I don't talk about politics much here, but American national politics are one of my passions, and I've followed the health care debate with particular interest, because the way it ends will likely have a serious impact on when, and for how long, I return to live in the United States. I'm constantly startled at what seems to be universal acceptance of the idea that, though America's health care system could use some work, at least it's not a European-style socialist system. Well, I live in a socialist European state, and it's wonderful. My premiums are around €275 a month (my employer pays the same), and for that price I am simply insured. If I lose my job, I keep my insurance, and my premiums are reduced. If my left eye goes blind for the same reason my right eye did in my childhood, my treatment will be covered - people here are shocked when I explain the concept of a "pre-existing condition." If I decide I want to switch insurance companies, I can pick any plan offered by any company; it is illegal to deny me coverage, and I'll pay the same as anyone else, regardless of my risk status. My deductible is €10 per calendar quarter, regardless of what treatment I receive. I've never had to wait for treatment, nor have I ever heard a story of someone else having to wait.
And for all of that, Germany pays around half what America does per insured person. Americans throw the word "socialism" around like it's the bane of all that is good in the world, but for some things, a socialist solution works. Fortunately, the legislation in the works will create a system in America that is similar in many ways to the system we have here in Germany. The two most important concepts, which look like they're likely to be in the final bill, are the individual mandate and what's called "guaranteed issue." The first means that you have to get some kind of health insurance (actually, the version I believe is in the bill now just says you have to pay a fee if you don't have insurance, which is actually likely to be a better deal if you're young and healthy). The second means that insurance companies have to insure you. These are both good things; it shouldn't be legal for insurance companies to actively seek to deny coverage to people who are sick or likely to become sick. And if there's no individual mandate, only the people are are sick will be likely to get insurance, which makes the average risk in the pool of the insured very high, driving premiums up, driving people out of insurance, raising premiums still higher, and so on, in what health insurance wonks call the "death spiral."
Health care reform has been tried again and again pretty much throughout the 20th century, and I'm thrilled that someone is finally going to pull it off.
That is a very interesting graph! (I couldn't find Ezra's source) The countries that spend between $1600 to $4400 all outlive Americans, with $1600 to $3100 being the best bang for their money. I'm sure the variables affecting each are interesting (obesity, environment, food). Preventative care seems key for Japan, 12+ doctor visits a year at $2500! Looks like American only get to the doctor once something bad occurs, which runs costs crazy. Do you have any insight into the Japanese system? Maybe a 3-way comparison: US, JP, DE?
ReplyDeleteDoes your current coverage pay elective and emergency care, you mention a deductible?
I would think some would pay a bit more in America if it prevented medical bills that can reach beyond thousands to hundred thousands of dollars.
Thank you so much for your comment, Roy. Ezra's source on the graph is National Geographic Magazine's blog: link. Unfortunately, I don't know very much about the Japanese healthcare system, because I never visited the doctor while I was living in Japan. The second time I visited, I didn't even have Japanese health insurance, because it was cheaper to get international insurance in Germany.
ReplyDeleteMy current coverage covers emergency care. Whether it covers "elective" care is a question of definitons. It rather infamously doesn't cover cleaning at the dentist, and it won't cover contact lenses (but it covers one new pair of glasses every two years). There are also copays associated with some drugs - it's common to have to pay €5 or so when you get a supply of certain medications.
The "deductable," as I said in my post, is actually just a €10 fee that you pay the first time you visit a doctor in any calendar quarter. It's not possible to get "medical bills that can reach beyond thousands to hundreds of thousands of dollars." The biggest bill I think you can end up with from a medical procedure is the hospital bed copay, which if I remember right from my appendectomy was about €25 a day.