Ken DeShaies: U.S. health insurance a broken system |

Ken DeShaies: U.S. health insurance a broken system

Ken Deshaies

T. R. Reid has done what many of us wish we had the time and money to do – investigate the health care systems in many of the industrialized nations. The book is full of statistics and charts and is well researched – by actually visiting each of the countries. The one thing that makes the U.S. so different from every other developed nation is that we have not considered it a moral obligation to provide health care to every citizen. We spend anywhere from 40 percent more to three times what all the other countries pay for health care. In 2005 numbers, we spend 17 percent of our GDP on health care, France spends 11 percent, the U.K. and Japan are at 8 percent and Taiwan is at 6 percent.

We rate lowest or near lowest among developed nations in every measure of quality, yet leave a significant portion of our population uncovered. We are the only nation that has decided that the provision of health care should be a profit-making endeavor. We are the only nation that allows its citizens to get into financial trouble, and even bankruptcy, over health care costs. And we are the only one that seriously rations health care delivery – it’s done primarily via insurance company denial of claims and of coverage. For medications, we pay anywhere from twice to 10 times what other countries pay for the same pill made in the same factory.

Only a couple of the countries operate health care delivery as a socialist system – the U.K. and Canada, for example. Most are hybrids or privatized systems. In France, there are dozens of insurance companies (everyone has to have insurance coverage – the government covers premiums for the poor), and all doctors, clinics, hospitals are privately owned and operated. The government simply sets the premiums and the reimbursement levels for all procedures. And the ways they save money (read, keep costs under control) are innovative and effective. In Japan, for example, doctors went to companies that make MRI scanners and got them to develop scanners that cost one-tenth of what we pay in this country. The scanners just don’t have all the bells and whistles a full-featured scanner has. In France, doctors do not have administrative assistants or records rooms. Every citizen carries a health card, called the Vital Card, that has every visit, every procedure, every pill and medication that you’ve ever had. When you visit the doctor, they simply swipe the card through a reader and voila, your health history is at hand. A study by the Bank of America concluded that if we could get our spending down to the French level, we’d save over $600 billion a year – enough to cover every citizen in this country.

Other countries are smart enough to also look at long-term savings. Our insurance companies consider preventive care a cost they can avoid, so most of our preventive care is government sanctioned (think smoking warnings and education). Other countries recognize the value of keeping people healthy and encouraging healthy lifestyles. They spend significant amounts to insure that you have regular physicals, that you are coached about healthy living, and understand that the savings in the future will pay the cost of preventive care many times over.

For those who feel malpractice insurance is one of our highest costs, it should be noted that doctors in other countries are rarely sued, that in fact they never expect to be sued, and the cost of such insurance in every other developed country is but a tiny fraction of what it is in the U.S.

U.S. insurance companies are happy to take your premiums as long as you don’t need the coverage. But they will spend tons of money to deny your claim or terminate your coverage when you need them most. It’s a shell game where only they know the rules. You are, in every case, the mark. They initially deny about 30 percent of all claims. Americans under 65 cannot get health coverage that is permanent.

The GAO has estimated that if we could get the administrative costs under control (down from the 20 percent margin enjoyed by private insurance companies to the less than 4 percent that it costs Medicare) the savings would pay for health care for all. And that is the truth that politicians don’t want you to hear, or understand or believe.

Get this book. It will be one of the most important you’ve ever read.

Ken Deshaies lives in Silverthorne.

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