Matthew Holt

Sunday reading-Jon Cohn on French & Dutch health care

Jon Cohn has a long article in the Boston Globe about how the French and Dutch get health care about right at half the American cost with none of that unpleasant Canadian or Britishness that FoxNews loves to complain about. Given that (if we get reform even vaguely right) we’ll look more like Holland or Germany that Canada, it's your essential Sunday reading.

Of course Jon is slightly too nice as ever. One minor point about access to specialty care—it may take longer there than here, slightly. But in the same Commonwealth study Cohn quotes, waiting times for elective surgery were shorter in Germany than they are in the US. And of course no one there gets bankrupted by the cost of medical care.

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George BergerMatthew HoltJohn R. GrahamBarry CarolNate Recent comment authors
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George Berger
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George Berger

I lived in Amsterdam from 1 June. 1972 till 8 Jan. 2009, I now live in Uppsala, Sweden. I shall cut-and-paste an article that I wrote and published, describing the disappointment that ended my stay there. DUTCH HEALTHCARE IS A DANGEROUS ‘ANOMALY IN EUROPE’ George Berger (PhD), Uppsala, Sweden 21 April 2009 The Netherlands is often thought to have a system of public healthcare whose generosity and effectiveness approaches those of the Scandinavian countries. Such notions no longer reflect reality. The country once had a mixed, public-private system that guaranteed access to everyone, provided excellent service, and was financed by… Read more »

Tom Leith
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Tom Leith

> Tom I was thinking the diabetes center
> would be capitated by the individual.
That’s fine, so long as the patient actually writes the check (so to speak). I think it’d help compliance to have a monthly payment (amateur psych) but you know you take what you can get.
t

Nate
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Nate

Matthew again i must disagree. Many more people maybe, many many more people is hyperbole. ***not intended to be read by anyone working for a pharmasutical company***** We have a program where any clients within a couple hundred percent of the federal poverty rate get carved out of the companies drug plan and put into pharmasutical assistance programs for all their brand drugs at no cost or $95 a month. A person diagnosied with a chronic disease that is following proper care guidelines will usually cost less if the plan eliminates cost sharing, removing any impedments to adequate care. The… Read more »

Matthew Holt
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Nate, much as I love you I’m not reading a 24 pge academic paper on bankruptcy formulas in Germany–especially as it wasn’t the country Cohn referred to. However, as the bankruptcy data includes lots of confounding factors, let me change the loose line to the tighter one of “many many more people in the US have trouble paying their medical bills” which is validated by the many Commonwealth studies http://tiny.pl/hhhng By the way, in the UK, the BMA just suggested abolishing the 7.50 GBP charge per Rx, saying that people with multiple prescriptions were having trouble paying–similar to Pitney Bowes… Read more »

Tom Leith
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Tom Leith

Oh, it doesn’t put my e-mail address automatically on the posts any more. Just as well, I suppose. Here you go: trl at masterpractice dottt com.
t

Tom Leith
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Tom Leith

Thanks for the pointer to the Cochrane paper, John. I’m finally reading Michael Cannon’s “Healthy Competition” and microeconomics has been a hobby of mine for a long time, so I guess it is not too surprising I’d think of something like “health status insurance”. Great minds and all that. I’ll have to read it (haven’t yet, but I found it. For the interested: http://www.cato.org/pubs/pas/pa-633.pdf) And yep, if “medical status insurance” can be treated like life insurance, the complication of an HSA isn’t really necessary. Nate, at least once upon a time it was OK to have a disability policy that… Read more »

Nate
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Nate

lol wonder if i pulled one out of the liberal playbook book and called capitation “global reimbursement” instead if the regulators would let me get away with it

Nate
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Nate

Tom that is a very interesting proposal. And Timely as I have a couple employers I am trying to help now that have problems with diabetics. It can be done but it effects the remaining benefits. Carriers now sell catastrophic illness policies that do just that, you get diagnosied with this we give you $20,000. Where you get in trouble is with HIPAA and ADA. People don’t realizie how much those two laws increased the cost of insurance. If you paid out 250,000 for diabetes you could not pay out more I don’t think for another illness. This would be… Read more »

John R. Graham
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Tom Leith: You wouldn’t even need an HSA. Just structure it like life insurance, for which proceeds are usually not taxable. I doubt that it would be as simple as you describe, but if you read John Cochrane’s paper on health-status insurance (Cato Institute, February 2009) he concludes that all the ailments and co-morbidities would result in a manageable schedule of allowances. The primary reason it does not exist today is that the government makes us get our health “benefits” from our employers. So, the insurers compete on an artificial economy of scale, by which they negotiate networks on behalf… Read more »

Peter
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Peter

“Providers, including hospitals and physician groups, show precious little interest in assuming this risk through either capitation, bundled payments or global budgets.” Barry, the U.S. system only rewards use/overuse, it does not reward thrift. Universal budgets would solve(force) a change to this mentality and waste. “Patients who want to shift to taxpayer financing seem to be saying, in effect: Don’t talk to me about actuarial risk. I want whatever healthcare services my doctor and I think will benefit me and whatever its costs, it costs and taxpayers should pay.” Which patients? NOT ME. I’ve always said that single-pay would fail… Read more »

John R. Graham
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Cohn’s article is well written, but I don’t see how he can claim that Republicans are against reform. Even John McCain proposed that the government should free Americans to buy health insurance that we chose, instead of forcing us to accept health “benefits” that our employers chose.
While this would make U.S. health insurance look more “European” in one sense, it wouldn’t put the government in charge.

Tom Leith
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Tom Leith

That’s really close Barry — I think it is more like “I want whatever healthcare services I think might have the remotest possibility of helping, somebody else should pay the bill, and I don’t care who else thinks what, no not even my doctor.” This is the condition we’re in and the courts have more or less gone along with it. (Contracts are always construed against the more powerful/knowledgable party). So Nate: would it be legal to write a medical insurance policy that says something like “if you’re diagnosed with Type II Diabetes you get a lump sum payment of… Read more »

Peter
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Peter

“The reasons named are similar to those mentioned in the U.S., with unemployment, divorce, and illness being among the top causes…”
I guess then Nate what you’re saying is that the further away you get from government run single-pay (Germany, Netherlands) the closer you get to medical bankruptcy.

Wendell Murray
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Reform is “hard” solely due to the accretion of vested interests that have more or less gotten their way over the decades primarily from the end of WWII. The issues are solely political. In terms of common-sense, factual evidence everywhere and so on reform is as simple as can be.
That is the point of Mr. Cohn’s article along with many other similar articles.

Barry Carol
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Barry Carol

Jon Cohn writes: “The French spend around 11 percent of their gross domestic product on healthcare, the Dutch around 10. In the US, we spend around 16 percent.” I wonder how much more the French and the Dutch would be spending if they paid U.S. prices for hospital care, physician fees, drugs, devices and imaging. I think the spending gap as a percentage of GDP would be much narrower assuming no changes in actual healthcare utilization in any of the three countries. When contemplating reform, I think we significantly underestimate the importance of culture in determining what people are prepared… Read more »