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["Fred Enga" <fenga AT astechman.com>]

Here is an article that gives the facts for non US healthcare.

Hope this answers most people's questions

Regards

Fred Enga

<http://www.washingtonpost.com/wp-dyn/content/article/2009/08/21/AR200908210
1778.html>

By T.R. Reid
Sunday, August 23, 2009

As Americans search for the cure to what ails our health-care system, we've
overlooked an invaluable source of ideas and solutions: the rest of the
world. All the other industrialized democracies have faced problems like
ours, yet they've found ways to cover everybody -- and still spend far less
than we do.

I've traveled the world from Oslo to Osaka to see how other developed
democracies provide health care. Instead of dismissing these models as
"socialist," we could adapt their solutions to fix our problems. To do that,
we first have to dispel a few myths about health care abroad:

1. It's all socialized medicine out there.

Not so. Some countries, such as Britain, New Zealand and Cuba, do provide
health care in government hospitals, with the government paying the bills.
Others -- for instance, Canada and Taiwan -- rely on private-sector
providers, paid for by government-run insurance. But many wealthy countries
-- including Germany, the Netherlands, Japan and Switzerland -- provide
universal coverage using private doctors, private hospitals and private
insurance plans.

In some ways, health care is less "socialized" overseas than in the United
States. Almost all Americans sign up for government insurance (Medicare) at
age 65. In Germany, Switzerland and the Netherlands, seniors stick with
private insurance plans for life. Meanwhile, the U.S. Department of Veterans
Affairs is one of the planet's purest examples of government-run health
care.

2. Overseas, care is rationed through limited choices or long lines.

Generally, no. Germans can sign up for any of the nation's 200 private
health insurance plans -- a broader choice than any American has. If a
German doesn't like her insurance company, she can switch to another, with
no increase in premium. The Swiss, too, can choose any insurance plan in the
country.

In France and Japan, you don't get a choice of insurance provider; you have
to use the one designated for your company or your industry. But patients
can go to any doctor, any hospital, any traditional healer. There are no
U.S.-style limits such as "in-network" lists of doctors or
"pre-authorization" for surgery. You pick any doctor, you get treatment --
and insurance has to pay.

Canadians have their choice of providers. In Austria and Germany, if a
doctor diagnoses a person as "stressed," medical insurance pays for weekends
at a health spa.

As for those notorious waiting lists, some countries are indeed plagued by
them. Canada makes patients wait weeks or months for nonemergency care, as a
way to keep costs down. But studies by the Commonwealth Fund and others
report that many nations -- Germany, Britain, Austria -- outperform the
United States on measures such as waiting times for appointments and for
elective surgeries.

In Japan, waiting times are so short that most patients don't bother to make
an appointment. One Thursday morning in Tokyo, I called the prestigious
orthopedic clinic at Keio University Hospital to schedule a consultation
about my aching shoulder. "Why don't you just drop by?" the receptionist
said. That same afternoon, I was in the surgeon's office. Dr. Nakamichi
recommended an operation. "When could we do it?" I asked. The doctor checked
his computer and said, "Tomorrow would be pretty difficult. Perhaps some day
next week?"

3. Foreign health-care systems are inefficient, bloated bureaucracies.

Much less so than here. It may seem to Americans that U.S.-style free
enterprise -- private-sector, for-profit health insurance -- is naturally
the most cost-effective way to pay for health care. But in fact, all the
other payment systems are more efficient than ours.

U.S. health insurance companies have the highest administrative costs in the
world; they spend roughly 20 cents of every dollar for nonmedical costs,
such as paperwork, reviewing claims and marketing. France's health insurance
industry, in contrast, covers everybody and spends about 4 percent on
administration. Canada's universal insurance system, run by government
bureaucrats, spends 6 percent on administration. In Taiwan, a leaner version
of the Canadian model has administrative costs of 1.5 percent; one year,
this figure ballooned to 2 percent, and the opposition parties savaged the
government for wasting money.

The world champion at controlling medical costs is Japan, even though its
aging population is a profligate consumer of medical care. On average, the
Japanese go to the doctor 15 times a year, three times the U.S. rate. They
have twice as many MRI scans and X-rays. Quality is high; life expectancy
and recovery rates for major diseases are better than in the United States.
And yet Japan spends about $3,400 per person annually on health care; the
United States spends more than $7,000.

4. Cost controls stifle innovation.

False. The United States is home to groundbreaking medical research, but so
are other countries with much lower cost structures. Any American who's had
a hip or knee replacement is standing on French innovation. Deep-brain
stimulation to treat depression is a Canadian breakthrough. Many of the
wonder drugs promoted endlessly on American television, including Viagra,
come from British, Swiss or Japanese labs.

Overseas, strict cost controls actually drive innovation. In the United
States, an MRI scan of the neck region costs about $1,500. In Japan, the
identical scan costs $98. Under the pressure of cost controls, Japanese
researchers found ways to perform the same diagnostic technique for
one-fifteenth the American price. (And Japanese labs still make a profit.)

5. Health insurance has to be cruel.

Not really. American health insurance companies routinely reject applicants
with a "preexisting condition" -- precisely the people most likely to need
the insurers' service. They employ armies of adjusters to deny claims. If a
customer is hit by a truck and faces big medical bills, the insurer's
"rescission department" digs through the records looking for grounds to
cancel the policy, often while the victim is still in the hospital. The
companies say they have to do this stuff to survive in a tough business.

Foreign health insurance companies, in contrast, must accept all applicants,
and they can't cancel as long as you pay your premiums. The plans are
required to pay any claim submitted by a doctor or hospital (or health spa),
usually within tight time limits. The big Swiss insurer Groupe Mutuel
promises to pay all claims within five days. "Our customers love it," the
group's chief executive told me. The corollary is that everyone is mandated
to buy insurance, to give the plans an adequate pool of rate-payers.

The key difference is that foreign health insurance plans exist only to pay
people's medical bills, not to make a profit. The United States is the only
developed country that lets insurance companies profit from basic health
coverage.

In many ways, foreign health-care models are not really "foreign" to
America, because our crazy-quilt health-care system uses elements of all of
them. For Native Americans or veterans, we're Britain: The government
provides health care, funding it through general taxes, and patients get no
bills. For people who get insurance through their jobs, we're Germany:
Premiums are split between workers and employers, and private insurance
plans pay private doctors and hospitals. For people over 65, we're Canada:
Everyone pays premiums for an insurance plan run by the government, and the
public plan pays private doctors and hospitals according to a set fee
schedule. And for the tens of millions without insurance coverage, we're
Burundi or Burma: In the world's poor nations, sick people pay out of pocket
for medical care; those who can't pay stay sick or die.

This fragmentation is another reason that we spend more than anybody else
and still leave millions without coverage. All the other developed countries
have settled on one model for health-care delivery and finance; we've
blended them all into a costly, confusing bureaucratic mess.

Which, in turn, punctures the most persistent myth of all: that America has
"the finest health care" in the world. We don't. In terms of results, almost
all advanced countries have better national health statistics than the
United States does. In terms of finance, we force 700,000 Americans into
bankruptcy each year because of medical bills. In France, the number of
medical bankruptcies is zero. Britain: zero. Japan: zero. Germany: zero.

Given our remarkable medical assets -- the best-educated doctors and nurses,
the most advanced hospitals, world-class research -- the United States could
be, and should be, the best in the world. To get there, though, we have to
be willing to learn some lessons about health-care administration from the
other industrialized democracies.