Wednesday, August 8, 2018

How does the rest of the world get such fabulous affordable heath care?

That headline is of course a gross oversimplification and exaggeration. There are some benefits but also plenty of negatives under these various health care systems around the developed world. It is true, however, that in most first world countries, they do have some form of universal health care. How it performs varies widely depending on the system adopted. All these system, however, tend to eat up a considerably smaller percent of gross national product than the United States  The United States spends about 18% of Gross National Product on healthcare each year. In comparison, France spends about 11% of its GNP.

The United States is far from a pure free market system. The US does have socialized medicine (similar in some ways to Great Britain's National Health Service), such as the medical systems for the United States Armed Forces and the Veterans Administration. We have a Canadian health care model in Medicare (Medicare and Medicaid were actually based on the Canadian system).  We have elements of the German/French system in employer funded health care. And of course we have a very flawed Democrat imposed regulatory scheme that made things worse called Obamacare.

The United States care has excellent world class health care, if you can afford it. Frustrating but still very good health care if you are typically insured (with lots of co-pays and self pay and significant financial burdens in worse case scenerios). Poor care if you are under-insured (and the working poor do worse than than those at a poverty level). Our system with its layers of insurance and regulation does increase the overall costs far more than they would in a free market setting.

Leaving the British system aside (which does generally sucks) and the Canadian system (which has some serious flaws), the French and German systems (they are both hardly perfect) do provide fairly decent health care at a much lower percent of GNP than in the USA. Japan, South Korea, and Taiwan follow similar models. How do they do it?  A very good read on the topic is T.R. Reid's The Healing of AmericaI don't agree with all of Reid's positions, but he does a very good job describing health care systems around the world.  Getting back to how they manage to keep costs under control:


They also do things in France like have your health records portable on a credit card chip (which is very smart actually, it makes record keeping way easier and cheaper). When you go to a French doctor, you hand him your card and your records all pop up. They (for the most part) don't have medical malpractice lawsuits and doctors insurance coverage is considerably less than here. Medical insurance is mostly non profit (sort of like the old Blue Cross Blue Shield). Germany does allow you to obtain private insurance for greater medical services. In France and Germany if you are working, you are directly paying premiums for healthcare (the state pays for unemployed and others). Since there is no fighting over how services are coded, it requires far less staff. Hospitals are typically non-profit too. So that efficiency helps, but it is still just a fraction of health care costs. The biggest thing is...


It is actually transparent. In France, for example, prices for common procedures are listed at doctor's office. They are negotiated each year. Doctors protest they are not getting paid enough (and compared to US doctors they definitely paid less), but that is how they make the systems work.

I am not suggesting we do that. I would prefer going in the opposite direction and allowing a freer, transparent, market driven health care (similar with what you find in plastic surgery and orthodontics, which are typically not insurance driven).Still, there are elements of these other countries systems that warrant a closer look.

TOM: In The Mailbox 08/08/18: American Power: Britain’s Labour Party Pushing For Second Brexit Vote

Twitchy:  Doctors will just have to take a massive pay cut for the USA to be more like Canada

Instapundit: Choice is Good: Trump allowing lesser health care plans (with lower costs)

Once you establish an entitlement like this, it is a huge political cudgel to use on opponents!

Kaiser Health News: Doctors once opponents, embracing single payer

Powerline: Medicaid For All (be careful of this becoming true...)

Lem's Place: Healthcare reform and how the US stacks up


  1. There's also one more thing about the French healthcare system. If you are a patient, who believes your healthcare professional acted in malpractice; you can't sue them in regular court. Rather, a panel of Doctor's reviews your case and determines if any harm occurred and what compensation you receive.

    In the United States, we call this Tort Reform. It lowers overhead and thus lowers cost. It also brings a bit of certainty to both patients and healthcare professionals.

    1. You know how that plays out of course, the doctors typically cover for each other. I am not a fan of tort reform. Truth is, it's difficult to sue a doctor in most of the US and juries tend to protect them too.

    2. The best tort reform measure we could implement (in my opinion) is "loser pays". If the loser of a lawsuit was required to pay the legal fees of the winner, that would go a LOOOONG way toward eliminating nuisance and frivolous suits, which would go a long way toward getting litigation (and litigation insurance) costs under control in many industries.

      Sure, the winner of a case can always sue to recover legal costs after it's over now, but there are no guarantees that will be granted. It needs to be just a part of the deal: don't bring suit unless you have a legitimate expectation of winning because if you lose, it's going to cost you.

      That would also encourage legitimate bad actors to settle instead of letting it get to the trial stage.

    3. Whether you like it or not; it is part of the French healthcare system, and it is most often ignored.

      Here's a true story. Wife worked at the county ER. It is a place that the US Army send medics to get real life training in GSWs. A guy walks in claiming to be epileptic. He has no history of this, and is exhibiting no signs of a seizure. He's there, because he wants drugs. The nurses triage him twice. As required, he see's a Doctor, who noting no symptoms other than the patients pretend seizures that nobody believed, recommends discharge. Doctor does ask the patient what kind of meds he wants, and the patient names the most potent opioid prescribed. Doctor says no and signs the discharge.

      The patient is wheeled outside, gets up, and has an epileptic seizure immediately, falls to the ground, and hits his head on the hospital sidewalk. Is that malpractice?

      I'll just note, this was one of about 2 dozen drug seekers that came to that ER that day. Most were denied treatment because they exhibited no symptoms, other than signs of regular drug use. All left without incident, but also left having conditioned the doctors and nurses not to trust patients. None of those drug seekers would be held liable for their behavior. They won't even face a jury, because they won't get sued or prosecuted.

    4. Leland: No (or I should say very limited) med liability is true in almost all countries except the the USA. It is what it is.

      The case you just described, it's egregious and frivolous. Since most doctors and hospitals get to decide whether to settle or not as part of their insurance policies, they can force the insurer to make that guy sue and then defend the case. Point is it is hard to sue doctors, but insurance costs are also high in the USA. Just be aware that tort reform often means real malpractice (which your wife must know does happen at county hospitals) results in no remedy for the victim.


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