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Which Country has the Better Heath Care?

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Which Country has the Better Heath Care?

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Aaron E. Carroll and Austin Frakt. September 27th, 2017. "Which Country Hasthe Best Health Care System? Readers Respond." Within the article they gave the chance for the viewers to leave their own opinions on the subject which they would respond to. One viewer wrote, as a holder of American and British passports and health care "If you’ll forgive me for saying so, the U.S. system has a sense of selfishness to it. Your country seems to have lost your sense of “together.” Rather, it looks like “everyone for themselves.” whereas the Authors completely agreed that with the freedom of choices come the choice of being without health care. In my opinion I wholeheartedly agree but with the freedom of choice its not that they are choosing not to have it they simply can't.

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If you missed it, read our bracket tournament on the best health system in the world. Aaron E. Carroll and Austin Frakt, who wrote the article, are back to answer reader questions. TRANQUILLITY OF SPIRIT

I have both French and American passports. Americans should understand the tranquillity of spirit that truly universal health care brings to a population. People have worries ... but not about losing everything because of an illness. - Bob Nelson, Calais, France

I'm British. For me the idea that "Can I afford to accept treatment?" is bizarre. And harsh. If you'll forgive me for saying so, the U.S. system has a sense of selfishness to it. Your country seems to have lost your sense of "together." Rather, it looks like "everyone for themselves." - Arthur, Glasgow

Austin and Aaron respond: You are certainly not the only people to feel that way, but it seems many Americans value choice over security. This includes plentiful options for health insurance, including the "choice" to be uninsured. This freedom comes with at least three kinds of costs. First, it's more than just a headache to choose a health plan. Studies show people - even experts - are terrible at doing so, routinely picking plans that aren't the best for them. Second, the vast array of health plans with varying requirements and protocols impose administrative costs on physicians and hospitals. By one estimate, the administrative complexity of the U.S. health care system adds nearly $300 billion per year in avoidable costs. Third, strong results from the Oregon Medicaid study (a randomized trial of access to Medicaid coverage) include that the program significantly reduced the financial risk of poor health and improved mental health. It's safe to say that the U.S. health care system may be many things, but tranquil isn't one of them.
DARN PAPERWORK

I have practiced medicine for nearly 40 years, mostly in a large academic health center. The frictional administrative costs of multiple insurers, each with its own forms, rules, payment, denials and appeals apparatus, highly paid C-suites, shareholders, etc., and the counterpart to this required by all providers in order to get paid - billers, coders, compliance folks, etc. - is a colossal waste and does nothing to enhance access or quality of care. - Concerned MD, Pennsylvania

I chose France, for many reasons, but primarily because their system is well organized and administered, which results in better and more efficient care for patients. Check out their "card of life," which contains timely, accessible and secure health care/financial info and speeds payment to doctors and hospitals. Far less paper and insurance hassles and denials. - Scott, Port St. Lucie

Austin and Aaron respond:
In a comparison of the U.S. and Canadian health systems, scholars at Harvard concluded that the commercial health care market in the United States imposes inefficiently high administrative costs. One reason they're not lower is that no single insurer can move the system toward efficiency - it's a collective action problem. But some of the high cost imposed on doctors and hospitals may benefit insurers, since they lead to delayed payments and denial of claims.

Patients are caught in the middle when health care providers and insurers bicker over claims and care. That kind of tussle seems to be reduced when the provider is the insurer - as when a hospital system offers a health plan. This is more evidence that the organization of health systems and coverage can make a difference in consumers' experience, just as the commenters suggest.

However, we should be careful not to think there are too many savings to be had by removing just any kind of administrative waste. A number of advocates have argued that by removing medical underwriting and individual rating, insurers would be much more efficient and save money. After the Affordable Care Act imposed guaranteed issue and community ratings, huge savings did not result. Further, one person's waste is another person's job. The trade-offs can't be ignored.

THE SWEET SPOT IS REGULATED NONPROFITS?

Based on personal experience with the German health care system and my sister's personal experience with the Swiss system: Both systems use competing nonprofit private companies (that is the key) that are heavily regulated. A highly regulated nonprofit company is an efficient compromise construction between a government single-payer system (not exposed to competition) and between a free market of competing, unregulated, for-profit health insurance companies. - Gerhard, NY

Austin and Aaron respond:
This may be entirely correct. Let's remember that Switzerland won the battle, and most people in that country do have insurance from a regulated market of guaranteed-issue, community-rated nonprofit private insurance companies. Many components of the United States health care system are nonprofit, too, and there's a robust literature on how nonprofit and for-profit entities fare relative to each other. For instance, there appears to be a relationship between the availability of nonprofit nursing homes in an area and levels of consumer welfare. A " review of systematic reviews" of profit versus nonprofit hospitals found that for certain outcomes nonprofit hospitals performed better. Overall quality and efficiency differences could not be determined, though. In general, however, it appears that for-profit entities focus on cost (pushing it lower) while nonprofits focus on quality (pushing it higher). There are always trade-offs, and we in the U.S. have generally favored the latter.

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Which Country Has the Best Health Care System? Readers Respond

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If you missed it, read our bracket tournament on the best health system in the world. Aaron E. Carroll and Austin Frakt, who wrote the article, are back to answer reader questions. TRANQUILLITY OF SPIRIT I have both French and American passports. Americans should understand the tranquillity of spirit that truly universal health care brings to a population.

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The Economics of Healthcare: Crash Course Economics #29

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Angelo Abundes barackobama, berniesanders, +15 others Today I found this cartoon and it helped me realize that our system needs change. #europeanhealthcare #reform #healthcare Angelo Abundes There is no reason to ignore an issue at hand #noexcuses #heathcare #change repadamschiff, mikethompsondes...

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Republicans attempt to defend their new bill for tax-reform.

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Republicans attempt to defend their new bill for tax-reform.

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Stephen Collinson. December 20th, 2017. "GOP borrow 'Obamacare' playbook to defend tax bill: You'll like it when you see it." The article tells about how Republicans are using a very similar argument to what Obama had used years ago to gain support for his Obamacare act claiming that lawyers should pass it as its the "right thing to do." I believe that in the sense of passing bills there is no "right thing to do" and that such an argument by the republicans ludicrous and is just to get it passed, the morally right thing to do in the sense of good of doing good is to deny the bill.

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Republicans finally have their longed-for tax reform, but now they have to sell it. And the rhetoric they are using to do so is raising comparisons to desperate Democratic efforts to mitigate the unpopularity of Obamacare seven years ago.

In short: It will get more popular once people learn more about it and the other party stops criticizing it.

"I got to say, out there on TV telling mistruths, disguising the facts of this thing, that's going to make it unpopular," House Speaker Paul Ryan, R-Wisconsin, said Tuesday.

"The lies that have been spread, they vanish because you see what's in the bill," Democratic Sen. Chuck Schumer of New York said in 2010, predicting that when seniors got better access to prescription drugs and small businesses secured tax cuts under the new law, the public would quickly embrace it.

Every big piece of legislation is a leap of faith, especially those, like the GOP's latest triumph and the Affordable Care Act, that are passed along purely partisan lines.

Back in 2010, the ACA was viewed by the public almost as unfavorably as the Tax Cuts and Jobs Act -- which Tuesday night was saddled with a long, legislative-ese name -- is now.

At that time, according to a CNN Opinion Research Poll, 59% of Americans opposed Obamacare, as Republicans torched the plan as a huge government takeover of health care. On Tuesday, a new CNN poll found that 55% of voters opposed the controversial Republican tax bill, which is branded by Democrats as a massive bonanza for the rich.

Back in 2010, President Barack Obama's White House rationalized the ACA's unpopularity by arguing that it was the process of passing the bill, not the benefits contained in it, that were unpopular. Officials also accused Republicans of diminishing the measure's support by demonizing its provisions. Democrats voiced repeated confidence that once it became law, Americans would love it.

In early March 2010, the White House was betting that while Obamacare was unpopular with voters, opinion would soon turn in the favor of Democrats, The New York Times reported.

"The President has always subscribed to the notion that the politics will catch up," then-White House spokesman Robert Gibbs told the paper.

Top Senate Democrats shared those hopes.

"I think as people learn about the bill, and now that the bill is enacted, it's going to become more and more popular," Schumer, now the Senate minority leader, said on NBC's "Meet the Press" on March 28, 2010. Six months later, Obama's then senior political adviser David Axelrod, a few weeks ahead of a midterm election that saw the GOP win back the House -- partly owing to the ACA's unpopularity -- also predicted that voters would eventually rebound to the President's favor.

"I think that health care over time is going to become more popular," Axelrod said on "Meet the Press" on September 12, 2010.

In some ways, Axelrod was correct, despite the midterm election rout. Obamacare did slowly become more popular, and by the time Trump and the GOP attempted to repeal it this year it was marginally positive in public perceptions.

But those modest polling increases came far too late to help Democrats and Obama, a factor Republicans may bear in mind as they contemplate the chances of the tax bill reviving their own dinged polling numbers.

What Republicans are saying now

Ryan, as he celebrated the House's initial passage of the tax bill on Tuesday, was in the exact opposite position as he was when Democrats used their monopoly on Washington power to pass the ACA.

But his comments sounded awfully familiar, as he blamed Democrats for making the bill unpopular and he said he had "no concerns whatsoever" about the measure's public standing.

"When people see their withholding improving, when they see the jobs occurring, when they see bigger paychecks, a fairer tax system, a simpler tax code, that's what's going to produce the results," Ryan said, in another echo of Schumer.

Republican Rep. Peter Roskam of Illinois on Tuesday adopted a novel argument, saying the tax reform bill's huge unpopularity was actually an advantage because it created "low expectations" that would cause a sudden surge in popularity.

"I think this is going to be far more pleasant for people," Roskam said on CNN's "New Day."

Another Republican, Sen. John Kennedy, of Louisiana, also adopted a familiar Obamacare defense when he argued that the tax reform bill was unpopular only because people did not yet understand what was in it:

"A lot of the stuff that never made sense to me, we cleaned up, and once folks learn that, they'll be appreciative."

McConnell: 'it is the right thing to do'

Senate Majority Leader Mitch McConnell has been adopting a loftier defense of the bill, arguing that patriotism requires lawmakers to do their duty to pass it.

"It's not just a question of making people happy. It's a question of getting the country growing again," the Kentucky Republican said on Hugh Hewitt's radio show earlier this month. "I hear the bill's not very popular, but plenty of times when you try to do a big bill, it's not popular. But it is the right thing to do."

The "right thing to do" argument is one that is often rolled out to convince lawmakers to take a vote that might come back to haunt them -- or to console members of Congress whose political courage costs them their seats.

McConnell might not have remembered, but Obama made similar arguments to reconcile the price paid by some Democratic lawmakers for backing the ACA.

"They had a chance to insure millions ... but then this same vote would likely cost them their new seats, perhaps end their political careers," Obama said as he accepted the Profiles in Courage Award at the John F. Kennedy Presidential Library in Boston months after leaving office. "These men and women did the right thing."

What happens next?

Of course, there is no certainty that just because Obamacare was unpopular when it passed, and reaped a heavy political toll, that the GOP's big tax bill will have a similar effect.

But given the outrage among Democrats over its passage -- The Center for American Progress's president and CEO, Neera Tanden, branded the tax "scam" as "immoral" and "venal" on Tuesday -- the new law could mobilize progressives, just as the ACA whipped up conservative enthusiasm ahead of the 2010 midterms.

"This tax bill will be an anchor around the ankles of every Republican. If they haven't learned it yet, they're going to learn it next November," Schumer said on Tuesday.

By the end of the day, Ryan had endured enough of the comparison.

"The Affordable Care Act proved to reduce health care choices, to raise premiums, to make health care unaffordable," Ryan said.

"This is going to do the opposite. This is going to grow the economy. It's going to increase paychecks. It is going to increase take-home pay. And that, I believe, is going to be very popular."

Only time will tell.

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gop borrows 'obamacare' playbook to defend tax bill  - cnnpolitics

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GOP borrows 'Obamacare' playbook to defend tax bill

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Republicans finally have their longed-for tax reform, but now they have to sell it. And the rhetoric they are using to do so is raising comparisons to desperate Democratic efforts to mitigate the unpopularity of Obamacare seven years ago. In short: It will get more popular once people learn more about it and the other party stops criticizing it.

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Mitch McConnel. August 10th, 2017. "The fix for American health care can be found in Europe." In this cartoon you can see that the current American Health Care is portrayed as a run down ambulance filled with people who are unhappy with almost everything they need such as administration forced to fit inside of the car, meanwhile the European Healthcare is an organized building with separate areas for different insurance holders with happy patients.

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Kaitlyn Schallhorn. September 20th, 2017. "Single-Payer Health Care: What is it?" The article speaks about Bernie Sanders' plan to reform the current American Health Care system into the rising popularity European plan, single-payer health care but also explaining the facts of such Health Care. I want Bernie Sanders to maintain his idea since it not only removes the burden of expensive Health Care from the every day person but it also raises the overall quality by making the government pay for all of the financial cost.

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After weeks of promotion and speculation, Sen. Bernie Sanders officially unveiled his plan to move the U.S. health care operation to a single-payer system last week.

With the ObamaCare debate continuing in the U.S., popularity for the European-style health care model of single-payer has gained more traction, especially among more progressive Democrats.

"Today we begin the long and difficult struggle to end the international embarrassment of the United States being the only major country on Earth not to guarantee health care to all its people," Sanders, I-Vt., said in a statement.

He blamed Republicans for "trying to take away health care from up to 32 million" people. "We have a better idea: guarantee health care to all people as a right, not a privilege, through a Medicare for All, single-payer health care program," Sanders said.

Even before his much-anticipated plan was announced, Sanders shored up support for a single-payer system among many prominent Democrats, including Sens. Elizabeth Warren, D-Mass., and Kamala Harris, D-Calif. - two women largely thought to be potential 2020 presidential contenders. His legislation already has 16 co-sponsors.

Former Sen. Max Baucus, D-Mont., credited with being the Affordable Care Act's architect, also backed Sanders' plan before it was officially announced.

Notably, Senate Minority Leader Chuck Schumer, D-N.Y., and House Minority Leader Nancy Pelosi, D-Calif., have not yet endorsed the plan.

President Donald Trump vowed on Twitter to veto Sanders' plan - and hit his fellow Republicans for failing to pass health care reform earlier this summer.

"Bernie Sanders is pushing hard for a single payer healthcare plan - a curse on the U.S. [and] its people," Trump said. "I told Republicans to approve healthcare fast or this would happen. But don't worry, I will vote because I love our country [and] its people."

Some states have already tried - and failed - to implement such a system, in which the government serves as the sole payer for health care costs. Like the current health care law and recent GOP proposals to overhaul it, single-payer plans are controversial.

Here is a look at what single-payer health care is, and how it compares to other models.
What is single-payer health care?
The term "single-payer health care" denotes that only one entity bears the financial responsibility of health care - the government. Under this system, the government would be solely responsible for covering health care costs.

"The basic idea of single-payer is to cover everybody with a single government program, and that program would basically cover all the doctors and hospitals," Dr. Adam Gaffney told Fox News.
SINGLE-PAYER HEALTH CARE GAINS MOMENTUM - BUT IS IT AFFORDABLE?
Gaffney is an instructor of medicine at Harvard Medical School and practices pulmonary and critical care medicine at Cambridge Health Alliance.
What does Sanders' plan do?
Sanders' Medicare for All plan would be implemented over a four-year period, according to a summary of the bill released by his Senate office.

In the first year, the plan would call for the improvement of "traditional Medicare for seniors and people with disabilities by covering dental, vision and hearing aids" - things that are not covered under the current law.

The plan also would allow children under the age of 18 to enroll in the Medicare for All program in the initial stage of implementation.

The first year of Sanders' plan would lower the Medicare eligibility age to 55. The second year would lower the age to 45, and the third year would lower it to 35. By the fourth year, Universal Medicare would be expanded to everyone.

Keeping in line with a large promise of ObamaCare, Sanders' plan promises that Americans will be able to choose their health care providers.

The plan also promises to lower the costs of prescription drugs, as it would give the federal government "the ability to stand up to drug companies and negotiate fair prices for the American people," the summary said.

The legislation would additionally provide comprehensive coverage, including, in part: hospital services, ambulatory services, mental health and substance abuse treatment services and reproductive and maternity services, including abortion.
What's the argument for single-payer?
Gaffney, who works with the progressive advocacy group Physicians for a National Health Program (PNHP), contended that single-payer systems give the consumer more choices when it comes to choosing a doctor or hospital.

"It gives people real choice when it comes to health care. People don't really care about that choice of an insurance plan," Gaffney said. "They want to be able to go to the doctor they know or trust, and they want to be able to go to the hospital that's convenient or has the services they need."

"It gives people real choice when it comes to health care."
- Dr. Adam Gaffney

"Under our current system of insurance networks, of out-of-network billing, of high co-payments, people can often not go and receive the care they need," he added.
CALIFORNIA DEMS REPORT 'BULLYING,' DEATH THREATS FROM THE LEFT AFTER SHELVING HEALTH BILL
A slight majority of Americans currently support a single-payer system, according to a June poll from the Kaiser Family Foundation. The 53 percent in support of single-payer is slightly higher than in previous years, the non-profit found.

"There's a rise in energy and passion around this," Gaffney said, attributing the increased support to the 2016 presidential campaign of Sanders, who was widely popular among younger voters. Sanders heavily campaigned on a Medicare for All platform.

However, Michael Tanner, a senior fellow at the libertarian Cato Institute, attributed the increase in support to the Affordable Care Act "not working out quite the way" voters had hoped.

"I think the letdown after ObamaCare has led a lot of Democrats to say, OK, we need to go further," Tanner told Fox News.
What's the argument against it?
Joel White, president of the Council for Affordable Health Coverage, expressed opposition to single-payer because of the "devil in the details."

"In other countries, we have seen single-payer shows us that putting more control of health care into the hands of politicians is bad medicine," White told Fox News. "Costs and taxes will rise, or patient access will be severely diminished - turning America's medical system into a third-world product."

"I want people to understand that there is a trade-off involved."
- Michael Tanner, Cato Institute

And Tanner called the idea of single-payer a "utopia" - meaning, "there is no such thing as a health care system anywhere in the world that provides unlimited care to everybody."

"I want people to understand that there is a trade-off involved," Tanner said. "You can have widespread care that provides benefits that are well beyond the current insurance system, but that doesn't have co-payments or deductibles. Or you can have low cost. But you can't have both."
DOES NANCY PELOSI SUPPORT SINGLE-PAYER HEALTH CARE?
The idea of the government fully taking over health care also doesn't sit well with some people, Tanner said.

"The government hasn't done a very good job with the health care system it already runs," he said. "Medicare is nearly $50 trillion in debt, there [are] still all sorts of problems with the VA system, Medicaid provides coverage that is barely better than being uninsured. So the government's track record is not very successful."
What about ObamaCare?
A common misconception is that ObamaCare provides universal coverage. Unlike a single-payer program, the Affordable Care Act does not provide universal health insurance coverage because approximately 28 million people are still uninsured.

For example, a government could require all citizens to purchase health insurance - including through a marketplace like ObamaCare - but it's not single-payer unless the government is also the sole provider of health care payments.

In fact, according to a chart released by PNHP, ObamaCare has more similarities to the failed Republican American Health Care Act (AHCA) than to a single-payer program.

Both the Affordable Care Act and the AHCA allow for insurance companies to have some control over a person's choice of health care provider, and both allow insurers to control premiums and deductible costs.
How much would it cost?
There is widespread disagreement over how much it would cost to implement a single-payer health care system. Supporters say it would cut excessive administrative costs compared to those incurred by private insurers. But critics, including most Republicans, warn that the savings would be less dramatic than expected - and the system would cost too much.

Sanders estimates the price tag for his plan would be about $1.38 trillion per year for the first 10 years, based on an analysis conducted by an economist at the University of Massachusetts-Amherst.

But other experts have projected higher costs -- anywhere from $2.5 trillion a year, according to the nonpartisan Urban Institute, to the Committee for a Responsible Federal Budget's estimate of $2.8 trillion a year.
Has the U.S. ever tried to implement single-payer?
A bill introduced by Rep. John Conyers, D-Mich., would establish a Medicare for All program to provide Americans with health care, including medically-necessary care, emergency care, primary care and prevention, dietary therapies, prescription drugs, mental health services, dental services and vision care.

The legislation currently has 117 cosponsors - the largest number of House Democrats to sponsor a single-payer bill to date, Gaffney said. No Republicans have signed on to the bill.
DEMOCRAT INFIGHTING OVER ABORTION 'LITMUS TEST' POSES NEW HEADACHE
Regardless of support among congressional Democrats and liberal progressives, single-payer systems haven't been successful at the state-level so far in terms of implementation.

California Assembly Speaker Anthony Rendon, a Democrat, was forced to shelve a single-payer plan after the $400 billion price tag was revealed. Vermont, too, decided to forgo a single-player plan in 2014 because of cost.

Harold Pollack, a University of Chicago professor who has written extensively on health care policy, said he does not believe that single-payer can be achieved at the state level without the federal government as "an eager partner."

"The impact [of single-payer] will be very different on different people," Pollack said, adding that the "big failure of the American health care system" is that the government doesn't currently leverage low prices.

Sanders told Vermont Public Radio last month that he understands moving to a true single-payer system would take time to implement and proposed lowering the age of Medicare eligibility to 55 years of age.

"That's one way to phase it in," he said.

In California, the bill is not technically dead as legislators work in sessions.

Kaitlyn Schallhorn is a Reporter for Fox News. Follow her on Twitter @K_Schallhorn.

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After weeks of promotion and speculation, Sen. Bernie Sanders officially unveiled his plan to move the U.S. health care operation to a single-payer system last week. With the ObamaCare debate continuing in the U.S., popularity for the European-style health care model of single-payer has gained more traction, especially among more progressive Democrats.

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Good Health for All (GHA) 25 December 2017 / 6:00 PM / Planning Room Attendees Group President: Angelo Abundes, Vice President: Randy Martins, Candidate: Barack Obama Agenda Third Meeting Discussion of Next Representative to Reason With. After insuring that Adam Schiff would stand strong on his ...

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I come from a background of little wealth meaning a great deal of holding back on the necessities or desires everyone wants in their day to day life. Trips to the hospital were something to fear as I grew up due to the heavy cost with each visit and our lack of health insurance to help cover the cost only worsened the problem since we could't even afford that. there would be nothing else to make me happier than seeing health care available to not just those who are in desperate need of it. I believe that in order to achieve the GHA's cause of making Health Care affordable, we must appoint former president Barack Obama a he too follows the belief that those unable to pay for Health Care should not be forced to live without it.