Sunday, July 26, 2009

Health Care in Europe

I've been discussing health care on a couple of people's Facebook pages lately. It is an issue that is near and dear to me, as an independent person having to buy my own healthcare and health insurance in the market. I'm pretty satisfied with my health care insurance, except for the fact that the price is sky-rocketing with no end in sight. And, I have a $2,500 deductible. So, for a simple procedure for my wife I just had to fork over $2,400. For my family of four, my monthly premium is now more than the mortgage on my first house (including taxes, PMI and everything). It's my third largest monthly bill behind only my mortgage and my car payment. Health insurance, which used to be an afterthought (in terms of how much I had to pay) is now a major spot in my budget and is increasing at an amazing rate. This year alone, it jumped over 30%.

I hear from many of my friends that they are scared of a government run health insurance system. They point to examples of government inefficiency, waste and bureaucracy that we all are way too familiar with. However, as Obama pointed out, if someone proposed a plan like what we've got today where it's not portable, you can be denied coverage, the cost is guaranteed to double in the near term and you're not guaranteed to get the care you need whether you're covered or not, no one would vote for it. If you haven't personally felt the sting of rising health care costs, you're probably on an employer paid plan. But, even those buffers are wearing thin. When I first got coverage there were no deductibles or co-pays. No one cared what anything cost. Now co-pays for well-care have increased, people are having to pay deductibles before their coverage kicks in. Employers are asking people to pay some of their own premiums. And jobs are being lost and wages frozen because health insurance premiums are such a significant cost for employers. The system is broken, folks.

I don't think a completely socialized national plan is the answer for America for a number of reasons. But, if you've seen the movie Sicko, you've seen how it has worked for other countries. Recently, people I know were speculating on what health care is like in places like Europe and Canada. I've seen a recent ad on TV where a "Canadian nurse" is warning us to not adopt a system like theirs. I happen to know a guy in Canada who says their health care system is excellent. I know a guy in Ireland who thinks their system is really good. You can still buy private insurance. But, the National Health System is good enough that most people don't. I asked him to share his thoughts with me and he sent the following:

Every health care system in western Europe is different, though all of them are comprehensive in that the whole population is covered, and none of them are financed primarily by private health insurance but rather by tax revenues or by compulsory social health insurance (normally with contributions from employers and employees). They are either run directly by the state or if not are closely regulated by law and by statutory bodies. But obviously I can only speak from experience for the UK national health service (NHS) which also covers us here in Northern Ireland.

I'm not sure what critics of our system mean by "rationed", Brian, so maybe you could clarify that further. Obviously in any health care system, however financed or run, medical resources are finite and that can lead to waiting lists for some kinds of procedures - hip replacements for example. Waiting lists had become quite high for some non-emergency operations in the 1990's, though they have come down considerably in recent years as more resources were pumped into the system, but those who can afford it often take out private health insurance to avoid the waiting lists. We do have private sector clinics, hospitals etc., and some doctors and surgeons combine private practice with working for the NHS.

As part of my terms and conditions of employment in Nortel, I can choose to be covered by a private health insurance scheme for a small premium, but I've never had any occasion to make use of it. The NHS is generally excellent in dealing with the most serious illnesses (and with accident & emergency) such as stroke, heart disease, cancers, MS and so on.

12 years ago, when I had a serious eczema problem - eventually much of my body was covered by seeping sores and rashes - the NHS admitted me to a local hospital where I stayed for about a week. I had regular appointments afterwards at the dermatology dept in the same hospital and received a variety of treatments, including UV radiation treatment when my hands were seriously affected.

Recently, as you know, I found that I had a higher than normal white blood cell count (discovered when I was donating blood which I did several times a year). The blood transfusion service rang me and advised me to make an appointment with my doctor. He saw me quickly and did further tests which confirmed that I had a high wbc count. They referred me to the City Hospital in Belfast, a couple of weeks later, where I was more comprehensively tested and saw a specialist, who told me I had lukemia (CLL to be precise). Currently I go in for testing and a consultation with the specialist 3-4 times a year, and if I eventually show symptoms they will start giving me treatment right away - probably chemotherapy.

Personally, Brian, I would have to say that I've never experienced any serious problems with the NHS - and not only in my own case, but with my family and my wife's family. When my dad had to be taken into care because of dementia, the NHS found a nursing home for him (in a beautiful spot right in the heart of the countryside) and it didn't cost me a penny. I could go on and on...for instance, the old lady who lived next door to me when I moved into this house eventually developed cancer (at 103!) - she had people who called every day to do household chores and make her food, and nurses who were in and out all the time (at the end, they were actually there 24/7, as she didn't want to go into hospital to die).

I'm rambled on and on as usual so just one more comment. The leader of the main opposition party in the UK (the Conservative Party), David Cameron, recently lost his 6 year old son who had suffered from cerebral palsy and epilepsy.
There have always been people on the Conservative Party's right wing who wanted to introduce 'market forces' and increased privatization into the NHS. Cameron has promised the public that he will not go down that route, pointing out that his own son was cared for under the NHS from his birth to his death.
In a speech in 2006, Cameron said :
“I’ve spent the night in A&E departments and slept at my child’s bedside. I’ve got to know the people who dedicate their lives to helping others."

“The fact that we have in this country a health service that takes care of everyone, whatever their needs, whatever their background, is one of the greatest gifts we enjoy as British citizens. We should never forget it, and we should never take it for granted.”

There is a big social consensus in the UK that the NHS has been one of our great achievements in the post-war period. Admittedly it has slipped from its position at the cutting-edge of European health care systems - most experts would say that there are many better national health care systems in other parts of Europe (France and Germany for instance & I would be surprised if the Scandinavian systems aren't top notch but I know nothing about them).

If there's any other info I can give you, Brian, don't hesitate to ask.
Here's my point. Our system is broken. It's unsustainable. If we do nothing, none of us will be able to afford health care in the not too distant future. We already pay way more than many other countries that have much better outcomes than we do. We are scared to trust this to the government yet, the private sector has not only not improved things over the last 15 years since we started discussing this, it's gotten worse. I hear a lot of people saying (now), "Let the private sector handle it". Up until now there's been no motivation to. Health care delivers are happy with the status quo because they can raise prices without any fear of competition. Insurance companies are happy because they just pass that along to you and me in the way of higher premiums and there's not a darn thing we can do about it. No one (until recently) shops for the best price on a surgical procedure. My hope is that, if nothing else, the government's threat to completely overhaul the whole system will motivate some of these corporations to do something before the government has to and maybe, just maybe we'll see real reform in the next couple of years. If that happens withough the government having to insure a single citizen, I'd be fine with that. But, doing nothing is not an option anymore.
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Drew Costen said...

When I needed an ultrasound and x-rays this winter I went to a walk-in clinic here in Toronto, Ontario (because my family doctor lives on the other side of the city since I've moved and I've been too lazy to look for a new one closer to home), saw a doctor in less than an hour (which I've done in just as short a period of time on a weekend as well as on a weekday), and within a few days I'd had my ultrasound and x-rays done. We think that Lydia (my wife) is currently having a mild allergic reaction to something so she called her doctor (who she found with no problem whatsoever after moving here from the US) and saw her the next day. When she passed out after having her wisdom teeth pulled back in October she saw a doctor at the ER in less than an hour, and they had her seeing specialists for tests for her heart (just in case) very quickly as well (within a couple weeks from what I recall. The second set of tests took another month, but we could have done it the same day as the first one if we'd had the time, but since we were pretty sure it was just the meds and dehydration that caused it we opted to wait, which is what it turned out to be). Yes, I've waited up to 6 hours at the ER in the past, but never for anything serious. When I've been in large amounts of pain I've never had to wait very long at the ER.

Honestly, aside from the fact that you guys still have the death penalty, the one thing that keeps me from even thinking about moving from Canada to the US is the lack of universal health care down there.

As far as scary stories about our health care system, maybe it's worse in smaller towns or in other provinces, but I've never had trouble with our system, nor do I know of anyone else who has either (and I've asked around).

Anonymous said...

Interesting blog. I agree 100%. I have private insurance through my company and its quite good, but I agree that something is wrong with the system, and it keeps on getting worse. Too many people are being left behind. The comments from your friend in Ireland are thought provoking.

My main concerns are the cost involved. I just wish this had happened 10 yrs ago, before the Medicare D act,Iraq War (part deux),Wall St Bailout, etc etc. We have an $11 trillion dollar debt now, and that doesnt include the unfunded liabilities of Soc security and Medicare/Medicaid. I cant imagine how our kids and grandkids will pay off the current debt we have. The idea of adding another trillion plus to the debt is sobering.

My second concern is that between lobbyists, the dopes in Congress and bad advice, it will be hard to get this thing right. I really hope they look at the other countries that are doing it (pretty much every other country in the world), and do this right. Who says we have to do it like Canada, if other countries implement it better. I hope Obama would consider this the "Manhattan PRoject" of his time, and get the finest minds available to find out the best way to carry this out, and then go on TV, tell how his plan will work, and make his case the public. I feel if the people understand whats invovled, and know he takes it as his most important task, he can succeed.

Brian said...


We won't have a system like Canada's. So, nothing to worry about there. There's a lot of fear mongering going on right now. I have found and to be beneficial sites to check out some of the rumors that are circulating.

I'm pretty sure that whatever we do, it won't be perfect. ;-) OTOH, the system is so broken now, I have great confidence that whatever we do will be an improvement.

I wouldn't be surprised to see healthcare reform raise the deficit a little, even though the administration claims it won't. They are building into their plans way it will pay for itself (and a tax increase on the wealthy). But, think about the deficit if we do nothing and our bloated healthcare system continues to be a drain on our economy.

Brian said...

Thanks for that update on the Canadian healthcare system. You say you waited 6 hours in the emergency room. Guess what? I cut my ear on a tree branch a couple of years ago. It's a long story. But, it cost me over $500 (the total bill was over $900) and about half a day of running from Urgent Care to the Emergency Room then sitting and waiting for a few stitches. My Own Version of Sicko Just about every time I touch our health care system I find something that's not so great about it. We had to take our daughter to see a specialist about her elbow the other day. It took 3 months to get an appointment with this guy. Our appointment was scheduled for 3:40 PM. Long story short, he walked into the examining room to see us at 5:00. Someone else waiting with us told us the last time she had seen him, she waited for 4 hours.

Anyone who tells you our healthcarea system doesn't have problems just isn't paying attention.

Don said...

"doing nothing is not an option anymore." I totally agree with your statement. However, our family doctor is a "defector" from Canadian medicine and has nothing good to say about it. He is a fine, caring, and the best doctor we have ever had. He says his mom died at 86 because in his opinion she was expendable because of her age. A pretty harsh statement! Things such as his experience make it so hard to know what is best and what to support. I am with you that we no longer can do nothing.

Brian said...


There are horror stories from Canada and horror stories from the United States. How many people here have died because their insurance company would not approve a procedure? I think Michael Moore did a pretty good job of pointing out just some of the problems with our system in the movie Sicko

Anyway, the Canada thing is a bit of a straw man. No one is advocating adopting a system just like Canada or Ireland or any other country. Our system, I'm sure will be uniquely American.

I am grateful to finally hear people in agreement that we have to do something. That, at least, is a step forward. I've seen this coming for a long time now (kind of like our problem with foreign oil). I'm glad that others are realizing that we have to do something different.

Someday said...

I think there should be a debate about this across the country. It's a good idea to examine our options.

I don't think what works or does not work for Canada is even relevant. Let's face it, Canada and Ireland with their combined populations are comparable to California's population.

What concerns me is that no one seems to be reading these 1000+ page bills before they vote on them. What's the big hurry? Slow down for once and read it. Put it on the web for a week or so so the American people can digest what their representatives are voting on like they promised.

I'm all for a healthy debate. What turns me completely off is the way everything is being rammed through by the President and Prime Minister Pelosi have been urging congress to vote on these things too fast for any honest debate to occur. If the plans are so good, surely they will hold up to any criticism and opposition.

This is not an emergency. A meteor is not hurtling towards us. Let's examine all of our options before we commit to spending yet another mind boggling Trillion dollars that we do not have.


Brian said...


I understand what you are saying. But, "slow down" is often code for "let's do nothing". There is a powerful lobby that would like to see the momentum we've got behind real reform stifled again. Their tactic is stall and spread Fear, Uncertainty and Doubt until health care reform dies a natural death (again). Presidents normally get their biggest programs done in their first year in office. And, we've been trying to get this done for decades. I think Obama is setting deadlines (knowing they'll be missed) to keep some sense of urgency on this thing.

Brian D said...

I can appreciate Someday's comment about "spending another mind boggling trillion dollars". But if you do it right, you should be able to create a universal health care system for no more than you're spending today. After all, you guys are already spending nearly twice as much per head on health care as we do in the UK!

But I suppose the problem is that any reformed system has to pass through the political sausage machine, so there will be lots of compromises and things tacked on to keep special interest groups on board.

Brian said...

Brian D,

Thanks for weighing in. The thing about our health care system today is no one is really uncovered. We don't let people die in the streets (usually). We don't turn people away because they have no coverage. What we do is treat them anyway. Then, if they don't have any coverage or not much money, we take what they've got (often bankrupting them- a recent study showed 50% of people who file for bankruptcy do so because of medical bills and the majority of those are insured) or we "write off" the costs which translates to those of us who are covered pay for it because those costs roll back into the overall cost and raise our premiums.

As a result, people who have no coverage often delay treatment making what could be minor or preventative care major. Our emergency rooms are overrun because many people use them for primary care.

I agree. We could provide true universal coverage for less than we're spending today. It'll take an investment to get there for sure. But, in the long run, the system should cost us less, not more.

Angela Douglas said...

I am an American and I REALLY wish we had a program like NHS or Canada. No program is going to be perfect, but I'd trade what we have here for something like that in a minute, even if I had to wait 6 months for a hip replacement! (I'm reasonably sure that people with immediate medical emergencies aren't made to wait! That would be insane!)

We have insurance through my husband's job but the price tag keeps going up (we have to pay a percentage of the premium) and we're constantly getting letters from the insurance company that they've raised co-pays or changed benefits (usually so that we have to pay more out of pocket for them).

In the last year, we have gotten hit hard by medical issues. My husband had to have hernia surgery and then both eyes operated on for cataracts even though he's quite young to have developed them (it's a genetic thing) We've had to make two ER visits with our kids that happened to get very ill on a weekend when our regular doctor is off. I was also pregnant and gave birth in November. This year, I started having problems with my feet and have had to make several visits to the podiatrist at $20 a visit copay (so that he could do all these ineffective things the insurance company mandated he do before doing what he knew would help...custom made orthopedic shoe inserts I still had to pay $100 out of pocket for even with insurance covering part of it) Add onto that all the routine visits for check ups/preventive care for our family. It adds up fast. Not counting all the copays for routine visits, my pregnancy check ups, and my podiatrist visits, we are currently paying off our copays to the hospital for my husband's surgeries ($200 per surgery, total of $600), the two ER visits ($200 each, total $400) and my maternity stay (24 hours, no complications, didn't even have any pain meds or epideral, gave birth 45 minutes after arriving...cost $200). Paying what we can afford to pay per month to pay these bills off, and we started paying more than a year ago, we will still be paying on them well into next year and that's if nothing else happens requiring hospital care.

Wow...if I could walk out of the hospital or ER or even the doctor's office without having to pay a dime or worry about bills, that would be more wonderful than I can even describe. Paying the equivalent in U.S. currency of $10-$12 for any prescription would be wonderful. Right now, I never know how much a prescription will be. If a generic is available, it's usually $10 with my insurance, but if not, it can be anywhere from $20 on up into the hundreds. I just recently had to switch contraceptive pill brands because what my OB/GYN had me on, even with insurance, was costing me $44 a month! My insurance has also now instituted a policy that at the beginning of the calendar year, EACH family member has to meet a $50 out of pocket cost before they'll start covering their share of prescriptions. It's outrageous!

The fringe right wingers keep harping on a govt. plan not giving people freedom to choose...but I don't have that freedom in reality now. We simply can't afford a family health insurance plan on our own even if it would be better than what we have. We are stuck with the plan my husband's employer has contracted with. And as far as supposed "rationing" being a happens now with insurance companies. Our insurance company has denied coverage on things before. They force us to go through a whole "approval" process to see certain specialists. Bureaucrats that are more concerned with their company's profits than they are with my family's health are making these decisions, not the doctors.

Our system is a farce. I support Obama's plan even if it is imperfect because we need something done, but I still won't be completely happy until the U.S. catches up with the rest of the world, silences the selfish, greedy idiots, and gets a national health care plan akin to Europe and Canada.

Sam said...

All I think about health care is politics. No wonder why it's one of the biggest expenses we have.

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