Painful Truths the U.S. Can Learn from Global Healthcare

It is maddening that teeth are so often treated like luxury bones, with their care separated from other medical care...as if the health of our teeth and gums doesn't have any impact on the rest of our bodies. sigh

I'm a dual Canadian-US citizen, have used both systems over the years and actively observed family (and visited ER's with them, including my own emergencies) in both places. I can only offer you my personal experience: I would never, ever go to the US for health care again. Period. It isn't that you can't find a good doctor or hospital in the US, you can find them. Its that the billing nightmare is beyond extraordinary, even with a healthy income and insurance. Its too messy, and much more likely to lack access to care because of it. On the other hand, the issues of "quality" I hear about the Canadian system are largely unfounded and untrue. Do we have a family doctor shortage? Yes Canada does, but we still have a higher proportion of people with family docs than the US regardless of having a shortage. And you can still go to a hospital or walk-in clinic any time to receive medical services, regardless of that. Is it a problem? Yes it is. But its a 'better problem' to have, we need to train more family docs. I could offer more experience and stories, but I assume most wouldn't have time to read, so I'll leave it there. I'd never go to the US for health care. Period. I am happy to live in Canada on the basis of health care.

What I'm interested in is how all these systems cover long term illnesses (type 1 diabetes, child birth, disabilities, degenerative disease...). In France they're 100% covered regardless of your employment status because just Giving You Insulin (without copay or premiums or deductibles) means you're likely to not go to the ER and cost the community more.

As an Australian I can tell you that most people I know find the American healthcare system bizarre and needlessly expensive. My brother had a medical emergency soon after moving to Delaware. Because of a mixup with his insurance he ended up tens of thousands of dollars in debt. This absolutely could not have happened in Australia.

As somebody that works in the Singapore healthcare system, that was a very accurate and succint coverage of our healthcare model

I'll just add that the PBS system in Australia means that you only pay up to to a maxum $30 for prescription drugs

Small correction/update: as of very recently, Canada introduced pharmacare coverage. Currently only contraception and diabetes meds & equipment are covered, but the legislation includes mechanisms for adding more to the plan in the future

I have dual US/Euro citizenship and moved back to Europe 5 years ago. Healthcare here is like in the UK, zero costs to citizens. The wait times are fine, honestly, similar to regular appointments in the US. I recently became ill and have gone to the ER, specialist visits, tests, treatments, therapy, etc. It would have cost me thousands of dollars in the US even with insurance. I paid nothing here. I was just thinking about this today, how lucky I am to have universal healthcare now!

in england, we have private healthcare as well, you'll just continue to pay the national insurance cost, but there's private hospitals, and private everything as well

I would be so exceptionally happy if we had single payer. Both as someone with no insurance and as a medical provider. Only having to worry about one system to credential with, submit claims to, and trouble shoot with would be incredible. Instead I have a huge spread of reimbursements, requirements, and systems. Oh and to add i'm currently small and not providing insurance to my staff at this time. I want to but it's costly.

The UK has been under-funding the NHS and private insurance has become more common among its citizens. I don't know any of the numbers, but I do know that ZombieCleo's dental work was covered under her private insurance with her NHS dentist.

The healthcare systems in most other countries also have a much stronger bargaining position when negotiating prices with pharmaceutical and medical services companies. This leads to significantly lower prices on medicine, even when purchased out of pocket. Standardised pricing for blood work etc. also means your freedom of choice is focused on the doctors and hospitals, and not based on comparing wildly varying rates between them.

Should have covered Denmark's system as well -- another hybrid system of mostly govt. but allowing pvt insurance for certain sectors/issues.

To me it's as simple as the cost for US healthcare is double any other developed country for worse outcomes. For what we spend on our premiums in the existing system, we could get substantially better coverage under single payer by eliminating the 20%+ profit margin middleman plus millions of highly paid white collar workers that do nothing but create/manage artificial complexity (at health systems, in the insurance companies, and at every employer in America).

I don't think the problem is finding better models or even convincing the American public to try something new. I think the problem is political. The special interests are just too powerful and they won't allow any change.

I have lived in the US and Canada and interacted with both systems. One note is that depending on the province Canada also has differing degrees of private options similar to Australia. There's a lot said about the Canadian vs American system but one thing I'd like to note is that it seems like the paperwork and registration for things is just easier. In both BC and Quebec the process of getting into the health system and having care paid for just involves a lot less bother than dealing with the US health insurance exchanges and of course it's vastly cheaper. The biggest problem is lack of availability of family doctors. I would love to see an episode of the impact of having a family Dr vs walk in clinics on long term health outcomes and lifetime cost of care. Ie: if it is more expensive to provide a family doctor then is that cost recovered by preventing acute health issues that are more expensive to treat and have other social costs such as time out of work.

surprised Japan wasn’t mentioned. It’s like a better version of France. Same basic concept, but you can go beyond an add on, you can get employer coverage, and get supplemental plans to pay your living expenses while you miss work due to illness, you can get personal cancer plans, personal full plans, multiple insurance to cover gaps, etc. ALSO, vision and dental AND holistic (massage, acupuncture, etc) are included in the basic Shakahouken (spelling?) that every resident gets.

The USA has a health system that works fully as intended: to squeeze out the last cent from people who have no choice but to cough up that last cent if they want to live. Either because with treatment they can continue working, but have to cover insane costs, often putting them into debt. Or they DON'T get care, thus loosing their ability to work, thus loosing their jobs, thus loosing their employer dependent benefits of health insurance; or they simply die from the affliction. Great choices, right? What I don't get is that this video didn't even touch on the oldest continually existing healthcare system, Germany's. It offers both statutory health insurance but also the choice of private health insurance (PHI). However you have to be willing and able to afford the much greater insurance fees for private health insurance. The break-even-point for income is at around 65k€ a year income as a single person. For any person with a spouse and/or kids an SHI will remain viable for much longer, as under SHI non-working spouses and kids are automatically co-insured for free. The German healthcare system includes very basic dental reconstruction, as well as a very basic visual aids (ie the cheapest frames and lenses with absolutely no additional features). Physiotherapy however is covered. Preventative care is part and parcel of the SHI system as the insurers recieve their share from the central pot of ALL SHI fees according to the number of customers they have. This means SHI want to prevent as many illnesses as possible while having the largest number of customers at the same time. PHI allows for doctors and hospitals to charge up to four times the price for SHI coverage, making them incentize PHI patients over SHI. Still over 80% of people in Germany choose SHI over PHI, which includes a large section of people that COULD choose PHI due to their financial situation. In addition to that, the German government has set up rules and regulations for a panel from ALL insurers (both SHI and PHI) to negotiate with pharma companies as well as doctors and hospitals to regulate a standard price list. These include ALL treatments as well as ALL drug prices for generica. Specific brand drugs MAY be included IF the pharma companies agree to reasonable prices with the panel of insurers and doctors. This leads to equal power distribution for the negotiation instead of the horrible negotiation position of individual insurers having to negotiate with individual doctors and hospitals; or worse, even individual citizens trying to negotitate with these conglomerates. As such, the negotiation stance for both major participants, insurers and doctors vs pharma companies and hospitals, is brought to a level playing field. With the price list negotitated among these private sectors without any actual involvement of the government (they just set up the framework of the limits what's possible), reasonable costs will be negotitated that are CONSISTENT across the country. No checking for in-network, coverage, etc. ALL insurers guarantee the coverage of the negotitated prices, and ALL doctors, hospitals, and pharma companies can caluclate with guaranteed prices as well. However the typical red tape of Germany throws a spanner into the works, as far too much regulation is placed on individual doctors, either in practices or in hospitals to provide data on the individual patient to the insurance companies, and vice versa. That's where Germany's system suffers most. There are only a handful of copays there are in Germany. 1. Generic prescription drugs in pharmacies: 5€ (or free), with brand type prescription drugs at 10€. There are however additives you may WANT to buy, which you will have to cover yourself. But even those don't exceed roughly 100€ per month. If they are medically NECESSARY however, you will again drop down to 5 or 10€ per prescription. 2. Dental healthcare: if you go beyond any of the minimal reconstruction into any part of 'beauty improvement' like professional cleaning, bleeching, etc, you have to cover these yourself. There are however supplemental insurances you can get to cover those costs, which usually are worth their low yearly costs. 3. Visual aids: if you want stylish frames and lenses with superior finishes or qualities like auto-darkening, anti-mirroring, etc, you have to cover these yourself. Again, additional supplemental insurances exist for that. 4. Hospital stays: to cover your food you will be charged 10€ per day, up to 240€ per YEAR of continuous hospital stay. That's it. 5. Any elective surgery (especially plastic surgery trying to 'improve' the natural state) that is not strictily medically necessary you will have to pay yourself (duh, obviously). However, reconstructive plastic surgery in case of amputation or damage IS covered 100%. Again, if you want special features on prosthetics, you might have to argue with your insurer what's medically necessary, and what is at best a style feature. With all of that out of the way, Germany provides 100% coverage for ALL citizens in Germany. The government itsself has absolutely NO access to the insurance fees paid by either employers or employees. Thus, these ARE deducted from your pay check/wages automatically, but the government doesn't get their hands on it. Thus, these aren't technically taxes, but insurance fees. But within this system, all SHI fees are collected into one pot, and distributed by a rather complex (and inefficient) system among all SHI companies. PHI goes directly to the respective PHI companies.

Starting this year Canada is phasing dental care. Start for people earning less than $95K/ year it will expand over the next couple of years. Japan which has the highest life expectancy in the world, is also worth a look. It offers national health for everyone and covers 70% of everything including dental. it also caps maximum copays so covers catastrophic care. Private insurance usually through insurance is available. hospitals are a mix of public private and charitable. Note charitable hospitals are really charities, often offering free care, not corporations pretending to be charities while paying CEOs millions in salary and not paying employees enough to use the charitable car. There is even fully private care that is not covered by national health. The only one I know of offers prescription refills over the web, it is so efficient the patients still pay less than the usual 30% copay. Also municipalities will offer free annual checkups on your birth month. I think it would also be worth pointing out that the US spends more of its GDP on health care yet still has the lowest life expectancy in the G7. Even the life expectancies in the richest counties only match other G7 countries' life expectancies.

And there are other ways. In Chile, there's a national public system called Fonasa, which everybody can belong to. You pay a percentage of your salary or pension, and you have full access; it is tiered according to your income, but you aren't denied attention if your income is low or nonexistent - you can even get transplants. Yet, it is chronically underfunded and very slow - the dictatorship tried to dismantle it in favor of private healthcare, it failed, but it damaged it. In consequence, there are private health insurance companies, called Isapres. They pretty much work like American companies, with all the good (way faster than Fonasa, more amenities) and the bad (expensive, confuse, they don't cover everything). They are not tied to people's jobs, so, as long as you have the required income level, you keep your plan. Finally, there's purely private healthcare. You go wherever you like and can afford, pay cash, and that's it. That's mostly the way of things like cosmetic plastic surgery. On the other hand, if you have a life-threatening emergency, you go to any public clinic or hospital and get care, even if you are not registered in Fonasa or are an undocumented immigrant. Time for the USA to learn from Chile too?