by L.A.S.
With all the news coming out of Washington this week regarding Obama's national health care proposal, it is difficult to focus on just one or two threads for an article or discussion. But one major thread is that Dennis Kucinich is again taking the lead regarding national healthcare, and has come out in support of a single-payer plan.
The alternative news site AlterNet has been very enthusiastic about his version of healthcare reform. You may read their article here: www.alternet.org/blogs/politics/141404/how_dennis_kucinich_may_save_the_health_reform_battle/
Kucinich would allow states to create their own single-payer programs. This is a positive step. However, in the current economic climate, I doubt that many states are in any shape to start up a new public benefit program. Some states, like California, are dropping eligible people from the public healthcare programs that they already have.
Perhaps Obama's plan is meant merely as a transitional phase from the present multi-payer, all-private (except for Medicare) situation to a true single-payer plan such as one finds in many European countries and Canada. I could live with that, but I think that the insurance companies are bound and determined to avoid covering the people that they do not want: those who have pre-existing conditions, and those who run up large bills.
We saw when Medicare first was rolled out as a result of the President Johnson initiative under his "Great Society" programs, that the insurance companies could not dump the seniors fast enough. In fact, they terminated policyholders even before they had been formally enrolled into Medicare! Let us hope that someone has thought to insert verbiage to prevent a similar fiasco this time around.
One approach to reducing the cost of medical care that is not used enough is to manage cases for improved drug therapy (and other management of chronic conditions) so that patients spend fewer days in the hospital. This requires a progressive attitude!
One may read a rather long article on the Nursing Center website about interventions with high-risk or at-risk families on Medicaid, or on a public health plan in other countries. Typically, visiting nurses make regular home visits and help to educate parents and monitor the progress of children in the studies. Overall, such intervention returns about $17,000 per family in the program (they take into account not only hospitalizations that have been avoided, but also crime and domestic violence, and other costs to society: "Cost-benefit analysis of the NFP reveals that there is a $17000 return to society for each family served by the program.13 These benefits were calculated on the basis of the program's impact on societal outcomes such as crime, substance abuse, teen pregnancy, child abuse and neglect, and domestic violence.")
Let's hope that such relatively low-cost interventions will be the norm, and produce better management of childhood asthma and other chronic conditions.
Showing posts with label Single-payer. Show all posts
Showing posts with label Single-payer. Show all posts
Saturday, July 25, 2009
Saturday, August 30, 2008
Maybe a French-style National Healthcare System Might Be More Compatible With Ours?
A proposal for a Canada-style healthcare system has been floundering around our Congress for several months, (Rep. John Conyers National Health Insurance Act --HR 676) but shouldn’t we ask if a French-style system might be a less disruptive solution?
Let me compare the Canadian and French systems briefly --
Canada has a SINGLE-PAYER system, in which the government pays the bills according to a fee structure it negotiated with health care providers. Patients can still choose their own doctor. The doctor in turn may be either paid by the government or in private practice. (Patients who are in a hurry might choose a private-pay doctor; the government physicians are often overworked and months-long delays to get an appointment are common.) The United States’ Medicaid and Medicare are most similar to single-payer systems.
By contrast, in the British style of socialized medicine, the doctors are actually government employees. Hospitals are run by the government. Hospitals are run comparable to the Veterans Administration. Given the repeated VA scandals in healthcare and hospital conditions, one would much prefer any private hospital over the VA. This is a sad thing to say, although to be fair, the VA facilities are just showing their age and need a great deal of renovation.
The French system is called a non-profit MULTI-PAYER. Clinics and hospitals are all private, and may be either non-profit or for profit. Medical providers are paid according to a negotiated fee structure. The funds come from payroll contributions from both employers and employees.
This is somewhat similar to what we have now in the private sector. A major difference is that the French government has far better leverage in negotiating what the fees are than any single employer has, and unlike the U.S. federal government, it uses that leverage.
French payroll taxes replenish a sickness fund which covers 75% of the medical bills. The balance comes from patients, government and supplementary insurance.
Coverage is universal under all three templates -- British, Canadian, and French. By contrast, the current American system has nearly 50 million of us completely uninsured -- 9 million of the uninsured are children.
The patient has the ultimate power to choose his or her doctor under all three plans displayed here. Popular American plans commonly limits our choice of providers to those who are part of a given network.
The average cost of medical care per Briton is $2,389, and the average Briton ranks 24th on WHO‘s health ranking. For a Canadian it is $2,989, and he ranks 35th. For a Frenchman it comes to $2,902, who marches all the way up to 4th on WHO‘s list. And for an American, it comes to a whopping $5,711, and in return for that, he places 72nd on WHO’s ranking.
Recent years have seen several so-called reforms, with limited results. In 2004, consumers were given the option to create Health Savings Accounts. These allow pre-tax dollars to be set aside for any medical or health expense not reimbursed by insurance. The downsides: they require more paper handling by both consumers and insurance companies, and some discourage preventive care.
States such as Massachusetts have moved to require insurance coverage, with a government subsidy to those who cannot afford it. While it does not result in universal coverage, it has cut the numbers of uninsured by nearly two-thirds.
When you add up all the co-pays, premiums, deductibles, etc., even those with insurance often pay the full cost of the medical care. There is little downward pressure on medical expenses.
Allowing the poor to buy into Medicaid, Medicare, or SCHIP has become controversial even tho it seems very direct and logical. This proposal came from a plan studied by the National Coalition on Healthcare. Consumers pay in according to a sliding scale, with subsidies for the poor.
Everyone gets covered. The monetary savings can be significant. NCHC says in the first decade health care savings would total $320.5 billion; businesses that now provide health insurance would save $848 billion, and families who currently buy insurance would save $309 billion.
Since the end of the 1960s, the number of doctors in France increased from 60,000 to more than 185,000 at the beginning of the 21st century. There are three doctors for every 1,000 habitants, which is a superior ratio when compared to other Western nations (Great Britain 3:1800, USA 3:2700, Germany 3:3400 and Italy 3:5900).
A sector of the French healthcare system consists of not-for-profit private hospitals. Private hospitals were originally denominational and provide 14% of the inpatient services among French Medical Care Institutions. They are financed through endowments like public hospitals, but they still have the right to privacy like private clinics.
A positive feature of the French healthcare system is the cooperation between the public and private sector. The long waiting lists for surgery that everyone associates with socialized medicine are avoided here. Indeed, private medical care in France provides more than 50% of surgeries.
Yes Magazine has an online chart - http://www.yesmagazine.org/article.asp?ID=1515
More specifics of the French plan is at FrenchEntree.com -- http://www.frenchentree.com/fe-health/DisplayArticle.asp?ID=197
Let me compare the Canadian and French systems briefly --
Canada has a SINGLE-PAYER system, in which the government pays the bills according to a fee structure it negotiated with health care providers. Patients can still choose their own doctor. The doctor in turn may be either paid by the government or in private practice. (Patients who are in a hurry might choose a private-pay doctor; the government physicians are often overworked and months-long delays to get an appointment are common.) The United States’ Medicaid and Medicare are most similar to single-payer systems.
By contrast, in the British style of socialized medicine, the doctors are actually government employees. Hospitals are run by the government. Hospitals are run comparable to the Veterans Administration. Given the repeated VA scandals in healthcare and hospital conditions, one would much prefer any private hospital over the VA. This is a sad thing to say, although to be fair, the VA facilities are just showing their age and need a great deal of renovation.
The French system is called a non-profit MULTI-PAYER. Clinics and hospitals are all private, and may be either non-profit or for profit. Medical providers are paid according to a negotiated fee structure. The funds come from payroll contributions from both employers and employees.
This is somewhat similar to what we have now in the private sector. A major difference is that the French government has far better leverage in negotiating what the fees are than any single employer has, and unlike the U.S. federal government, it uses that leverage.
French payroll taxes replenish a sickness fund which covers 75% of the medical bills. The balance comes from patients, government and supplementary insurance.
Coverage is universal under all three templates -- British, Canadian, and French. By contrast, the current American system has nearly 50 million of us completely uninsured -- 9 million of the uninsured are children.
The patient has the ultimate power to choose his or her doctor under all three plans displayed here. Popular American plans commonly limits our choice of providers to those who are part of a given network.
The average cost of medical care per Briton is $2,389, and the average Briton ranks 24th on WHO‘s health ranking. For a Canadian it is $2,989, and he ranks 35th. For a Frenchman it comes to $2,902, who marches all the way up to 4th on WHO‘s list. And for an American, it comes to a whopping $5,711, and in return for that, he places 72nd on WHO’s ranking.
Recent years have seen several so-called reforms, with limited results. In 2004, consumers were given the option to create Health Savings Accounts. These allow pre-tax dollars to be set aside for any medical or health expense not reimbursed by insurance. The downsides: they require more paper handling by both consumers and insurance companies, and some discourage preventive care.
States such as Massachusetts have moved to require insurance coverage, with a government subsidy to those who cannot afford it. While it does not result in universal coverage, it has cut the numbers of uninsured by nearly two-thirds.
When you add up all the co-pays, premiums, deductibles, etc., even those with insurance often pay the full cost of the medical care. There is little downward pressure on medical expenses.
Allowing the poor to buy into Medicaid, Medicare, or SCHIP has become controversial even tho it seems very direct and logical. This proposal came from a plan studied by the National Coalition on Healthcare. Consumers pay in according to a sliding scale, with subsidies for the poor.
Everyone gets covered. The monetary savings can be significant. NCHC says in the first decade health care savings would total $320.5 billion; businesses that now provide health insurance would save $848 billion, and families who currently buy insurance would save $309 billion.
Since the end of the 1960s, the number of doctors in France increased from 60,000 to more than 185,000 at the beginning of the 21st century. There are three doctors for every 1,000 habitants, which is a superior ratio when compared to other Western nations (Great Britain 3:1800, USA 3:2700, Germany 3:3400 and Italy 3:5900).
A sector of the French healthcare system consists of not-for-profit private hospitals. Private hospitals were originally denominational and provide 14% of the inpatient services among French Medical Care Institutions. They are financed through endowments like public hospitals, but they still have the right to privacy like private clinics.
A positive feature of the French healthcare system is the cooperation between the public and private sector. The long waiting lists for surgery that everyone associates with socialized medicine are avoided here. Indeed, private medical care in France provides more than 50% of surgeries.
Yes Magazine has an online chart - http://www.yesmagazine.org/article.asp?ID=1515
More specifics of the French plan is at FrenchEntree.com -- http://www.frenchentree.com/fe-health/DisplayArticle.asp?ID=197
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