Tag Archives: physicians

Health Insurance In the US Will Not Be Reformed

16 Dec

A libertarian extols the virtues of the French single-payer health care system, and declares it vastly superior to the American status quo, but doesn’t want to implement it here because I-Me-Mine:

when free marketers warn that Democratic health care initiatives will make us more “like France,” a big part of me says, “I wish.” It’s not that I think it’s either feasible or advisable for the United States to adopt a single-payer, government-dominated system. But it’s instructive to confront the comparative advantages of one socialist system abroad to sharpen the arguments for more capitalism at home.

For a dozen years now I’ve led a dual life, spending more than 90 percent of my time and money in the U.S. while receiving 90 percent of my health care in my wife’s native France. On a personal level the comparison is no contest: I’ll take the French experience any day. ObamaCare opponents often warn that a new system will lead to long waiting times, mountains of paperwork, and less choice among doctors. Yet on all three of those counts the French system is significantly better, not worse, than what the U.S. has now.

Need a prescription for muscle relaxers, an anti-fungal cream, or a steroid inhaler for temporary lung trouble? In the U.S. you have to fight to get on the appointment schedule of a doctor within your health insurance network (I’ll conservatively put the average wait time at five days), then have him or her scrawl something unintelligible on a slip of paper, which you take to a drugstore to exchange for your medicine. You might pay the doc $40, but then his office sends you a separate bill for the visit, and for an examination, and those bills also go to your insurance company, which sends you an adjustment sheet weeks after the doctor’s office has sent its third payment notice. By the time it’s all sorted out, you’ve probably paid a few hundred dollars to three different entities, without having a clue about how or why any of the prices were set.

In France, by contrast, you walk to the corner pharmacist, get either a prescription or over-the-counter medication right away, shell out a dozen or so euros, and you’re done. If you need a doctor, it’s not hard to get an appointment within a day or three, you make payments for everything (including X-rays) on the spot, and the amounts are routinely less than the co-payments for U.S. doctor visits. I’ve had back X-rays, detailed ear examinations, even minor oral surgery, and never have I paid more than maybe €300 for any one procedure.

The United States Senate has effectively killed off the byzantine centrist compromise called the “public option”, and is poised to pass some form of legislation that will, perchance, provide some sorely needed consumer protection in the health insurance industry, and, mayhaps, will insure more people, but the type of system such as that described above is denigrated as un-American socialism.

You know, a few weeks ago I saw billboards over in Ontario that were selling “fast-track your medical procedure” at Kaleida facilities in New York. Definitely there are problems inherent in the Canadian system, and those provincial health ministries are acutely aware of them and working to improve the speed of service. I’ve seen Canadian medical records in my line of work, and they depict excellent care, done efficiently, with no waiting list even for MRIs – if you go to the right facility.

But if you look at that Kaleida site, there are only a handful of procedures that are highlighted for Ontarian medical travelers – bariatrics (weight-control surgery), colonoscopies, orthopedics, pediatrics, and radiology. The United States could very well adopt a Canadian single-payer system and endeavor to avoid the mistakes that Canada has made. Look at the French experience, above. Instead, we reject the Canadian experience because it isn’t perfect.

I looked at the wait times for Mississauga, a busy Toronto suburb. 96 days for knee replacement surgery. But you can click a link to see the shortest wait times in the province, and find you can go to Mt Sinai in Toronto, where the wait is 61 days. Or you can go to a hospital in Chatham, where the wait is only 48 days. For lung cancer surgery, the wait is 22 days in Mississauga hospitals; the shortest wait time in the province.

The wait for an MRI is also 96 days for Mississauga hospitals. But click the link, and there’s a hospital in Toronto that will see you in only 28 days, which meets the Provincial target time.

The procedures are fully covered – no bills, no possibility of rescission. The care received is exactly what your doctor thinks you should get, regardless of cost. We can demagogue the Canadian system all we want – and frankly France does it better than Canada – but to reject single-payer out of hand because of wait times that can be more than halved if you’re willing to drive the equivalent distance between Millard Suburban and Buffalo General, is ridiculous.

Our system is far from perfect. In fact, it’s far more broken and expensive and wasteful than Canada’s. And wait times? I called my doctor for a checkup – a well visit – and had to pick a day 4 weeks away. For sick visits, I usually have to wait a day or two, and sit in a waiting room, feeling ill, for literally hours. Oh, huzzah.

Ideally, we’d let the doctors design the legislation. The system we choose to adopt should make their jobs easier. Instead, we leave the job to congress and the health insurance lobby.

Oh, and Joe Lieberman is a disgrace.