5 Myths About Health Care Around the World

[Danno 1,228]

Well, I agree Danno that the author of this report was clearly biased toward one end...which is not the way to sway people affectively. However, you have to admit that the article makes some good points?

How is it okay that millions are without insurance and that thousands go bankrupt from medical bills every year?

It's ok because Danno and his a$hole friends don't give a flying shît about anyone else.

Bud, my A$$hole friends and I do care about others, typically we address those concerns with our own money and time.

You on the other hand (as well as your A$$hole friends).... always seek to force others into addressing the needs you are most concerned about, no matter the cost nor the failed end result of all this "kindness".

Despite all your chest beating, you still have not answered my simple questions before you plunge us into another Govt sink-hole.

-Why can't Govt run the VA hospital system in a way in which we would all want to use it?

-Why can't we "experiment" with different plans and see which model works best.

I welcome the success if it should come!

You guys keep comparing us to countries which are smaller than many of our states.... yet you claim

no one state is big enough to get this jewel of a healthcare system you dream of off the ground.

The Gov is the largest employer in the country why not take this huge pool of people and... let's see what you can do?

The truth is, you want to lock out competition..... and lock in everyone, so that as the "system flounders.... you can remind us how much worse off we would be had we not implemented this monopoly of health-care.

[Mr. Big Dog 10,747]

You may be forgetting the crucial fact that Medicare is payed for by everyone (155,500,000 people) and provided to only a certain group (45,000,000 people.) Excluding the premiums Medicare charges to it's recipients, over 3 people are funding 1 person to be on Medicare, and it's still unsustainable.

A system that takes funding from 3 and provides to 1 can never be considered cost-effective. It also can never be considered more cost-effective than 1 for 1 private insurance (no matter how horrible and costly they are), because at least two-thirds of those funding Medicare receive a cost, but no effect.

Nevertheless, as I've already stated, the problem is not insurance, it's health care. My aim was never to make a case defending private insurance, but merely illustrate that it doesn't matter who pays. The costs are astronomical, whether payed by all Americans collectively, or separately via individual plans. Therefore, high hopes of a public plan making health care cheaper are lost.

First off, I cited the per enrollee cost growth above. That's a pretty good indicator of cost containment - since it considers only the actual outlays - and Medicare while not performing well outperformed the private insurance impressively.

Secondly, one of the issues that Medicare is encountering is that the ratio of contributors vs. beneficiaries is shifting due to the baby boomers reaching medicare eligibility. This is in big part why the rates would need to be raised to keep the system afloat unless there are offsetting savings on the other side of the equation.

And on this last point, we appear to agree. What needs to be addressed in a bad way and isn't really addressed at all in the current debate is the cost side of the equation. We need to find a better and more efficient way of delivering health care. Having the system set up where it rewards providers to perform more services rather than being rewarded for providing necessary services ensuring good outcomes is obviously a system that will make health care more expensive than it needs to be. Not every headache requires an MRI.

Edited October 29, 2009 by Mr. Big Dog

[one...two...tree 2,762]

You may be forgetting the crucial fact that Medicare is payed for by everyone (155,500,000 people) and provided to only a certain group (45,000,000 people.) Excluding the premiums Medicare charges to it's recipients, over 3 people are funding 1 person to be on Medicare, and it's still unsustainable.

A system that takes funding from 3 and provides to 1 can never be considered cost-effective. It also can never be considered more cost-effective than 1 for 1 private insurance (no matter how horrible and costly they are), because at least two-thirds of those funding Medicare receive a cost, but no effect.

Matt, a pay as you go system is sustainable when the coffers are not tapped into and taxes are adjusted as necessary. All insurance works on the premise that some will use the service more than others. You won't find one single private insurance fund that pays out a 1:1 ratio.

[mRx 16]

You may be forgetting the crucial fact that Medicare is payed for by everyone (155,500,000 people) and provided to only a certain group (45,000,000 people.) Excluding the premiums Medicare charges to it's recipients, over 3 people are funding 1 person to be on Medicare, and it's still unsustainable.

A system that takes funding from 3 and provides to 1 can never be considered cost-effective. It also can never be considered more cost-effective than 1 for 1 private insurance (no matter how horrible and costly they are), because at least two-thirds of those funding Medicare receive a cost, but no effect.

Matt, a pay as you go system is sustainable when the coffers are not tapped into and taxes are adjusted as necessary. All insurance works on the premise that some will use the service more than others. You won't find one single private insurance fund that pays out a 1:1 ratio.

I was not referring to a "pay out" ratio, Steven. Insurance provides coverage; "pay outs", as you alluded to, are an uncertainty, and not equal. If it were equal, it wouldn't be insurance in any sense of the word. There must be a precedent of uncertainty about the future for any insurance to take place. A situation where there is a 1:1 ratio implies the future is known, therefore negating the need to insure oneself against anything.

Anyways, I pay for Medicare and receive no insurance coverage against uncertainty. That's what I was referring to...

[Mr. Big Dog 10,747]

Anyways, I pay for Medicare and receive no insurance coverage against uncertainty

yet

[scandal 951]

You may be forgetting the crucial fact that Medicare is payed for by everyone (155,500,000 people) and provided to only a certain group (45,000,000 people.) Excluding the premiums Medicare charges to it's recipients, over 3 people are funding 1 person to be on Medicare, and it's still unsustainable.

A system that takes funding from 3 and provides to 1 can never be considered cost-effective. It also can never be considered more cost-effective than 1 for 1 private insurance (no matter how horrible and costly they are), because at least two-thirds of those funding Medicare receive a cost, but no effect.

Matt, a pay as you go system is sustainable when the coffers are not tapped into and taxes are adjusted as necessary. All insurance works on the premise that some will use the service more than others. You won't find one single private insurance fund that pays out a 1:1 ratio.

I was not referring to a "pay out" ratio, Steven. Insurance provides coverage; "pay outs", as you alluded to, are an uncertainty, and not equal. If it were equal, it wouldn't be insurance in any sense of the word. There must be a precedent of uncertainty about the future for any insurance to take place. A situation where there is a 1:1 ratio implies the future is known, therefore negating the need to insure oneself against anything.

Anyways, I pay for Medicare and receive no insurance coverage against uncertainty. That's what I was referring to...

Actually, you do. The American people as a whole made a social contract across the generations to ensure medical coverage for all of us in our old age, when our health care needs are highest yet our incomes are usually lowest (since we're retired). Your coverage benefit will come when you too are 65 and eligible for Medicare.

You may not like this social contract, you may say "hey, I never voted for that!". You may even want to repeal it, which is your right in our democracy. But the fact is that Congress at the time (during the Johnston Administration) saw fit to make this social contract in which working people pay into a system so that seniors may benefit. In due course, current generations of working people will age and reap the same benefits as the next generations step into the work force.

The 3:1 ratio makes sense because there are more working people making contributions than people drawing benefits. That's a matter of demographics, not economics.

The concept is sound, if the actuarial data is properly applied. To be solvent, it needs to take into account demographic shifts, most notably the rapidly retiring Baby Boomers. This is a crisis for both Medicare and Social Security which Congress has been terrified of tackling due to voter rage. A relatively modest change to contribution levels (i.e. Medicare payroll tax), or benefit eligibility (e.g. change the eligibility age to 67 or so), or coverage -- or a combination of these, can correct the coming solvency crisis for Medicare and Social Security.

I do agree that there is a moral outrage if the crisis is not solved. It is outrageous that we current working people may be making contributions to these programs throughout our careers only to be told we are unable to receive benefits from a bankrupted fund when we reach retirement. Current projections for Medicare and SS call for just such a scenario unless the funding model is adjusted.

[spookyturtle 9,465]

Is it true that some countries have health care for sheep?

[mRx 16]

You may be forgetting the crucial fact that Medicare is payed for by everyone (155,500,000 people) and provided to only a certain group (45,000,000 people.) Excluding the premiums Medicare charges to it's recipients, over 3 people are funding 1 person to be on Medicare, and it's still unsustainable.

A system that takes funding from 3 and provides to 1 can never be considered cost-effective. It also can never be considered more cost-effective than 1 for 1 private insurance (no matter how horrible and costly they are), because at least two-thirds of those funding Medicare receive a cost, but no effect.

Nevertheless, as I've already stated, the problem is not insurance, it's health care. My aim was never to make a case defending private insurance, but merely illustrate that it doesn't matter who pays. The costs are astronomical, whether payed by all Americans collectively, or separately via individual plans. Therefore, high hopes of a public plan making health care cheaper are lost.

First off, I cited the per enrollee cost growth above. That's a pretty good indicator of cost containment - since it considers only the actual outlays - and Medicare while not performing well outperformed the private insurance impressively.

OK, I see what you mean. If we're looking at the same data, (Chart 1-7, PP. 9) there appears to be some issues that would make it more difficult to come to the conclusion that Medicare outperforms PHI, as you can see by reading the bullets below the chart.

There is no doubt about it though; costs are rising, and have for both public and private systems.

To be honest, I would be all for a public option provided the bill included the abolition of the entire regulation myriad that has monopolized the US health industry. As you've already noted, we are at or near the bottom globally, yet we have more regulation in our health care industry than any country in the world.

It hasn't done us much good, but huge corporations, bureaucracies, and politicians have sure profited nicely from it.

But I'm not holding my breath for such meaningful action to happen in my lifetime...

[Mr. Big Dog 10,747]

You may be forgetting the crucial fact that Medicare is payed for by everyone (155,500,000 people) and provided to only a certain group (45,000,000 people.) Excluding the premiums Medicare charges to it's recipients, over 3 people are funding 1 person to be on Medicare, and it's still unsustainable.

A system that takes funding from 3 and provides to 1 can never be considered cost-effective. It also can never be considered more cost-effective than 1 for 1 private insurance (no matter how horrible and costly they are), because at least two-thirds of those funding Medicare receive a cost, but no effect.

Nevertheless, as I've already stated, the problem is not insurance, it's health care. My aim was never to make a case defending private insurance, but merely illustrate that it doesn't matter who pays. The costs are astronomical, whether payed by all Americans collectively, or separately via individual plans. Therefore, high hopes of a public plan making health care cheaper are lost.

First off, I cited the per enrollee cost growth above. That's a pretty good indicator of cost containment - since it considers only the actual outlays - and Medicare while not performing well outperformed the private insurance impressively.

OK, I see what you mean. If we're looking at the same data, (Chart 1-7, PP. 9) there appears to be some issues that would make it more difficult to come to the conclusion that Medicare outperforms PHI, as you can see by reading the bullets below the chart.

Actually, looking at that data and the verbiage around it, I noticed that the same conclusion was made there (pg. just under the chart):

• Although rates of growth in per capita spending for Medicare and private insurance often differ from year to year, over the long term they have been quite similar. When comparing spending for benefits that private insurance and Medicare have had in common—notably, excluding prescription drugs—Medicare’s per enrollee spending has grown at a rate that is 1 percentage point lower than that for private insurance over the 1970 to 2006 period.

• This comparison is sensitive to the endpoints of time one uses for calculating average growth rates. Also, private insurers and Medicare do not buy the same mix of services, and Medicare covers an older population that tends to be more costly. In addition, the data do not allow analysis of the extent to which these spending trends were affected by changes in the generosity of covered benefits and, in turn, changes in enrollees’ out-of-pocket spending.

• Differences appear to be more pronounced since 1985, when Medicare began introducing the prospective payment system for hospital inpatient services. Some analysts believe that since the mid-1980s, Medicare has had greater success at containing cost growth than private payers by using its larger purchasing power. Others maintain that relative to the 1970s, benefits offered by private insurers have expanded and cost-sharing requirements declined. In addition, enrollment in managed care plans grew during the 1990s. These factors make the comparison problematic, since Medicare’s benefits changed little over the same period

Now take that 1% difference in growth rate - it's a somewhat smaller difference than what I had quoted earlier but what I read and quoted earlier covered a different time span - and suppose that the annual cost growth rate for Medicare was 9% making that number 10% for PHI. Take a cost of $1,000.00 in 1970 and then apply the respective annual growth rates to that base line. When you arrive in 2009, you will find that this original $1,000 has grown to almost $29,000 under Medicare and to over $41,000.00 under PHI - almost 43% more than Medicare. This is why I say that the government has been more effective controlling cost growth than PHI.

...we have more regulation in our health care industry than any country in the world.

Says who? You keep repeating this claim and I must admit that I find this hard to believe.

[SMR 368]

As Americans search for the cure to what ails our health-care system, we've overlooked an invaluable source of ideas and solutions: the rest of the world. All the other industrialized democracies have faced problems like ours, yet they've found ways to cover everybody -- and still spend far less than we do.

I've traveled the world from Oslo to Osaka to see how other developed democracies provide health care. Instead of dismissing these models as "socialist," we could adapt their solutions to fix our problems. To do that, we first have to dispel a few myths about health care abroad:

1. It's all socialized medicine out there.

Not so. Some countries, such as Britain, New Zealand and Cuba, do provide health care in government hospitals, with the government paying the bills. Others -- for instance, Canada and Taiwan -- rely on private-sector providers, paid for by government-run insurance. But many wealthy countries -- including Germany, the Netherlands, Japan and Switzerland -- provide universal coverage using private doctors, private hospitals and private insurance plans.

In some ways, health care is less "socialized" overseas than in the United States. Almost all Americans sign up for government insurance (Medicare) at age 65. In Germany, Switzerland and the Netherlands, seniors stick with private insurance plans for life. Meanwhile, the U.S. Department of Veterans Affairs is one of the planet's purest examples of government-run health care.

2. Overseas, care is rationed through limited choices or long lines.

Generally, no. Germans can sign up for any of the nation's 200 private health insurance plans -- a broader choice than any American has. If a German doesn't like her insurance company, she can switch to another, with no increase in premium. The Swiss, too, can choose any insurance plan in the country.

In France and Japan, you don't get a choice of insurance provider; you have to use the one designated for your company or your industry. But patients can go to any doctor, any hospital, any traditional healer. There are no U.S.-style limits such as "in-network" lists of doctors or "pre-authorization" for surgery. You pick any doctor, you get treatment -- and insurance has to pay.

Canadians have their choice of providers. In Austria and Germany, if a doctor diagnoses a person as "stressed," medical insurance pays for weekends at a health spa.

As for those notorious waiting lists, some countries are indeed plagued by them. Canada makes patients wait weeks or months for nonemergency care, as a way to keep costs down. But studies by the Commonwealth Fund and others report that many nations -- Germany, Britain, Austria -- outperform the United States on measures such as waiting times for appointments and for elective surgeries.

In Japan, waiting times are so short that most patients don't bother to make an appointment. One Thursday morning in Tokyo, I called the prestigious orthopedic clinic at Keio University Hospital to schedule a consultation about my aching shoulder. "Why don't you just drop by?" the receptionist said. That same afternoon, I was in the surgeon's office. Dr. Nakamichi recommended an operation. "When could we do it?" I asked. The doctor checked his computer and said, "Tomorrow would be pretty difficult. Perhaps some day next week?"

3. Foreign health-care systems are inefficient, bloated bureaucracies.

Much less so than here. It may seem to Americans that U.S.-style free enterprise -- private-sector, for-profit health insurance -- is naturally the most cost-effective way to pay for health care. But in fact, all the other payment systems are more efficient than ours.

U.S. health insurance companies have the highest administrative costs in the world; they spend roughly 20 cents of every dollar for nonmedical costs, such as paperwork, reviewing claims and marketing. France's health insurance industry, in contrast, covers everybody and spends about 4 percent on administration. Canada's universal insurance system, run by government bureaucrats, spends 6 percent on administration. In Taiwan, a leaner version of the Canadian model has administrative costs of 1.5 percent; one year, this figure ballooned to 2 percent, and the opposition parties savaged the government for wasting money.

The world champion at controlling medical costs is Japan, even though its aging population is a profligate consumer of medical care. On average, the Japanese go to the doctor 15 times a year, three times the U.S. rate. They have twice as many MRI scans and X-rays. Quality is high; life expectancy and recovery rates for major diseases are better than in the United States. And yet Japan spends about $3,400 per person annually on health care; the United States spends more than $7,000.

4. Cost controls stifle innovation.

False. The United States is home to groundbreaking medical research, but so are other countries with much lower cost structures. Any American who's had a hip or knee replacement is standing on French innovation. Deep-brain stimulation to treat depression is a Canadian breakthrough. Many of the wonder drugs promoted endlessly on American television, including Viagra, come from British, Swiss or Japanese labs.

Overseas, strict cost controls actually drive innovation. In the United States, an MRI scan of the neck region costs about $1,500. In Japan, the identical scan costs $98. Under the pressure of cost controls, Japanese researchers found ways to perform the same diagnostic technique for one-fifteenth the American price. (And Japanese labs still make a profit.)

5. Health insurance has to be cruel.

Not really. American health insurance companies routinely reject applicants with a "preexisting condition" -- precisely the people most likely to need the insurers' service. They employ armies of adjusters to deny claims. If a customer is hit by a truck and faces big medical bills, the insurer's "rescission department" digs through the records looking for grounds to cancel the policy, often while the victim is still in the hospital. The companies say they have to do this stuff to survive in a tough business.

Foreign health insurance companies, in contrast, must accept all applicants, and they can't cancel as long as you pay your premiums. The plans are required to pay any claim submitted by a doctor or hospital (or health spa), usually within tight time limits. The big Swiss insurer Groupe Mutuel promises to pay all claims within five days. "Our customers love it," the group's chief executive told me. The corollary is that everyone is mandated to buy insurance, to give the plans an adequate pool of rate-payers.

The key difference is that foreign health insurance plans exist only to pay people's medical bills, not to make a profit. The United States is the only developed country that lets insurance companies profit from basic health coverage.

In many ways, foreign health-care models are not really "foreign" to America, because our crazy-quilt health-care system uses elements of all of them. For Native Americans or veterans, we're Britain: The government provides health care, funding it through general taxes, and patients get no bills. For people who get insurance through their jobs, we're Germany: Premiums are split between workers and employers, and private insurance plans pay private doctors and hospitals. For people over 65, we're Canada: Everyone pays premiums for an insurance plan run by the government, and the public plan pays private doctors and hospitals according to a set fee schedule. And for the tens of millions without insurance coverage, we're Burundi or Burma: In the world's poor nations, sick people pay out of pocket for medical care; those who can't pay stay sick or die.

This fragmentation is another reason that we spend more than anybody else and still leave millions without coverage. All the other developed countries have settled on one model for health-care delivery and finance; we've blended them all into a costly, confusing bureaucratic mess.

Which, in turn, punctures the most persistent myth of all: that America has "the finest health care" in the world. We don't. In terms of results, almost all advanced countries have better national health statistics than the United States does. In terms of finance, we force 700,000 Americans into bankruptcy each year because of medical bills. In France, the number of medical bankruptcies is zero. Britain: zero. Japan: zero. Germany: zero.

Given our remarkable medical assets -- the best-educated doctors and nurses, the most advanced hospitals, world-class research -- the United States could be, and should be, the best in the world. To get there, though, we have to be willing to learn some lessons about health-care administration from the other industrialized democracies.

T.R. Reid, a former Washington Post reporter, is the author of "The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care," to be published Monday

http://www.washingtonpost.com/wp-dyn/conte...2101778_pf.html

This article makes some good points but I think it's obvious that it's one-sided. However, the more important point is that this article is at most a case for health care reform in America. But most of us agree; we need reform. It's only a question of how. The article actually does little to support one form of reform or another.

As the article points out, the American health care system is already fragmented, highly regulated, and, for many demographics, socialized. What we have is not the free market run-a-muck. Most of the problems in American healthcare are caused by the government doing a whole bunch of half measures.

Let's consider some of the root causes why healthcare in the US is expensive, slow (in terms of waiting for an appointment), and ineffective.

1. Malpractice insurance. The American legal system awards huge sums to trial lawyers and plaintiffs. Although outrage when suffering occurs from a doctor's mistake is understandable and justified, everyone makes mistakes. It's ridiculous to cripple the entire health care system because of this. Reasonable health care reform needs to address this issue. Awards should be limited to reasonable sums at the very least. In my opinion, a doctor should only be liable if he/she made a decision that he/she knew was suboptimal at the time. And the burden of proof should be on the plaintiff. Also, lawyers should be financially responsible for bringing worthless cases to court. The current house bill contains no tort reform (not even a limit on malpractice awards).

Read this article for more on malpractice insurance:

http://www.cbsnews.com/stories/2004/04/02/...ain610102.shtml

2. Regulation/Prohibition of interstate insurance companies. In America, health insurance companies cannot operate across state lines. Think about it. Even if there are only 2 or 3 insurance companies in each state, that's over 100 options if you allow buying insurance across state lines. Although some states have only 1 major provider, some have more than half a dozen, so several hundred total US providers is a reasonable estimate. But the government only allows a person to have access to a couple.

3. Payroll taxes: Most Americans receive insurance through their employer. That seems counterintuitive. The reasonable thing is for the company to pay employees the money spent on health care so that employees could purchase their own insurance. Although you would lose collective bargaining power, that isn't a problem for auto insurance, homeowners insurance or life insurance, which many Americans buy independently, for reasonable rates (in my opinion). The real reason that Americans receive health insurance through employers is to reduce payroll taxes. If the company pays you more money, they have to pay more payroll taxes. A competitor (for employees) can offer comparable benefits for a lower bottom line by reducing pay but paying for health care directly. A reasonable solution here would be to lower the payroll tax rate and tax all benefits. Companies would have an incentive to let people look for their own healthcare.

4. Income taxes on Doctor's income: In combination with malpractice insurance, office overhead, and other things that reduce a Doctor's take-home pay, many Doctor's work reduced schedules and take more vacation. The current progressive tax system means that doctors effectively make less money on the fifth day of a workweek than on the other 4 (or the last month in a year, or however you like it). Thus, there is much less incentive to a doctor who owns his own practice to stay open 5 days a week. This is particularly true in a practice with multiple doctors. Usually all of the doctors don't work all of the days.

5. Accumulation of the other 4 (and other factors): This just means that becoming a doctor is less appealing. A lot of kids want to be doctors. They're respected, get to help people, and make decent money. But as the industry gets more convoluted, those kids grow up, face reality and become something else. We're facing a shortage of doctors. This is of course a complicated issue with many factors, but I don't think that any of the above issues are encouraging young people to become doctors.

The claim that insurance companies have runaway profits just doesn't make sense in a free-market environment. If this were the free market, we would have tons of new insurance companies and competition to drive the cost down. Here are two possible explanations. A: Insurance companies are so heavily regulated and controlled that it's impossible for new companies to break into the market. Admittedly, this is an environment that existing companies and lobbyists would try to encourage, but if such a situation exists, you can only blame it on the government for letting it happen. This isn't free market B: Insurance companies really have huge costs and the claims against them are a myth. This includes the possibility that regulation is so difficult to comply with that costs are driven up.

If insurance companies are making huge profits, who are these people that are getting rich. These companies are publicly owned, but their stocks aren't skyrocketing or paying huge dividends. Even if there were a three hundred executives each making tens of millions of dollars, that's only a 3 billion dollars (and that's probably a very generous estimate). Yes that seems like a lot. Yes, it's probably excessive. But in an industry that is around 16% of the American economy, it's barely a blip when it comes to explaining why health care costs are spiraling out of control (Think about it. With 300 million Americans, 3 billion dollars in executive pay is only 10 dollars a person. If average health care costs had only risen 10 dollars over the last couple of years, I don't think we would be having this conversation)

The American government has crippled the health care industry with ridiculous malpractice liability, excessive regulation, unfair competition (in the form of medicaid and medicare which don't cover costs but demand service anyways), and unnecessary complexity, but many politicians proceed to point fingers at insurance companies and the free market as to why American health care is subpar. In reality, we don't have free-market healthcare. As the original article points out, we have a fragmented, unnecessarily complex system that, as a result, has ridiculous overhead costs. Yes, we need to reform the system. Yes, we might look overseas to see what works and what doesn't. That doesn't mean that we need more bureaucracy by introducing a government run health care system.

[DeadPoolX 9]

We need more preventative health care measures. Like this:

[mRx 16]

Nevertheless, as I've already stated, the problem is not insurance, it's health care. My aim was never to make a case defending private insurance, but merely illustrate that it doesn't matter who pays. The costs are astronomical, whether payed by all Americans collectively, or separately via individual plans. Therefore, high hopes of a public plan making health care cheaper are lost.

First off, I cited the per enrollee cost growth above. That's a pretty good indicator of cost containment - since it considers only the actual outlays - and Medicare while not performing well outperformed the private insurance impressively.

OK, I see what you mean. If we're looking at the same data, (Chart 1-7, PP. 9) there appears to be some issues that would make it more difficult to come to the conclusion that Medicare outperforms PHI, as you can see by reading the bullets below the chart.

Actually, looking at that data and the verbiage around it, I noticed that the same conclusion was made there (pg. just under the chart):

• Differences appear to be more pronounced since 1985, when Medicare began introducing the prospective payment system for hospital inpatient services. Some analysts believe that since the mid-1980s, Medicare has had greater success at containing cost growth than private payers by using its larger purchasing power. Others maintain that relative to the 1970s, benefits offered by private insurers have expanded and cost-sharing requirements declined. In addition, enrollment in managed care plans grew during the 1990s. These factors make the comparison problematic, since Medicare’s benefits changed little over the same period.

This is why I say that the government has been more effective controlling cost growth than PHI.

I've added emphasis to the particular points that I was referring to regarding the difficulty of coming to such a conclusion.

As I've said already though, insurance (or who pays for health care) is not the real problem.

...we have more regulation in our health care industry than any country in the world.

Says who? You keep repeating this claim and I must admit that I find this hard to believe.

OK, you're really taking me out of context if your expecting quantified comparisons of per-word health care regulation among countries determining who has the most. You know as well as I do that there is no data available to prove or disprove this. But that's not--and never was--my point. Furthermore, even if I could prove that there are more regulatory agencies in the US (which I probably could), it wouldn't be accurate proof to blame regulation as the problem, would it?

My point--that there is a coercive monopoly enforced by regulation strangling our health care industry, forcing prices up, and unaffected by who pays-- is well-proven, however. A look at the history of the AMA (I posted a great article on this topic, which you seemed to agree with) seems to be solid intent for monopoly, while the fact that US health care is the most expensive in the world is proof that such a monopoly exists.

My main intention of getting in this debate was to prove that costs are rising, irregardless of payer as evident by actuarial data from the Medicare trustee board and rising private premiums; not to get into a pissing match about PHI/Medicare comparisons in which arriving at logical conclusions are problematic (to say the least).

I know this topic is over 10 days old, but I'm out of the US, and internet is not always available.

[Joseph & Ana 0]

Very good summary. Unfortunately, the fact that our health care system is far from the best in the world will fall on deaf ears in this great country of ours. Despite the overwhelming evidence to the contrary, too many Americans have allowed themselves to be manipulated into believing that only the absence of government will produce the best result. It's almost like a religion.

LOL...No, those of us that have dealt with the Government all our adult lives have come to our own conclusions!

The fact of the matter is that there is ample evidence both within the US as well as in other comparable countries that government works better than private for profit enterprise in creating effective and efficient ehalth care systems. Again, Medicare outranks private insurance in service, coverage and cost. The health care systems of comparable countries outrank the US system in effectiveness, efficiency and overall health outcomes. The only item where we rank way on top is cost. Nothing to be proud of.

The evidence that government does a better job of organizing health care is on the table. Your "conclusions" are based on ideology rather than reality.

No one cares that all those countries that were mentioned have BANKRUPT healthcare systems that are unsustainable. France and Germany both being in the news recently.

[Mr. Big Dog 10,747]

Very good summary. Unfortunately, the fact that our health care system is far from the best in the world will fall on deaf ears in this great country of ours. Despite the overwhelming evidence to the contrary, too many Americans have allowed themselves to be manipulated into believing that only the absence of government will produce the best result. It's almost like a religion.

LOL...No, those of us that have dealt with the Government all our adult lives have come to our own conclusions!

The fact of the matter is that there is ample evidence both within the US as well as in other comparable countries that government works better than private for profit enterprise in creating effective and efficient ehalth care systems. Again, Medicare outranks private insurance in service, coverage and cost. The health care systems of comparable countries outrank the US system in effectiveness, efficiency and overall health outcomes. The only item where we rank way on top is cost. Nothing to be proud of.

The evidence that government does a better job of organizing health care is on the table. Your "conclusions" are based on ideology rather than reality.

No one cares that all those countries that were mentioned have BANKRUPT healthcare systems that are unsustainable. France and Germany both being in the news recently.

Bull. Neither country pays nearly as much per capita or nearly as much as share of the GDP for health care - universal health care no less - as the US does. If the German or French systems were bankrupt as you claim - which they are not - then the US system would be beyond bankrupt at this point. Take Germany for example:

Mention European health care to an American, and it probably conjures up a negative stereotype — high taxes, long waiting lines, rationed care.

It's not that way in Germany. Very little tax money goes into the system. The lion's share comes, as in America, from premiums paid by workers and employers to insurance companies.

German health benefits are very generous. And there's usually little or no wait to get elective surgery or diagnostic tests, such as MRIs. It's one of the world's best health care systems, visible in little ways that most Germans take for granted.

Checking In With An Old Friend

Juergen in der Schmitten was a medical student when I first met him 17 years ago. Now, he's a 42-year-old general practitioner in a suburb of Dusseldorf.

On one particular night, Juergen was the doctor on call for the region. Any German who needs after-hours care can call a central number and get connected to a doctor.

Around 11 p.m., a woman with a fever called Juergen. She wanted him to make a house call. They talked for maybe five minutes, in the end agreeing that she would come into his office in the morning.

A situation like this would be unlikely in the United States. Americans might not get through to a doctor at all, let alone have a discussion about whether the physician should make a house call in the middle of the night to treat a case of flu.

The Patients' Perspective

Sabina and Jan Casagrandes say they've had really good care from the German health system. And they've used it a lot.

Sabina is American, Jan is German. They live in a fourth-floor walkup with their two little girls in Cologne, an ancient city on the Rhine in western Germany.

"I've probably been very expensive for the health insurance system here," Sabina says. "When I was 33 years old, I had a giant lump on my neck all of a sudden, where your thyroid is. And it was a big tumor."

It took two operations to remove her cancer. Luckily it was curable with surgery and radiation. Sabina says she had the best care she could imagine.

"Then I came home to my little daughter, who I couldn't really lift up because of my neck having been cut open," Sabina says. "So I asked my doctor, 'What can I do?' And she said, 'Well, your health insurance will pay for someone to come help you in the house.'"

Sabina's health insurer paid a friend to shop, cook and even help care for the baby until Sabina was back on her feet. That's not unusual in Germany. In fact, under the country's system for long-term care, family members can choose to be paid for taking care of a frail elder at home if they want to avoid nursing home care.

Coverage For All

The health care system that took such good care of Sabina is not funded by government taxes. But it is compulsory. All German workers pay about 8 percent of their gross income to a nonprofit insurance company called a sickness fund. Their employers pay about the same amount. Workers can choose among 240 sickness funds.

Basing premiums on a percentage-of-salary means that the less people make, the less they have to pay. The more money they make, the more they pay. This principle is at the heart of the system. Germans call it "solidarity." The idea is that everybody's in it together, and nobody should be without health insurance.

"If I don't make a lot of money, I don't have to pay a lot of money for health insurance," Sabina says. "But I have the same access to health care that someone who makes more money has."

But she acknowledges that nearly 8 percent of her salary is a sizable bite.

"Yes, it's expensive. You know, it's a big chunk of your monthly income," Sabina says. "But considering what you can get for it, it's worth it."

Actually, it's about the same proportion of income that American workers pay, on average, if they get their health insurance through their job. The big difference is that U.S. employers pay far more, on average, than German employers do — 18 percent of each employee's gross income versus around 8 percent in Germany.

More Added Benefits In Germany

Moreover, German health insurance has more generous benefits than U.S. policies cover. There are never any deductibles, for instance, before coverage kicks in. And all Germans get the same coverage.

For instance, the Casagrandes' insurance covers an expensive medicine Jan needs for a chronic intestinal problem. He says if they moved to America, they might not be able to buy insurance at all because of their pre-existing conditions — a nonproblem in Germany.

"He says for himself — or for us — the health care system in the United States is the major reason why we have never moved there, and never will move there. Because both of us have chronic illnesses that have to have a lot of medical attention, and we would go broke," Sabina says, translating for Jan.

Jan adds something else. "It's also the No. 1 reason in the United States that people personally go bankrupt," Sabina translates, "which would never happen here ... never!"

Coverage For The Family

On the other side of Germany, in Berlin, we meet another couple who know both the American and German health systems.

Nicole and Chris Ertl own Tip Toe Shoes, a children's shoe shop in a well-off area of the German capital. The Ertls sell high-quality European shoes — tiny Italian sandals, French and Danish boots and clogs in wonderful colors.

Chris is from San Diego, Nicole is German. She also works part time as a physician therapist and gets her health care through her job like the great majority of Germans. Like the Casagrandes, she's happy with her coverage.

"It's a good deal!" she says. "It's really good because it's a package."

It's a package many Americans might envy. Nicole pays a premium of $270 a month for insurance that covers her children, too. Nicole pays a single $15 copayment once every three months to see her primary-care doctor — and another $15 a quarter to see each specialist, as often as she wants. She pays no copayments for her children's care —-and her insurance even covers her daughter's orthodontia bill.

"They always have good care," Nicole says, "because for kids, everything is free. The drugs, it's always free" until they turn 18.

Different Rules For The Self-Employed

But even though her insurance covers the kids, it doesn't cover her husband. Because Chris Ertl is self-employed, he has to buy insurance on his own, from a for-profit insurance company.

About one in 10 Germans buy this so-called "private" coverage. It's not just for people who are self-employed. Civil servants and anyone who makes more than $72,000 a year can opt out of the main system. It's a kind of safety valve for people who want more and can pay for it.

But most people don't opt out. Chris says that's because there's a fundamental difference in the way Germans view health care and the government's role — which, in Germany, means refereeing the system and making sure it's fair and affordable.

"The general opinion in Germany is always that the government will do it for us, everything will be OK," Chris says. "In the States, I think you grow up knowing that no one's going to help you do anything. If you want health care, go get it."

It's important to remember that the German government doesn't provide health care or finance it directly. It does regulate insurance companies closely — the nonprofits in the main system and the for-profits where Chris gets his coverage. So Chris' insurer can't raise his rates if he gets sick or jack up his premiums too much as he gets older. The government also requires insurers to keep costs down so things don't get too expensive.

"Where am I better off medically?" Chris says. "I would probably say Germany."

In some ways, Chis Ertl's coverage is better than his wife's. He gets his choice of top doctors — the chief of medicine, if he wants. If he goes into the hospital, he gets a private room. When he goes to the doctor, he gets a free cup of coffee and goes to the head of the line. All this embarrasses him — and annoys Nicole.

"When he goes to the doctor, he has a lot more service," she complains.

Germans really hate any hint of unfairness in health care. The fundamental idea is that everybody must be covered and, preferably, everybody should get equal treatment. So the fact that 10 percent or so can buy some perks is an irritant — something Germans complain about but manage to put up with.

But it's unthinkable that 48 million people wouldn't have health insurance at all — the situation in America. As an American, Chris thinks that's shameful. "It's terrible," he says. "It's unbelievable. It shouldn't happen."

Germans, he says, would never tolerate that. And their system has been working pretty well for 125 years.

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T.R. Reid - the author from the OP, will be on Frontline (PBS) tonight with an in depth coverage of health care systems around the world. Matt, if you read this - please do yourself a favor and at least watch it.

Sick Around the World

T.R. Reid examines the health-care systems of countries including England, France, Germany, Japan and Switzerland for ideas on how to improve care in the U.S. duration: 60 min details: [CC] [sTEREO]