Fascinating Health Care Article

H

Hornin Hong Kong

1,000+ Posts
I've now lived outside the US for 8.5 years, inthe UK they have universal single payer (which was awesome IMO), in HK they have free healthcare for the poor, no insurance unless you are rich, and most people just got to a doctor and pay if they are sick (costs about 50-100 bucks).

Best by far is HK in quality of care, followed by USA, UK. For Hassle best is HK, then UK, then far in the rear is USA. For Cost, best is HK, then UK, then aburdly far in the rear is the US (about to get much worse).

One thing that you gain perspective on is insurance (when you see other systems). Why do we think this a good idea? It removes you from being the client of the healthcare provider. Disaster. This article talks about many things but in the end it points out that comprehensive insurance makes no sense, catastrophic should be mandated, and HSAs.

The Link

Tell me what you think.
 
I have not read the article. However, remember when you are talking about which system you like best, it is based on your personal experiences. Some systems are better for minor issues and some systems are better for catastrophic issues. Some systems are better for the poor, some systems are better for the middle class, and some systems are better for the rich. It is unlikely that a single system outperforms all others in all categories.

As for your mention about the problems of health insurance, you are absolutely correct. During the healthcare debate however many years back I discussed the evolution of our system and the problems with it. As typical on political message boards, people liked to argue but few wanted to learn. After the political debate ended, I pretty much decided that 1) for better or for worse the government had decided on changes so discussing the merits of different options was useless and 2) talking about facts of healthcare was time consuming for me, especially with some of the zealots who simply like to argue about things that they only have a peripheral knowledge about. It is like a bunch of people arguing with you about derivatives. At some point you would simply give up. It was kind of interesting though that the political debate kind of took the same non-factual, highly superficial course that this board took.

With all that said, Milton Friedman did some excellent analyses back n the early 70s I think that were presient and relevant today. As we know, the more government has become involved, the worse healthcare has become in the US. The further away the patient has been removed from the provider the worse healthcare has become. And the more insurance has become a payment plan and the less it has become an actuarial insurance against rare events, the worse healthcare has become. As I see it, though, the political debate doesn't try to address the merits and pitfalls of different ideas, it is simply a grab for votes.
 
That article is superb, and I think he largely gets it right. The biggest problem with healthcare is a gross over-reliance on insurance, and neither side really seems to get this. Most of the incentives and distortions that make government-run industries not work well are also present with industries funded by third-party payers like insurance carriers.

HSAs need to be heavily encouraged (not taxed and allowed to accrue non-taxable interest), and deductibles should be higher. Insurance coverage should be tailored around catastrophic and unexpected issues. As for the UK, you say it's "awesome," but the article points out that their costs are exploding as well. I don't think that's the right system.

In terms of quality of care, regardless of where you are, nothing beats being the real customer - meaning the one holding the money. My wife is pregnant, and here in Germany, though they have a hybrid system (mostly single-payer), she and I are not covered by it. We have private health insurance through Blue Cross Blue Shield. However, doctors who usually get paid through a single-payer with relative ease aren't going to go to the pain in the *** of dealing with a bunch of greedy ******** at a US insurance carrier that jerk them around from 6,000 miles away. They just aren't used to having to take that kind of ******** off of any big business and aren't willing to do it.

Accordingly, we pay the bill out of pocket, and that doctor and his office treat us like friggin' royalty - far better than either of us have ever been treated at a medical facility of any kind in the US. Why? Because I'm holding the money. They dispense the care, and I hand them Euros. It is amazing what a difference that makes.

Then I go home and submit the claim forms. If BCBS doesn't pay promptly I give them ****, threaten, and intimidate them until they do. In other words, I do the same thing I used to do for a living.
 
sounds like you will be in Germany for awhile. Just make sure that your son learns american football. What happened with he Azores?
 
Agree HHK -- that is one terrific article. I found one excerpt that everyone ought to read:

____________________________________________________________________________________________________

All of the actors in health care—from doctors to insurers to pharmaceutical companies—work in a heavily regulated, massively subsidized industry full of structural distortions. They all want to serve patients well. But they also all behave rationally in response to the economic incentives those distortions create. Accidentally, but relentlessly, America has built a health-care system with incentives that inexorably generate terrible and perverse results. Incentives that emphasize health care over any other aspect of health and well-being.
____________________________________________________________________________________________________
 
The biggest difference I now see in HK vs the US is that when people get sick in a non (to borrow the phrase int eh article) catastrophic way they expect to have to pay something.

However, they expect to pay something non insane - if they get out of the doctor under 100 bucks they are happy and they always do unless they are really sick

They can also do math, they don't think it's a good bet to bay 15 grand a year for a family of four (or whatever massive number you and your employer pay in the US) for non catastrophic health insurance vs just dealing with it yoruself.

They think, if your car breaks you get it repaired, this is no difference.

As a result health care here is MUCH cheaper (the cost of services), there is no paperwork or beauracracy, it's simple to get an appointment, the doctors make money (Much less overhead not having to deal with insurance).

When i need to go to my doctor I can generally call his office and see him within an hour or two.

I'm glad those of you who read the article enjoyed it. What really struck me is that Obamacare does none of the things that seem to work well in my experience and exacerbates all the problems inherent in the system to ludicrous degrees.

Let's do something else
 
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