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Carroll County Times

John Culleton: U.S. pays more, gets less for health care

Until recently we had the most expensive health-care system in the world and did not cover in any way significant numbers of residents, including both citizens and non-citizens.

With the delayed roll out of Obamacare through 2014 we will cover most citizens (non-citizens are still a problem) but the expense side is only marginally touched. Alone among major nations we cling to the concept of private enterprise in health care. Most of our providers are in the corporate sector. The non-profit hospitals, insurances, etc. are being rapidly taken over by corporations.

Between Medicare, Medicaid and many state programs, payment is frequently made through a government program. But the providers are not governmental.

Commentator Evan Thomas, of the Inside Washington television show, reminds us frequently that until we get rid of the fee for service payment model we will not get costs under control.

This will not happen while most providers are working for corporations.

A corporation may pay a doctor, nurse or physical therapist a salary, but the size of that salary (often with bonus) is dependent on the volume of services provided. For a primary care provider, the volume is frequently as high as 20 patients a day. And the pressure is always to see more patients, order more tests and rack up more income.

Not all payment coverages are equal. That office visit may offer a tiny reimbursement if the patient is covered under Maryland's Primary Adult Care program.

Medicaid is a bit better. Medicare pays only 80 percent of the usual charge. Many providers, individual or corporate, simply won't see such patients. But at least the government programs are less of a hassle when it comes time to render payment. After all, Medicare and similar programs are in the business of paying claims. The big health insurance carriers in the private sector are often in the business of weaseling out of payment.

I could tell you stories, but in the interests of avoiding a defamation suit I won't.

Other nations provide better health care at about half the cost of our health care. How do they do it? They have some form of (gasp) socialized medicine. Let's take Germany as an example.

According to the World Health Organization, the annual expenditure per citizen in the U.S. is $7,164, compared to Germany's $3,922. The German cost per person is 55 percent of the U.S. cost.

We spend 15.2 percent of our GDP on health care. Germany spends 10.5 percent, or about 30 percent less than we do.

But what about quality of care? Don't Arab potentates come here for the very best care money can buy? Yes, and that is part of the problem. Ordinary Americans don't get Mayo Clinic level care. The potentates do.

Until Romneycare, and later its clone Obamacare came along, significant numbers of our people got no care at all except through the emergency room.

Measuring quality of care is not easy, but two numbers, average life span and infant mortality, are available. On life expectancy Germany is tied for 21st place and we are in 38th place, ranking just below Cuba. On infant mortality Germany ranks 15th; we rank 49th, well below Cuba.

Germany has Europe's oldest universal health-care insurance system, with origins dating back to Otto von Bismarck (1883).

Approximately 92 percent of the population is covered by a "Statutory Health Insurance" plan, which provides a standardized level of coverage through approximately 1,100 public or private sickness funds. Standard insurance is funded by employee contributions, employer contributions and government subsidies. Higher income individuals sometimes choose to pay a tax and opt out of the standard plan, in favor of private insurance.

Obamacare may pull us up in the rankings closer to other modern states. If not, then the German and other models should be considered, with cost/effectiveness the criterion, not rants about free enterprise versus socialism.


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