Sick around the world
In Sick Around the World, FRONTLINE teams up with veteran Washington Post foreign correspondent T.R. Reid to find out how five other capitalist democracies -- the United Kingdom, Japan, Germany, Taiwan and Switzerland -- deliver health care, and what the United States might learn from their successes and their failures.Reid's first stop is the U.K., where the government-run National Health Service (NHS) is funded through taxes. "Every single person who's born in the U.K. will use the NHS," says Whittington Hospital CEO David Sloman, "and none of them will be presented a bill at any point during that time." Often dismissed in America as "socialized medicine," the NHS is now trying some free-market tactics like "pay-for-performance," where doctors are paid more if they get good results controlling chronic diseases like diabetes. And now patients can choose where they go for medical procedures, forcing hospitals to compete head to head.
While such initiatives have helped reduce waiting times for elective surgeries, Times of London health editor Nigel Hawkes thinks the NHS hasn't made enough progress. "We're now in a world in which people are much more demanding, and I think that the NHS is not very effective at delivering in that modern, market-orientated world."
Reid reports next from Japan, which boasts the second largest economy and the best health statistics in the world. The Japanese go to the doctor three times as often as Americans, have more than twice as many MRI scans, use more drugs, and spend more days in the hospital. Yet Japan spends about half as much on health care per capita as the United States.
One secret to Japan's success? By law, everyone must buy health insurance -- either through an employer or a community plan -- and, unlike in the U.S., insurers cannot turn down a patient for a pre-existing illness, nor are they allowed to make a profit.
Reid's journey then takes him to Germany, the country that invented the concept of a national health care system. For its 80 million people, Germany offers universal health care, including medical, dental, mental health, homeopathy and spa treatment. Professor Karl Lauterbach, a member of the German parliament, describes it as "a system where the rich pay for the poor and where the ill are covered by the healthy." As they do in Japan, medical providers must charge standard prices. This keeps costs down, but it also means physicians in Germany earn between half and two-thirds as much as their U.S. counterparts.
In the 1990s, Taiwan researched many health care systems before settling on one where the government collects the money and pays providers. But the delivery of health care is left to the market. Every person in Taiwan has a "smart card" containing all of his or her relevant health information, and bills are paid automatically. But the Taiwanese are spending too little to sustain their health care system, according to Princeton's Tsung-mei Cheng, who advised the Taiwanese government. "As we speak, the government is borrowing from banks to pay what there isn't enough to pay the providers," she told FRONTLINE.
Reid's last stop is Switzerland, a country which, like Taiwan, set out to reform a system that did not cover all its citizens. In 1994, a national referendum approved a law called LAMal ("the sickness"), which set up a universal health care system that, among other things, restricted insurance companies from making a profit on basic medical care. The Swiss example shows health care reform is possible, even in a highly capitalist country with powerful insurance and pharmaceutical companies.
Today, Swiss politicians from the right and left enthusiastically support universal health care. "Everybody has a right to health care," says Pascal Couchepin, the current president of Switzerland. "It is a profound need for people to be sure that if they are struck by destiny ... they can have a good health system."
We rank 37 in the world in quality and fairness and we should be ashamed about it. Sadly I don't think we can now do it since we are so far in debt we are considered to be broke. Here are five capitalist democracies and how they do it.



Well, there's the rub. That simply won't fly in America, and I think if we tried it no one would be in the insurance business.
I also wonder if the extremely high suicide rates in Japan have any impact on this.
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I can't imagine it's that high? I'd bet lifestyle, diet and broad access to preventative care has more to do with it.
Between the Boomers and the rapidly growing (in the fatter ass sense) population, the US is looking at a gigantic health care burden over the next couple decades. I can only hope there's some amazing medical breakthroughs in the next 5-10yrs that'll massively reduce the cost of treating the heavy hitters like diabetes, stroke, heart disease and cancer.
I'm not sure how you'd implement it, but it needs to be damned expensive for an individual to be overweight, sedentary or a smoker. That'd reduce your longterm health care costs dramatically. For example, every time I hear talk of a Fat Tax in Canada, I'm ALL for it. Tell me people wouldn't make dramatically different choices if the double whopper meal went from $6 to $16 and the Domino's 3lbs of heart disease for only $19.99 went to $49.99.
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I'd be all for taxing obesity, smoking, alcoholism, all of it, except that I do believe there are people who honestly aren't strong enough to quit their addictions to food, nicotine, and alcohol and I'm not sure it's fair to tax them on behaviour that they realistically cannot change. Shifting funding from treating diabetes, lung disease and liver disease to helping people quit their addictions might be more practical.
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Woah woah woah! Who said anything about alcohol?! Not that I drink or anything...
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We don't need to tax them. Just mandate insurance and the insurers will adjust their premium, deductable, etc. accordingly.
The problem with insurers not being allowed to make a profit is that it takes out any reason not to cut corners and do favors under the table. I assume the government keeps them from going broke, but otherwise what makes the employees care if they suck at their jobs?
rabbit wrote:
1Dgaf wrote:
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In fairness, we have a for profit healtcare industry in this country and most of them suck at their jobs already.
There is only an up or down--up to a man's age-old dream, the ultimate in individual freedom consistent with law and order--or down to the ant heap totalitarianism,... those who would trade our freedom for security have embarked on this downward course.
Cutting corners has a very negative connotation with regards to quality. Removing profit from healthcare does not mean that employees cannot be fired if they suck at their jobs.
Fedaykin98 wrote:
Yeah but it does mean their jobs are a lot less valuable to them.
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It's about double ours, though it has more to do with Japanese society being repressed and unforgiving about making mistakes.
I would think that a for profit company is MUCH more likely to skimp on quality and/or cut corners than an not for profit one.
What is the benefit to cutting a corner or giving lower quality if it's not going to increase your profit margins?
Fletcher wrote:
I'll bet they enjoy eating and watching tv as much as the next person. Health insurance being linked to employment is a nonsensical concept to begin with.
Fedaykin98 wrote:
I'm with you.
The abolition of debtor's prisons, also, did not result in the collapse of capitalism either.
There is only an up or down--up to a man's age-old dream, the ultimate in individual freedom consistent with law and order--or down to the ant heap totalitarianism,... those who would trade our freedom for security have embarked on this downward course.
It's a lot less work.
rabbit wrote:
1Dgaf wrote:
XBL: E Munnie
I agree. It makes labor less mobile and adds complexity to the administration of the workforce. Employers are dying to get rid of worrying about health benefits. I kind of wonder why the republicans want to fight it when so many of their corporate bosses are in favor of getting it out of the employment context.
While it is less work, the employee still has to worry about keeping their job and their boss can focus on the employee doing their job "well", with "well" becoming actually good work vs. getting patients in and out asap/denying claims because it's not cost effective to treat them.
Just because the company is technically NFP does not mean that they're automatically negligent and there is no incentive to do your job. Just because the company doesn't make a profit doesn't mean employees don't get paychecks. Heck, a lot of times employees get decent bonuses because the company is forced to reinvest whatever "profit" they may have made.
Fletcher wrote:
I don't think the US health care system is fixable at this point...
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Why would you care if it's not cost effective? If the government doesn't let you profit and thrive, then it is obligated to keep you from dying as well. Beyond that, I don't see competition as keeping insurance companies in line anyway. Sure, some NFPs compete, but they tend to compete for donations that they can then use for some bigger purpose. What bigger purpose are insurance companies going to serve?
rabbit wrote:
1Dgaf wrote:
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Higher Taxes vs Business Expense write-off?
Politely rude. Briskly vague. Firmly uninformative.
I may have been unclear.
I was referring to current practices. Currently, for profit insurance companies will make decisions that are bad for the insured because it isn't cost effective to treat them. Taking away the drive for more profits would hopefully abate that mindset.
Fletcher wrote:
Corporate taxes aren't going to go any higher or lower because of national healthcare plan, and the business expense write off is nice, but I think they'd prefer not to have the expense in the first place. It's not just paying for the health premiums. It's all the administrative costs that go with it.
See, from my end (my job is dealing with corporate insurance claims), we don't "make decisions that are bad for the insured." We follow the contract. If an insured wanted "better" or more coverage than the contract affords, they should have said so to their broker and underwriter when they bought the policy.
rabbit wrote:
1Dgaf wrote:
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