There are those who wonder,

“Other industrialized countries with differing forms of nationalized healthcare clearly have issues, so why don’t they change to the ones that work best (arguably Switzerland and Taiwan)?

Doesn’t that mean the gold standards aren’t what they are held up to be?”

Anti-Social NonBelievers

Now typically, those wondering are the ones whose blood pressure rises to unsafe levels at the mention of “socialized medicine”, even though the US bills currently under consideration propose “social insurance” (i.e., a public plan option with an individual insurance mandate).

Social insurance is what Switzerland, one of the gold standards, has. But anti-reform activists prefer dissecting the less effective nationalized healthcare systems (e.g., Canada or the UK), looking for real and perceived problems. It makes an uphill task slightly easier.

Because in actuality they are looking for any reason to resist changing our current privatized, supposedly non-government-involved healthcare patchwork quilt. No, it’s not a system. And yes, the government does insure 30% of US residents with health coverage.

The United States Healthcare Experiment

So to answer their question, let’s look at our situation in the “Land of the Free”, both in terms of pain points and change dynamics.

Compared with other industrialized nations, we have by far the most expensive healthcare, forecasted to be $8,160 per person this year, over twice that of the next most expensive country. Costs are predicted to soar from 16% GDP to 30% GDP by 2040 and we don’t even cover the entire population.  That’s already 142% of the next most expensive country, and 162% of the average 9.9% GDP for countries that cover essentially everyone. We spend more than $2 trillion a year on health care and the average family premium is projected to rise to over $22,000 in the next decade. That’s some expensive freedom, no?

For all that overspending, we rank dead last among 19 industrialized nations in preventable deaths. This means more people die from conditions like hypertension, appendicitis, cervical and colon cancer, and tuberculosis in the US than elsewhere. And we’ve improved hardly at all since 1997. That’s what our luxurious healthcare spending buys. So don’t get your blood pressure up too much over this healthcare reform business, it could be fatal.

In fact, compared with Australia, Canada, Germany, New Zealand, and the UK, we rank last or next-to-last on the five major dimensions of a health system: quality, access, efficiency, equity, and healthy lives. It’s not surprising, as we actually don’t have a health system.

Regarding quality, we do score high in preventive care, but fall down on chronic care management and safe, coordinated, and patient-centered care. We also lag in adoption of electronic medical records (EMR) and other information technology which, if implemented correctly, would make care more safe, efficient, and effective. Having helped hospitals and health systems for years in their efforts to get physicians to adopt EMR, I could write books on that type of resistance to change!

Access is also a huge issue in the US. People here go without needed health care due to cost more often than people in the other countries. If you’re insured, of course, you have rapid access to specialists. This contrasts with systems in the UK and Canada, where residents have little to no financial burden but can have long waits for specialist care.

But our 47 million uninsured in 2007 are rapidly growing due to mass layoffs in the poor economy. If you’ve ever seen a premium for COBRA coverage, you know why. If they get individual insurance, there’s no guarantee the insurer won’t find a reason to retroactively cancel coverage when they develop an expensive condition. So, much of our population doesn’t have access to care unless they want to bankrupt themselves.

Furthermore, the US actually invented a class of patients unique to the rest of the world: The Uninsurable. These folks can’t get individual insurance under any circumstances because private insurers don’t want the risk. For any conditions that need ongoing care, like asthma, diabetes, pregnancy, heart disease, kidney disease etc. these patients pay out of pocket. As you’ll see when we cover Equity, they pay the highest prices in the world.

Efficiency is a huge black eye. We rank dead last in healthcare expenditures (as covered above) and administrative costs (which are 30-70% higher than in countries with mixed private/public insurance systems and 300% higher than in countries with the lowest rates). Did you know we could save $51 billion annually just by reducing administrative costs to the mixed private/public systems level? Also, healthcare organizations rarely use multidisciplinary teams and their aversion to IT means cumbersome, manual paper-based processes.

Equity? Well, there isn’t any. Americans with lower incomes are much more likely than in other countries to report not seeing a physician when sick, not getting recommended tests, treatments or follow-up care, or not filling prescriptions because of costs. 

The uninsured (or insured but out-of-network) can pay 44 times more than their in-network insured counterparts for the same care. For example, there is the New Jersey patient who was charged $72,000 for a spinal fusion procedure that Medicare reimburses at $1,629. Private insurers would pay $1,955. All men—and women—are decidedly not created equal.

Healthy lives: kind of a no-brainer. The US has 25-50% higher mortality for treatable conditions like heart disease than the other countries. In fact, Medicare could save at least $12 billion a year by reducing readmissions and reducing hospitalizations for preventable conditions.

D Spells Disaster

What all of this spells out is not disaster in the making. It clearly points to a current disaster rapidly escalating to catastrophic proportions. By objective criteria we have the worst healthcare of any developed nation and pay by far the most for it, so much so that it threatens to bankrupt our government and even more of our people.

Our healthcare is unaffordable, unsustainable, inaccessible, unsafe, poor quality, and inefficient. The US free-market healthcare experiment is clearly a spectacular failure for its patients.

Yet angry mobs are interrupting healthcare reform town halls and writing hate mail calling our lawmakers Nazis and claiming they want to create death squads to kill your grandma. Apparently these people have health insurance that is (or they think is) guaranteed and low-cost. Either that or they have never used our healthcare services. So we’re dealing with either ostrich mentality or just plain cluelessness.

Change Is Scary

All this acting out points to a huge fear of change, even if where we are now causes extreme widespread pain. Although we are the healthcare laughing stock of the developed world, we would rather poke holes in healthcare coverage that is far superior to ours than face our own imminent demise.

Of course, there’s also Americans’ fear of our government. As an American expatriate so aptly said when explaining France’s excellent health benefits, “In France, the government is afraid of the people. In America, the people are afraid of the government.”

 “Home of the Brave”? Evidently not.

Resistance to change is a natural response, but we need to get over it if we want 1) real, affordable population healthcare, and 2) to regain our place as a world financial powerhouse.

Our future is on the line and we seem unwilling or unable to change our healthcare disaster.

So to answer the anti-social nonbelievers’ question: look to yourselves. Change is hard.

In a nutshell, other countries’ nationalized healthcare systems don’t have anywhere near the pain points the US does, and the US is clearly not motivated to change. Why would they put themselves through these contortions for anything less than a crisis? Unless, that is, they have a slam-dunk Cash For Clunkers-type fix up their sleeves.

Heck, in 1994 Switzerland was in a very similar situation to the one the US currently finds itself in, and its healthcare reform passed by a vote of 51% to 49%. That’s the definition of “squeaking by”.  Yet today they wouldn’t change it for the world.

Can we learn from that? I hope so.

©2009, Actively Fused LLC