Washington Matters


The World's Best Health Care System for Whom?


As the health care debate heats up in the U.S., an increasing number of letters and e-mails we get here at Kiplinger take a fairly simple approach.  The U.S. has the best health care system in the world, they proclaim, so why would anyone want a major overhaul? Some suggest only minor changes are needed, but a growing number argue that no change is necessary.

That raises a pretty basic question. The best health care system for whom?

Certainly it's not the best for the 45 million who have no insurance. Many of them don't go to doctors when they should, getting little in the way of preventive care and often waiting until the problem has gotten more serious and complications have set in. Some end up dying for conditions that could have been cured had they been dealt with earlier.

Some of the uninsured can pay for their own care. Many more get care at free clinics or from doctors and hospital emergency rooms that eat all or most of the cost. They make up the difference by charging others more, meaning the rest of us pay in higher bills or insurance premiums.

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It's not the best system for millions of others who are woefully underinsured. Many people who don't have insurance through their jobs can't afford comprehensive coverage on their own, so they buy catastrophic plans with high deductibles, meaning they pay for the first few thousand dollars worth of care. That also creates an incentive to postpone seeing a doctor until a problem has become more serious -- and potentially more costly.

Insurance is better for most people who have it through their jobs, but surprisingly few have any idea how much that's costing them. Premiums are deducted from paychecks, so people tend to be oblivious to the price (Quick -- what's your monthly premium?), and employers do a lousy job of letting workers know what the total cost is. Employers pay more than 75% of the total cost, so figure as a general rule that whatever your premiums are, your company is paying three times as much. That's money not available for raises or to hire more staff. It's also pre-tax money, which means it adds to the growing deficit. And next year, employer costs will go up about 10%.

Many people are also oblivious to the limits on their coverage. They don't realize their benefits are capped -- until they get a serious illness and find out their insurance has run out. And they don't realize how vulnerable they are, should they lose their job and have to get insurance on their own. That's especially true for individuals with pre-existing illnesses.

But when people say the U.S. health care system is the best in the world, they're not usually referring to insurance. They usually mean U.S. doctors and hospitals are top-notch, and that patients have their pick of the best specialists money can buy. That's true if you can afford it -- or is it.

T.R. Reid, a longtime Washington Post reporter, has just written a book (to be published early next year) that calls that view into question. The book's title says it all: "We're No. 37! Why Other Countries Have Better, Fairer, and Cheaper Health Care Than the USA." In interviews and op-ed pieces, Reid has pointed out that while the U.S. has the best trained doctors and researchers, the bloated administrative bureaucracy -- much of it private -- actually stifles innovation and increases cost. The hip or knee replacement you may have had last year is based on French innovation, for example. Many of the wonder drugs advertised endlessly on TV, including Viagra, are from British, Swiss or Japanese labs.  

Costs are much lower abroad.  An MRI scan of the neck region costs $1,500 here, but in Japan the price for the very same procedure is $98 and Japanese labs still make a profit. Much of the scare talk about lack of choice, rationing and wait times is built on misinformation. Canadians have their choice of providers. People in Germany, Britain and Austria have shorter average wait times for an appointment than do Americans. And Germans can sign up for any of 200 health insurance plans. On key statistics, such as life expectancy and infant mortality, the U.S. seriously lags most other industrialized countries.

None of this is to suggest that we throw out the U.S. health care system and start all over. There are plenty of areas where our system does better than most. But the next time someone tries to shut off the debate by simply declaring that it's crazy to talk about reform when the U.S. has the best system in the world, ask them exactly what they mean.

 




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