in an artery (such as those associated with the heart).   Regardless of what the blood tests revealed, they were going to keep me for the night.  A chest X-Ray was done and then I was taken to my room in Ward 12 (the coronary care unit).   Four of the six beds were occupied when I arrived about 10.00 PM.

– I never felt any pain after the morphine shot and that evening in the ward was mellow.  I read a book on my iPad and went to sleep about 11 PM.

Ward 12 - Cardiology

Ward 12 - Cardiology

– The next morning, the blood test results came back.  I’d definitely had a heart attack and there was an angiogram session in my future.   But, now it got problematic as I’d checked in Thursday evening and Friday’s slots in the Cath Lab (where the angiograms are done) were booked up for the day.   It was looking like I might be there for Friday and the weekend before I could get a slot in the Cath Lab.    I was a bit anxious about that; imagining sitting in the bed or walking the ward for all those hours.

Home - Thursday and Friday night

Home - Thursday and Friday night

– Colette came in and kept me company.  And then, in a stroke of luck, a spot opened up in the Cath Lab which they told me about around mid-day.   Yippie!

– True enough!   And by 4 PM, I was back out again from the angiogram procedure to find Colette (who’d gone home) back waiting for me in my room.

– The angiogram procedure was relatively painless and I was awake the entire time.   A small entrance to an artery in my right wrist was opened for access to my arterial system.  I lay on my back with multiple large computer screens to my left and the doctors to my right. Directly over my chest was a computer-controlled movable X-Ray unit that was shifted around to view the heart from several directions.  I was warned that there would be times when I’d have to turn my head, lest it take off my nose when it rotated.

– My right wrist ached as they worked on it, but not badly.   They threaded a very long, thin catheter up my wrist artery and all they way through into the heart’s arteries.

– I watched what they were doing on the computer screens but, truthfully, I had no idea what I was seeing, though I watched with careful fascination.  When the catheter reached my heart, they entered it into each set of arteries  and injected an Iodine-based dye that showed the outline of the arteries on the computer screens via the X-Ray imaging.

Note the constriction

Note the constriction

– I found out later that all my coronary arteries were in fairly good shape.  They were open with fairly good flow, except the one that had caused the problem.  And on that one, right at the junction of two arteries, it was badly constricted.   See the image to the left where the arrow is pointing.   Cardiologists use three levels to describe how badly closed an artery is;  they say 50%, 75% or 99%.   They said mine was 99%.   This is why the heart muscle, which needs to be fed by these branches, was starving for Oxygen and dying.  And this cell death is why the pain in my heart attack occurred.

– I asked the one of the doctors how these arteries get blocked off.   He said they either do it slowly through the gradual accumulation of  plaque along the walls or they do it suddenly when the harder surface of the inner wall of the artery splits and lets the softer material behind it protrude into the passageway.

– Given all the aerobic exercise I’ve done, I can’t believe this artery had been creeping slowly up to 99% blockage and I’d never noticed.   I think there had to be sudden change at the end wherein a mostly blocked artery suddenly became almost totally blocked.

– They found the blocked area using the angiogram technique and then, once it was identified, they shifted to another technique called angioplasty.  This is the technique of mechanically widening a narrowed or obstructed blood vessel using an empty and collapsed balloon on a guide wire, known as a balloon catheter.   The balloon is passed into the narrowed area and then inflated to a fixed size. The balloon crushes the fatty deposits, opening up the blood vessel for improved flow, and then the balloon is deflated and withdrawn.

Stent in place

Stent in place

– After the area is expanded, a third technique is employed in which a “Stent” is placed in the newly widened area and allowed to expand to hold the arterial walls at that expansion.

– After this, the long, thin catheter is withdrawn and the arterial opening on the wrist is closed and the procedure is complete.

– I was back in my room by 4 PM, as I said, to find Colette waiting for me.

– They kept me Friday night for observation and during the night they checked my wrist and my blood pressure a number of times.   Once again, I slept well.   My wrist ached a bit from the trauma of the artery being opened but I had no other problems.   I knew the stent was there but I couldn’t feel a thing.   In fact, during the procedure itself, when the catheter was snaked all the way from my wrist into the arteries of my heart, I felt nothing.   And, other than a small amount of local in my wrist, I was not anesthetized or sedated.

– Saturday morning came.   7 Am and the room lights came on and breakfast arrived soon afterward.

– Every hour or so, the nurse would come and relieve the pressure slightly on the device that was clamping the wound on my wrist.  Arteries have a lot of pressure on them and to get one to seal and heal is not a trivial thing.  After a number of pressure releases without blood spurting everywhere, it became obvious that it had closed correctly.

– Colette came in again (what a trooper she was through all of this!) and sat with me.   We played some games on my iPad and waited for the cardiology doctor to come and talk with me and discharge me.   Unfortunately, the doctor got tangled in an emergency situation in the morning so it was far into the afternoon before I was discharged.   But, given all that had happened and how well it had all gone, I had no complaints about this.

The Costs

– Now, I want to talk about the costs of all of this.  I.e., what I paid for these procedures here in New Zealand.  These figures are in NZ dollars but you can translate them into US dollars by multiplying the New Zealand prices by .82 – which is roughly the current exchange rate.


1. Visit to 24 Hour Emergency Clinic – $100

2. Ambulance – $67

3. Hospital Room (2 nights) – $0

4. Angiogram Procedure – $0

5. Angioplasty Procedure – $0

6. Stent Procedure $0

7. Prescriptions for four drugs for three months – $22

– These prices are not exact but they are good ballpark figures and it all comes to about $187 NZD or about $153 USD.

– 19Jun2011 – I’m adjusting this section as the bills arrive.  The 24 hour emergency bill came in and it was $100, not $150.   Still waiting on the ambulance.

– 24Jun2011 – Ambulance bill came.   $67 NZD.  I’d estimated $50 NZD.

– 24Jun2011 – Also go a letter that I have (1) an ultrasound session appointment, (2) a physiotherapy session and (3) a follow on meeting with the doctor that put the stent in.  My expectation is that because these are all part of the public health services, that I will not be charged for any of these.   I’ll update this if that assumption is not true.

– I spent sometime this evening trying to come up with the prices for these procedures (Angiogram, Angioplasty and Stenting) in the US and it was a damn frustrating exercise – try it yourself.

– Try to find public, easily found figures for how much an Angiogram or an Angioplasty will cost you in a US hospital.

– But you’ll realize that there’s BIG money involved here.  Because, when you go searching, you are going to find dozens and dozens of websites trying to sell you these procedures overseas.

– Consider:  that for so many of these websites to be advertising with such competitive intensity, they must be able to still  make a lot of money selling these procedures overseas for much less than they cost in the US – or they would not be in such a competitive advertising frenzy.

– All of this ought to be telling you something about the US medical costs and whether or not they are reasonable and proportional to the services delivered.


– When you are in the US , you will hear a lot about how wonderful the US medical system is and about how terrible the socialized medical systems in places like France, Canada and New Zealand are.   They’ll tell you that you are very lucky to get the services you get, at the prices you get, in the US.

– It is an amazing pile of bull-droppings, is my opinion.   The sad fact is that the American medical system has very largely been captured by the ‘everything- is-about-profits‘ corporate world and the American people are much the poorer for it.

– If you want to get into a detailed discussion point-by-point comparing the US system with the socialized systems, you will, I’m sure, be able to find a few points here and there in which the US system wins.   But, on balance, the US system compares very badly.

– This has all been a near and dear subject to me over these last years and here’s a link that will take you through many of the things I’ve published previously on this Blog about the probems with US Healthcare and the US Medical System:

Click Here .

– If there’s a really sad bit to this story it is that all of this may have taken an option off the table for me.   I love New Zealand but I always thought that someday, I might return to live out my twilight years in the US.   I have some large doubts about that now.   First, no one there would ever insure me (post heart attack) for anything I could afford – unless I get a lot more affluent than I am now.  And, second, without insurance, I’d never be able to pay the bills if something did happen to me.  And if I owned a house, a business, or some land in the US – whoop – they’d all be gone!

– You know, that’s just not right.

Postscript: A friend, David D. wrote me about my thoughts here and pointed out something that I’d forgotten.  And that is that when I turn 65, I will be eligible for the US’s Medicare System so I may still have US options on the table in terms of medical coverage and that nice.   Thanks, Dave!

– Here in New Zealand, we all pay for healthcare through our taxes and we are all protected by each other’s payments.

– People say that taxes in countries with socialized medical systems are high.   I don’t find them so.   People with good jobs here will pay up to 33% of their wages as taxes.   But, on the other hand, we don’t have to pay for medical insurance, automobile insurance or business liability insurance because a plague of lawyers hasn’t managed to take over the system here.

– People here expect that the system will take care of them if they get cancer or are in an automobile accident and they are incredulous when I tell them how the medical systems works in the US.

– Know that I am well, my friends.   I’ve had a scare but in the big scheme of things, it was a relatively small heart attack.   In three to six weeks, I’ll be resuming my life just as it was in terms of exercise.

Health Insurers Making Record Profits as Many Postpone Care

Saturday, May 14th, 2011

– Oh, American healthcare, you make me so sad.  300 million people trapped in a system that has, itself, been captured by corporate interests who care for nothing but the maximization of their own profit.

– Dennis

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The nation’s major health insurers are barreling into a third year of record profits, enriched in recent months by a lingering recessionary mind-set among Americans who are postponing or forgoing medical care.

The UnitedHealth Group, one of the largest commercial insurers, told analysts that so far this year, insured hospital stays actually decreased in some instances. In reporting its earnings last week, Cigna, another insurer, talked about the “low level” of medical use.

Yet the companies continue to press for higher premiums, even though their reserve coffers are flush with profits and shareholders have been rewarded with new dividends.


– Research thanks to Cara H.

Mirror, Mirror on the Wall: How the Performance of the U.S. Health Care System Compares Internationally, 2010 Update

Wednesday, June 30th, 2010

– To all my friends in America who still think that the American Health system is the best on the planet and that the moneyed corporate interests are not taking all of you for a big ride – at your expense…

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Despite having the most costly health system in the world, the United States consistently underperforms on most dimensions of performance, relative to other countries. This report—an update to three earlier editions—includes data from seven countries and incorporates patients’ and physicians’ survey results on care experiences and ratings on dimensions of care. Compared with six other nations—Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom—the U.S. health care system ranks last or next-to-last on five dimensions of a high performance health system: quality, access, efficiency, equity, and healthy lives. Newly enacted health reform legislation in the U.S. will start to address these problems by extending coverage to those without and helping to close gaps in coverage—leading to improved disease management, care coordination, and better outcomes over time.

Executive Summary

The U.S. health system is the most expensive in the world, but comparative analyses consistently show the United States underperforms relative to other countries on most dimensions of performance. This report, which includes information from the most recent three Commonwealth Fund surveys of patients and primary care physicians about medical practices and views of their countries’ health systems (2007–2009), confirms findings discussed in previous editions of Mirror, Mirror. It also includes information on health care outcomes that were featured in the most recent (2008) U.S. health system scorecard issued by the Commonwealth Fund Commission on a High Performance Health System.

Among the seven nations studied—Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States—the U.S. ranks last overall, as it did in the 2007, 2006, and 2004 editions of Mirror, Mirror. Most troubling, the U.S. fails to achieve better health outcomes than the other countries, and as shown in the earlier editions, the U.S. is last on dimensions of access, patient safety, coordination, efficiency, and equity. The Netherlands ranks first, followed closely by the U.K. and Australia. The 2010 edition includes data from the seven countries and incorporates patients’ and physicians’ survey results on care experiences and ratings on various dimensions of care.

The most notable way the U.S. differs from other countries is the absence of universal health insurance coverage. Health reform legislation recently signed into law by President Barack Obama should begin to improve the affordability of insurance and access to care when fully implemented in 2014. Other nations ensure the accessibility of care through universal health insurance systems and through better ties between patients and the physician practices that serve as their long-term “medical homes.” Without reform, it is not surprising that the U.S. currently underperforms relative to other countries on measures of access to care and equity in health care between populations with above-average and below-average incomes.

But even when access and equity measures are not considered, the U.S. ranks behind most of the other countries on most measures. With the inclusion of primary care physician survey data in the analysis, it is apparent that the U.S. is lagging in adoption of national policies that promote primary care, quality improvement, and information technology. Health reform legislation addresses these deficiencies; for instance, the American Recovery and Reinvestment Act signed by President Obama in February 2009 included approximately $19 billion to expand the use of health information technology. The Patient Protection and Affordable Care Act of 2010 also will work toward realigning providers’ financial incentives, encouraging more efficient organization and delivery of health care, and investing in preventive and population health.

For all countries, responses indicate room for improvement. Yet, the other six countries spend considerably less on health care per person and as a percent of gross domestic product than does the United States. These findings indicate that, from the perspectives of both physicians and patients, the U.S. health care system could do much better in achieving value for the nation’s substantial investment in health.

– To the original: 

– research thanks to Bruce S.

Millions of cancer survivors putting off care because they cannot afford it

Monday, June 21st, 2010

– For me, the purpose of national governments should be to make the quality of life for their citizens of the highest quality possible consistent with not depriving future generations of those same benefits.

– And it should not be to allow Corporations the widest latitude of action in their monomaniacal pursuit of profits.

– Unfortunately, humanity in the large has not absorbed this lesson and we are all much the worse for it.

– Witness this story from the U.S. – home of unbridled Capitalism.

– – – – – – –

(NATIONAL) — A new study suggests America’s challenged and stressed employer based health care/health insurance system has come home to roost for millions of cancer survivors who are putting off medical care they need because they can no longer afford it.

The results, released online Monday by an American Cancer Society medical journal, shows that millions of cancer survivors are forgoing needed medical care because of concerns about cost or because they can no longer afford the care.

The new study, led by a Wake Forest University Baptist Medical Center researcher, estimates that more than 2 million of 12 million U.S. adult cancer survivors – or about 8% of the total – did not get one or more needed medical services because of the costs involved.

And about 10 percent also said they had to forgo filling prescriptions.

The study is being called the first to estimate how often current and former patients have skipped getting care because of money worries.

Survey participants were asked if they had needed medical care in the previous year but didn’t get it because they couldn’t afford it. Cancer survivors younger than 65 were between 1.5 and 2 times more likely to have said yes to that question than those who hadn’t had cancer.

The study showed that among cancer survivors, the prevalence of forgoing care in the past year due to concerns about cost was 7.8 percent for medical care, 9.9 percent for prescription medications, 11.3 percent for dental care, and 2.7 percent for mental health care.


The Fix Is In

Monday, March 15th, 2010

– Want to know why American health care costs are so high?   Read this:

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The hidden public-private cartel that sets health care prices.

Living in Massachusetts should, by all indicators, mean having access to good health care. Following the landmark passage of a health insurance mandate in 2006, the state today enjoys the nation’s lowest percentage of uninsured citizens. Major cities like Boston have the nation’s highest numbers of doctors per capita and anchor some of the world’s largest and most prestigious medical centers. And Massachusetts isn’t stingy—it spends more on health care per person than any other state. Yet, as a remarkable NPR documentary reported last year, patients calling Massachusetts General Hospital—ranked the fifth best in the nation by U.S. News and World Report—were informed that Harvard’s massive academic hospital was no longer accepting new patients needing primary care. And that problem isn’t limited to Massachusetts General—it’s occurring throughout the state. Despite near-universal insurance, oodles of doctors, reams of cash, and no dearth of bright minds, the average person in Massachusetts can’t find a new primary care doctor.

The nation soon may face the same fate. To have any hope of meaningful national health reform, therefore, we must address the perverse financial incentives that created and continue to inflame this problem.

The root of the shortage can be traced to 1985, when a Harvard economist named William Hsiao developed a scale to measure the relative value of every single one of the thousands of services provided by doctors, a job later compared to measuring “the exact amount of anger in the world.” For example, Hsiao’s team deemed that a hysterectomy required 3.8 times more mental effort and 4.47 times more technical skill than a psychotherapy session. In 1992, Medicare formally adopted Hsiao’s concept; private insurers followed suit. Today, this relative value-based system sets the prices—and therefore drives the priorities of American medicine.

Here’s how it works. Doctors do a job—like placing a coronary artery stent, reading an EKG, or spending an hour examining and diagnosing a patient with a complex problem like insomnia—and earn something called “relative value units.” In 2009, according to Medicare, the stent guy scores about 24 units for his relatively quick procedure, the EKG person gets 0.5 units for the 10 seconds his job requires, and the poor internist gets only 2.5 units for his hour of time. Figuring a doctor’s total take per task is straightforward: Medicare adds up a doctor’s total RVUs, multiplies the total by a fixed amount (roughly $40 right now), and writes the check.

– More…

– Research thanks to Hans D.

Ranking 37th — Measuring the Performance of the U.S. Health Care System

Monday, February 22nd, 2010

– A quote from the article, below:

Despite the claim by many in the U.S. health policy community that international comparison is not useful because of the uniqueness of the United States, the rankings have figured prominently in many arenas. It is hard to ignore that in 2006, the United States was number 1 in terms of health care spending per capita but ranked 39th for infant mortality, 43rd for adult female mortality, 42nd for adult male mortality, and 36th for life expectancy. These facts have fueled a question now being discussed in academic circles, as well as by government and the public: Why do we spend so much to get so little?

– – – – – – – – – – – – – – – – – – – – – –

Evidence that other countries perform better than the United States in ensuring the health of their populations is a sure prod to the reformist impulse. The World Health Report 2000, Health Systems: Improving Performance, ranked the U.S. health care system 37th in the world1 — a result that has been discussed frequently during the current debate on U.S. health care reform.

The conceptual framework underlying the rankings2 proposed that health systems should be assessed by comparing the extent to which investments in public health and medical care were contributing to critical social objectives: improving health, reducing health disparities, protecting households from impoverishment due to medical expenses, and providing responsive services that respect the dignity of patients. Despite the limitations of the available data, those who compiled the report undertook the task of applying this framework to a quantitative assessment of the performance of 191 national health care systems. These comparisons prompted extensive media coverage and political debate in many countries. In some, such as Mexico, they catalyzed the enactment of far-reaching reforms aimed at achieving universal health coverage. The comparative analysis of performance also triggered intense academic debate, which led to proposals for better performance assessment.

Despite the claim by many in the U.S. health policy community that international comparison is not useful because of the uniqueness of the United States, the rankings have figured prominently in many arenas. It is hard to ignore that in 2006, the United States was number 1 in terms of health care spending per capita but ranked 39th for infant mortality, 43rd for adult female mortality, 42nd for adult male mortality, and 36th for life expectancy.3 These facts have fueled a question now being discussed in academic circles, as well as by government and the public: Why do we spend so much to get so little?

Comparisons also reveal that the United States is falling farther behind each year (see graph). In 1974, mortality among boys and men 15 to 60 years of age was nearly the same in Australia and the United States and was one third lower in Sweden. Every year since 1974, the rate of death decreased more in Australia than it did in the United States, and in 2006, Australia’s rate dipped lower than Sweden’s and was 40% lower than the U.S. rate. There are no published studies investigating the combination of policies and programs that might account for the marked progress in Australia. But the comparison makes clear that U.S. performance not only is poor at any given moment but also is improving much more slowly than that of other countries over time. These observations and the reflections they should trigger are made possible only by careful comparative quantification of various facets of health care systems.


Best Healthcare in the World, Baby

Tuesday, February 16th, 2010

California may be a bellwether for the rest of nation, but apparently it doesn’t take long for the rest of the nation to catch up these days:

Consumers in at least four states who buy their own health insurance are getting hit with premium increases of 15 percent or more — and people in other states could see the same thing.

….The Anthem Blue Cross plan in Maine is asking for increases of about 23 percent this year for some individual policyholders. Last year, they raised rates up to 32 percent. And in Oregon, multiple insurers were granted rate hikes of 15 percent or more this year after increases of around 25 percent last year for customers who purchase individual health insurance, rather than getting it through their employer.

….”You’re going to see rate increases of 20, 25, 30 percent” for individual health policies in the near term, Sandy Praeger, chairwoman of the health insurance and managed care committee for the National Association of Insurance Commissioners, predicted Friday.


Healthcare outside the U.S. (read it and weep)

Tuesday, January 5th, 2010

Healthcare– I like to report on how health care works in other countries outside of the U.S.    I do this mostly for my U.S. readers who are constantly besieged by propaganda from vested interests in the U.S. that are attempting to convince them that what they have in the U.S. is the best that can be had.

Au contraire, mon ami.

– There’s an entire world of amazing health care options outside the insular U.S.  In all the other advanced western nations, in fact.

– It is a world wherein people automatically expect that one of the functions of their national government is to provide health care for its citizens.  Free.   And, if not free, then certainly easily affordable.

– Recently, in one of the on-line groups I participate in for immigrants (and wanna be immigrants)  to New Zealand, a discussion started up about how health care in New Zealand works.  One of those who spoke up had just been kidded (in a good natured way) about being a ‘Socialist‘ because she thought that the socialized medicine system here in New Zealand was a good thing.

– Here’s her reply just as she delivered it.   I love it and I think readers in the U.S. should be exposed to more information like this.

– To my friends in the U.S.:  You do not live in the best of all worlds with respect to health care.  And those who are trying to convince you that you do have serious financial skin in the game.  The longer they can keep you convinced that the U.S. system is the best system, the longer their profit making streak runs hot.

– Seriously folks, you’ve got to get out there and smell the roses outside the U.S. borders.  At a bare minimum, take a vacation to Canada and talk, seriously, to the Canadians you meet about their health care system – you will be amazed and shocked at how badly you are being treated.

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Hey there – Socialist???

Might take me a second to get use to the idea as I was raised that was a “bad” word.  But guess what?  If LOVING New Zealand health care makes me a Socialist, then a Socialist I am.  I cannot say enough about how GREAT the health care here in Kiwi Land is, and as you know it is one of the main reasons we came here and one of the main reasons we stay here.  Not only was all of my IVF treatment completely FREE of charge, all prenatal, birth and post op care (including the Plunket and Karitane nurses) was included. The Lactation Consultant in the hospital charged me $6 for a nipple shield and I had to buy my own toothpaste in the gift shop as I had an unexpected early admission prior to birth. We pay $37 for a visit to our GP.  ANYONE can walk in off the street (even a visitor who has just arrived) and pay $50 to see my doctor and get the exact same medical care.

A PRIVATE eye specialist charged my husband $95 for the full and complete 45 minute glaucoma workup-medicine included.  He goes yearly as his eyes are not bad enough to qualify for the hospital’s eye clinic but bad enough that we want to keep them from getting worse.  And here a 45 minute Doctor consultation means you get to speak WITH the doctor one on one for up to 45 minutes.  I could not believe how inclusive and involved the Doctors here are. As an American nurse I am use to docs flying in and out of patient rooms for 6 minutes and billing them for the hour.  When I finally did get pregnant, I called up a SPECIALIST OB/GYN as I did not want to trust the delivery of my baby to a Midwife.  They said it would be $1200 ALL INCLUSIVE for all prenatal, delivery, and post op care.  Lucky for me I developed Diabetes before I could get in to see the specialist, so all of my care was transferred to Endocrine Gynecologists for FREE as public health pays for all complicated pregnancys.   There is a $6 charge for blood draws unless of course you are willing to walk your procedure form over to Med Lab (4 blocks away)-wait 5 minutes, and then it is TOTALLY and completely FREE.

Can’t go on enough and despite everything (both good and bad) that has happened to us over the years – the one consistent and GREAT thing that we have had is PREVENTIVE, low intrusive medical care.  Unless you happen to work in the medical insurance business, I think you will find the care here far exceeds anything that I ever worked for or found in the United States.  The idea of ever having to go back to an American doctor while in the United States sends chills up my spine.  Here, I am a person and we are a family.  There, I often felt like a lab rat.  Relax – no one in true need of medical care would ever be denied treatment while waiting for a few pieces of paperwork to get sorted.  The system is set up so that you would be covered under ACC as a visitor until you were covered.

Chanah Luppens
AKA Melissa Luppens RN BSN (an RN for 18 years in the U.S.)
Missouri Nursing Liscense
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– Here’s a glossary of some of the terms Chanah used here for those who are not in New Zealand or do not have a medical background and thus might not be familiar with them:

IVF -In Vitro Fertilization

Plunketa (New Zealand) not-for-profit national organization whose people are passionately committed to supporting families and young children. We are the country’s biggest provider of Well Child/Tamariki Ora services. These include parenting advice and support, child health promotion and health education. They are offered to all New Zealand children and their family/whanau from birth to five years.  Most services are completely free.

ACC – The Accident Compensation Corporation (ACC) provides comprehensive, no-fault personal injury cover for all New Zealand residents and visitors to New Zealand.

Why We Spend So Much

Sunday, October 11th, 2009

This from Kevin Drum at Mother Jones – excellent stuff.

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Bob Somerby wants to know why the media isn’t a wee bit more interested in why the United States pays far more per person for medical care than other rich countries.  Here’s the rough answer:

  • We pay our doctors about 50% more than most comparable countries.
  • We pay more than twice as much for prescription drugs, despite the fact that we use less of them than most other countries.
  • Administration costs are about 7x what most countries pay.
  • We perform about 50% more diagnostic procedures than other countries and we pay as much as 5x more per procedure.

Underlying all this is the largely private, profit-driven nature of American medicine, but regardless of how you feel about that, the main lesson here is how hard it would be to seriously bring these costs down.  We can jabber all we want about incentives and greed and systemic waste, but the bottom line is that if we want to do anything more than nip around the edges, we’d have to pay doctors and nurses less, pay pharmaceutical companies less, pay insurance companies less (or get rid of them entirely), pay hospitals less, and pay device makers less.  That’s a lot of very rich and powerful interests who will fight to the death to prevent any serious cost cutting, and it’s why Obama and the Democrats in Congress have largely chosen to buy them off instead.

If you’re curious about this in slightly more detail, the chart on the right comes from a McKinsey Global Institute study of healthcare costs.  (An older but more interactive version is here.)  Healthcare spending tends to be higher in richer countries, and since the U.S. is a very rich country it’s unsurprising that we spend a lot on healthcare.  However, even when you account for that, McKinsey figures that we still spend about $2,000 more per person than we should, a total of about $650 billion.  The chart shows where this extra expense comes from: the dark blue areas are places where we spend more than expected and the orange areas show where we spend less than expected.

No matter how you slice the healthcare pie, though, compared to other rich countries we spend far more, cover fewer people, get hassled a lot more, and don’t get much better outcomes.  Unfortunately, there are a lot of people who profit handsomely from this state of affairs, so it’s not likely to change radically anytime soon.  Baby steps, my friends, baby steps.