Frontline on Healthcare

I watched a pretty good documentary yesterday on Frontline concerning universal healthcare and how it is achieved throughout the world. The host, T.R. Reid, who has done some great documentaries for Frontline, visits 5 other countries, all capitalist democracies who have universal healthcare in one form or another.

The UK is the first place he goes, and discussed their waiting lists, which you've mentioned in the past. There are no waiting times for primary care, or emergency room visits, but there are some waits for what he calls "elective" procedures, like hip replacement. Apparently, though, in the past 10 years, waiting times for these procedures have dropped significantly, to about a third, or even less, what they used to be.

This is the only single payer system he visits. The other four are Germany, Japan, Switzerland, Taiwan, which have universal care with many market forces built in. Switzerland is the closest example to our system, as they had virtually the same system we did before they went universal, and did so in 1994, at the same time Hillary made her first attempt at restructuring our system. The four countries are similar, in they have 4 fundamental similarities:

1. Private insurers must accept everyone, no matter their health condition.
2. The basic, standard level of health care dictated by the government must be non-profit, although suplemental insurance can be offered for-profit.
3. Puchase of coverage is mandatory for all citizens, while the government pays or suplements the costs for poor and lower class.
4. Government regulation of pricing for services offered.

The documentary does show the negatives to these systems. The biggest is that spending is far too low in Japan and Taiwan, to the point where hospitals and doctors are struggling to stay open. This would seem to be a big "Ah Ha!" moment for those who are against government price controls, but upon looking at another fact, this Gotcha is rebuffed slightly. The U.S. spends around 16-17% GDP on healthcare, where Taiwan is just over 6%, and Japan just over 8%. This number is obviously very low, and the government should be taking steps to ensure medical care providers are able to stay in business. You also have to remember that no matter what they're getting, even if it's a fair amount, people are always going to complain that they're not getting enough, that they want/need more.

This also leads to a common criticism that doctors are paid much less, and therefore there's much less incentive to become a doctor. Firstly, the concept that all, or even most, people who become doctors do it for the financial gain is probably wrong. Next, all of these countries subsidize medicial school for potential doctors, making barriers to entry much smaller. Hell, I might have become a doctor if didn't have to sadle myself with a quarter million dollar debt just to do so. Third, all of these countries control the cost of malpractice insurance, drastically lowering one of the major costs of being a doctor. Finally, the overhead of being a doctor is much lower, since the insurance companies can't dictate what care a patient receives, the struggle of a doctor's office to get paid to treat a patient drastically lowers, so they'll no longer need a small army of paperworkers.

The issue of the pharmaceutical industry is addressed in this documentary, but not on a satisfying scale. Personally, the drug companies may be making wonder drugs, but I'm not completely sold on this idea. For the sake of argument, even saying that they are, at what cost are they doing it? If a family has to suffer financial disaster to afford these wonder drugs, what good are they? T.R. Reid states that over 700,000 families a year go bankrupt in America due to medical emergency. He asks every health minister and president he meets in the movie how many families of each of these universal healthcase countries goes bankrupt because of medicial reasons, and every single one says none, that it would be national scandal if such a thing were to occur.

In the end, he basically makes a plea to look around the world to find what works, instead of just creating a system out of thin air, or even having no system at all, as we do now. The show is listed at one hour, but it's nearly 10 minutes shorter than that. Well worth a watch.