By Fareed Zakaria, CNN
America's health care system is broken. Our healthy life expectancy, the standard measurement, ranks only 29th in the world - behind Slovenia. Our infant mortality rate ranks 30th - more than twice that of Sweden and Japan. And for this sub-par care, we pay more than any other nation in the world. Almost one out of every five dollars spent in America is spent on health care.
Can it be fixed? How?
This Sunday at 8pm and 11pm ET/PT I'll explore these questions with a GPS Special: Global Lessons - The GPS Road Map for Saving Heath Care. This is the the first in a series of four GPS “Global Lessons” specials. The special will run again Saturday, March 24th, at 8pm and 11pm ET/PT. It will air on CNN International on Saturday, March 24 at 9:00pm ET.
The health care special will take you around the world to show you how other nations manage their health care. We'll learn lessons from Britain, Switzerland and Taiwan. I'll show you just how expensive U.S. health care can be - for comparatively low-quality returns. And finally, I'll share my own thoughts on what we need to do to fix our system. Be sure to tune in. You can also join a live discussion on twitter during the special using the hashtag #SavingHealthCare.
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Fareed, I thought heatlhcare was supposed to be "saved" by Obamacare? Why are we still having this conversation? Unless... You and others feel that more than Obamacare is needed. And by more, I mean, a single payer system. And if that's the case. Are you and the other libs out there willing to publicly admit that you, including Obama, have been going for single payer the whole time?
One simple reason that our healthcare is more expensive that Western Europe is the cost of pharmaceuticals in the US. Most Western European countries negotiate prices with drug makers. A simple example, with a few assumptions will make my point. Let's assume that the population of the US is roughly equal to the population of Western Europe. Let us also say that a particular drug costs $1.00 in the US and the average negotiated price in Europe is $0.50. This means that the average selling price for the US and Western Europe is $0.75 per pill. When Medicare Part D was passed, the Republicans made sure that the US could not negotiate prices because that would be 'socialism'. Thus, Medicare Part D becomes an huge government subsidy for the drug companies. The reality is that we are, in effect, subsidizing the cost of drugs in Western Europe. I find it curious that Republicans don't see that as socialism too.
In terms of other medical treatment, doctors in the US will always use the latest and greatest (and, thus, most expensive) technology whereas in Europe the medical profession understands the concept of 'better being the enemy of good enough'. The same is true for medication. Many of the newer and much more expensive antibiotics are proving to be no more effective, for the most part, than plain old penicillan at $5.00 per 10 day prescripton compared to maybe $5.00 a pill for the newer, still-on-patent, antibiotics.
The bottom line is that we Americans choose to pay more, whether consciously or subconsciously.
My friend, your comment, and many like them, is a large reason why I watch Fareed and read these comments. Information with fact, without the name calling...mostly. The information about drug pricing is much appreciated.Thanks
Excellent points and well written. Thanks
"The reality is that we are, in effect, subsidizing the cost of drugs in Western Europe."
Great point, jcrain!
We do subsidise the drug prices for the world, as well as subsidise any other medical advances by our out of the way high prices for anything medical. As a result Cuba has a health system with better outcomes than ours for a negligible fraction of a cost.
Look to congress, who has never let medicare negotiate with pharmia for drug pricing. We pay 5-10 times more for drugs than anyone else in the world. The whole bit about the cost of imaging, surgery, and hospital cost is due to the presence of a cost-plus system . . . no compteition at all.
Your remarks are quite accurate. Billy Tauzin was the Congressman who shepherded the Medicare Prescription Drug Act through Congress ( a bill written for the most part by PhRMA). They included the provisions banning Medicare from negotiating the cost of drugs and the re-importation of drugs from Canada. Shortly after the bill passed, Tauzin resigned to become Executive Director of PhRMA at $2M/yr. Conservative estimates suggest letting Medicare negotiate could save $70-100B/yr.
Very good point made. If there is room for negotiating drug prices, then it means that the mark up for the drugs is voluntary. I don't think that capitalism could be broken if the the price of product which is meant for saving people's health and lives will be regulated by strict federal law. It's like price for basic bread and milk that has to be affordable for everyone.
Lets not forget the constant bombardment on TV by drug companies trying to convince the whole populace that we need their product to survive. We are a society of drug pushers. Drugs are not advertised in other countries and doctors only prescribe medications when they are really needed. We also have a situation where healthcare is for profit instead of being run by non profit organizations. We were assured that companies could manage health care cheaper and more efficiently. Did Not Work!
wow you sure do know alot about health care in europe.i have lived in germany for 24 years and the care i recieved there was by far better than any care i have gotten in the usa. get your facts checked before speaken out loud about something you have only heard about thru a 3 rd persona
I agree with everything you say about drug prices. But that is only PART of the problem. We saw healthcare costs spike when "For profit" healthcare became the norm. After Reagan, it became acceptable to profit off of illness. This has been our downfall. For Profits know how to wring every penny they can from medicare and insurance companies. That and the increase of litigation of every little thing have destroyed our healthcare. Our officials have been bought and paid for by the health lobby, and has killed our system.
What arrogance. The US subsidizes the rest of the western world is a fallacy..why is it always somebody else's fault? Because it is easier to blame someone else than to accept your own failings as a nation conditioned to the view that any healthcare system must be priced in order to provide profits to the medical industry, one of the major lobbying groups who buy and sell politicians at will.
let's be honest. these are the ways to save health care and provide health care for everyone for FREE:
- no more new drug or technology development for next 20 years. enough drugs available already. more than 10 different types for anti-depressants, cholesterols, high blood pressure, etc.
- increase taxes to at least 20% to 50% like those systems in England.
- make doctors see at least 200 patients a day like that system in Taiwan. (note: medical malpractice lawyers will LOVE this. they will make tons of money from doctors' mistakes).
- medicaid for everyone!
don't know how many americans would go for any of the above.
truth is: come on people, stop comparing america to other countries in the world. we are so very very different. one state of our is bigger than most countries in the world. besides, no country in the world is as heterogenous as ours. americans are not not like non-americans. we demand everything, the best, and expect to pay the least.
ask yourselves these questions: how many doctors do you know go to other countries for training? why do doctors from other countries come here to practice? any why do powerful politicians and kings/queens from other countries come here for their medical treatment?
Phamaceuticals have actually been proven to be cost effective. Although we might be able to negotiate a better price, it has been proven that the use of medications ultimately saves the system money through reduced hospitalizations and the reduction of high cost procedures (e.g. heart surgery). There are much larger structural issues with our healthcare system that are causing high costs and poor results.
Well most of Obamacare does not go into effect until 2014. I'g love to see a single payer system. You should try doing some research amnd living somewhere else for a while...you'd learn a lot!
the term obamacare is just faux noose code for I am brainwashed and I think conservatism can save me from my own ignorance.
It is no secret that Obama had intended for a "government option" against which the Republicans fought tooth and nail, and to which Obama gave in, unfortunately (although it is arguable that that is the only way he could have made any progress at all. So your attempt at trying to create some idea of subterfuge or obfuscation or deceit is lame. If you follow Zakaria's study, you will find that ALL of the nations that are ahead of America declare that there is NO WAY they could have secured that measure of success WITHOUT a "universal option". Yet, we smart and superior Americans continue to bash them. May God help our idiotic souls.
Trey – About a month ago, I had a discussion with a friend who is an experienced physician and a good republican. He was complaining that he had to spend so much time and $$ filling out different insurance forms, with different coding practices (which codes are assigned to what medical conditions) that his effectiveness for the patients was considerably diminished. And (this I've heard from other physicians) about a third of the cost of medical care in this country goes to administration – paper pushers, albeit most is now on line, you still have to type it in. I asked him if a single-payer system would help, or did he feel that a single payer system had too many downsides.
He said – reluctantly – that yes, a single payer system would indeed help.
Of course we need a single payer system, Trey. I should think that is obvious. Better yet, allow our government to control healthcare totally, so that hospitals and pharma are not run for profit. At some point enough Americans will understand that no-one has an ethical right to profit the medical misfortunes of others. Doctors in the UK receive good pay, and live an upper middle class lifestyle. And don't forget that there is still private healthcare for those who choose it. Interestingly, only 5% do choose it. The rest are happy enough with the NHS, despite its shortcomings. As Americans with only private health insurance we are slaves to the corporations. This has to end. At some point enough Americans will EVOLVE to a fairer system for all.
Did you even WATCH the program? Why don't you take a look at the segment on Camden NJ and learn what is happening with complex patients in this country!
16a1543511cI wish more guys would write posts like this that are actually ieetrnsting to read and not boring like many others. With all the fluff floating around on the web, it is rare to read a blog like yours instead.keep updating your blog. thx! 195
The question I have for you is, is there any other HC delivery system in the world that offers universal coverage at a reasonable cost other than a single payer system?
If you watch Fareed's GPS Special Edition Sunday, March 18, you will find out that the biggest source of cost of our failed healthcare system, spending half of our money on the extremely sick people with dismal results. Fareed has said it all. We need political and moral will to solve this problem. His show is unbiased, non political. Yet it requires courageous resolve with political determination to improve our healthcare system. Big pharma, big for profit health insurance companies and perhaps the establishment (hospitals and physicians) are all players and get reimbursed substantially more than anywhere in the civilized nations. They exacerbate the problem, but not the root cause of the problem, as Fareed has accurately identified. Unfortunately the political propaganda, such as death panel, socialized medicine (hinting some kind of disaster) have all muddled the water and fooled the voters. This makes any positive measures even more difficult to implement with all the garbage fed by the Tea Party extremists.
Trey–I certainly don't speak for Mr. Zakaria nor Mr. Obama, but many feel that the health care act passed under the Obama Administration's term only dealt with a portion of the problem with health care in America, which "Saving Health Care" and Mr. Zakaria pointed out. There is not enough pressure to keep costs down and bend the curve as they say under this legislation. So your point about "obamacare saving health care" is not now, nor was it ever accurate. Bottom line–half of the population in this great country has to get over the fact that the current system, or any tangible free market solution to start reigning in costs is possible at this present moment. That leaves the government....and unfortunately it is being paralyzed by partisan politics, especially on this very issue. Taiwan's system, as presented in the special seems like a hopeful option.
Yes we do need single payer health care. The government ( as in Medicare) has no interest in profit and obscene CEO pay.So the idea to keep doing what we have been doing is what keeps our costs the highest in the world and not near the highest quality health care. The insurance companies and big pharma are what costs so much and if the government ran it all , obscene profits could instead be used instead by the folk who earned it. Whay have and insurance company and big pharma between you and your doctor???
Obamacare has not been fully implemented yet so it cannot be determined how it will work. After it has been in effect for a few years our elected officials are allowed to figure out how well it is working and modify it to work better. This is true of any law. The facts are we cannot sustain the path we are on with health care and something needs to be done. Obama and a Democratic congress were the first to address the imminent crisis of our health care due to the baby boomers getting old and having paid for Medicare. Our health cost twice as much per person as other industrialized countries pay and they care for almost all of their citizens. I truly believe that in twenty years we Americans will be saying “keep your hands off our Obamacare” , much like seniors now say “keep your hands off our Medicare,” to the Congress. It will be an amended and be a better Obamacare than we currently have.
The health care system can develop into a political cancer, if one doesn't tackle the tumour. Of course palliatives are seen as the obvious solution. But health consciousness on popular level is much more effective and sustainable.
I kissed my way up to VP at a health insurance company. Now I take over $500,000 of your health care dollars for NO VALUE ADDED to your health care. And that’s just me. Now think about how many other VPs, Directors, Managers, etc. are at my company alone. Now multiply that by thousands of others at hundreds of other health insurance companies. From 10 to 25% of your health care dollars go towards administration that adds NO VALUE to your health care. But my company’s PAC dollars will continue to fool you little people into thinking that a single payer system will be bad. Little people like you are so easy to fool. Little people also don’t realize that a single payer system is the ONLY system that would allow little people (as an entire country) to negotiate better health care prices. Little people don’t realize that the Medical Cartels already know that. And that is the reason why the Medical Cartels spend so much PAC money from the hospitals and doctors lobbying against a single payer system. Some little people say that a single payer system would cost you little people more. But if that were true, then wouldn’t the hospitals and doctors WANT that extra money? Yes they would. So why do the Medical Cartels lobby against a single payer system? It’s because the Medical Cartels know it would allow little people to negotiate better health care prices. And that’s what the Medical Cartels are afraid of. Period.
But us big wigs at insurance companies, hospitals, and pharmacy companies don’t ever need to worry about health care no matter what it costs. We get our health care paid for one way or another by you little people. And we get the little people that work at our companies to contribute to our PACs. And us big wigs say it’s to protect the little peoples’ jobs. But in reality it would be in the little peoples’ best interest to NOT contribute to the PAC. Again, little people are so easy to be fooled. I won’t ever have to worry about losing my job with so many little people being brain washed by the Medical Cartels’ PAC money. Not only that, the Medical Cartels’ PAC money is used to elect so many republicans that will never allow a single payer system. Republicans have always fought against any meaningful health care reform. But that’s what our Medical Cartels’ PACs pay them for. Politicians can be bought so easily.
Pretty soon the only people that will be able to afford health care is us big wigs. And that’s the way it should be. We don’t want you little people using up the resources when we need them. And once again, I thank you little people for capping my SS tax at the $106,800 level. Now I only pay 1.3% SS tax and you little people pay 6.2%. Also, thank you for extending my tax breaks. I’m using the extra money on my vacation houses.
Michelle Obama also took $300,000 for a position at a hospital prior to leaving for the White House. Its my understanding she was not replaced. Its called patronage and its the reason Pine Ridge Indian Rez still has 3rd world IHS care. When you hvae no political clout, your chances of lexus care is slim to none.
Excellent remarks by Timmy.
Allow health care providers with direct patient contact to earn a decent living, even allow high income levels for top medical professionals, but cut the whole idea of health care as a 'for profit' industry. Don't you know that cartoon where the medical student is taught to look at parts of the body as 'profit centers'?
Health (s)care in the US has been blown out of proportion, especially by those who are making big bucks without ever having the 'opportunity' to meet a real patient.
In The Netherlands we deal with rising costs of health care too, mainly caused by our demographics. Fortunately the equation to compute healthcare costs does not include the profits made by the type of fortune making stakeholders that want to maintain their wealth. Their only option is to scare people with the evils of socialized medicine.
"Allow health care providers with direct patient contact to earn a decent living, even allow high income levels for top medical professionals"
Agree with the general sentiment Anne, but people who study management know that in fact high income does not make people perform better. Evidenced of course by the better health outcomes in say Europe where they earn your "decent" pay but generally not more.
I'm a Brit in Thailand (universal healthcare system for the Thais) but my experience is that even well-insured Americans such as my friends here are confused or bogged down by paperwork and complications like that. It makes even them, the lucky ones, worry....and they tend to opt for operations here paid privately rather than returning for treatment.
I had a tenant who was an American PhD student doing a two year study abroad. He had to go through all sorts of hoops to stay registered at his college solely for healthcare reasons.
Cheeryble (John WIckenden)
Thank you for your honesty, Mr. S. What is your position on drug war?
Big-heart sarcasm may hopefully wake up the general populace, at least some thinking people in the US.
Well done Timmy, its great to see someone who has integrated so well into the American way.
Timmy – can you provide any comments that would lend credibility to your claim to be an insurance co. executive? What you say sounds right but only if you're telling the truth about your situation...
Go back to the drawing board and get it right. This would result in a major scrapping of what we have now, creating a whole new concept and design, then implementing it. What are the chances?
Less is more... http://www.aolnews.com/2010/01/01/solution-to-killer-superbug-found-in-norway/
I have worked for those people and they were real proud.
America need universal healthcare, No ifs, ands, or buts. I have heard many people complain that paying for other people is Un-American and other such non-sense, but I thought helping others was the American way. Not being greedy, self-absorbed fools. No universal health coverage is perfect. Ask many countries that have it! However, middle of the the road healthcare for all is better than none for most. I have severe asthma, and thanks to my crap insurance, I cannot afford one of my asthma medications. Every night I go to sleep, I may die from suffocation due to asthma because I cannot afford the almost $200 per month expense of the medication. Yet, when I lived in Arizona, I could drive to Mexico and get the same medication for a few bucks. We have to do something. I would love to see anyone come up with a good idea, single payer, universal, whatever.
There is the Goldhill article in The Atlantic magazine, Sep 2009 : Many good ideas to start an intelligent debate. FZ GPS on Healthcare is mostly factual information.
While visiting Banff 2 years ago, park radio announced their MRI was being lost. They had underutilized MRIs in Calgary and its only an 1.5 hour ride by ambulance.
The RICHEST OF THE RICH ski at Banff and the MRI was more than paid for when they could charge for it even if it was underutilized. Capital expenditures go first. We missed the boat when we let Medicare pass. Once Uncle Sam was writing the check of the room, prices began to spiral and our once largely non-profit or church administered hospitals became profit centers.
My brother was saved by a life flight from his small town in Nebraska to Sioux City after a brain bleed. Is their life flight justified by the amount of use? Sioux City is about 50,000 population.
Mediocre care for all isn't what works. I flew to House Ear Clinic (almost 20 years ago) for an acoustic neuroma surgery. Brackmann saved existing hearing in 70% of the cases. UNMC was 25% and Mayos was only 35%. It cost me $300 more because I had preferred provider. The UNMC physician assigned a resident to research my surgery and that better surgical approach was adopted. Hillary care was being debated at the time and it had 4 zones. LA was not in my ZONE.
A hospital room used to cost no more than a hotel. We had St. Joes, Lutheran, Methodist, Immanuel, VA, County for truly indigent, and UNMC a teaching hospital. Insurance didn't cover every visit. Insurance is to spread the risk of a catastrophic unexpected expense. What is catastrophic varies, but care should never be 'free.'
Absolutely.
If it wasn't such a disaster our system would be laughable. The libertarian critique form the right is misguided and self serving, if not disingenuous. The wealthy right wing are in danger of creating the people's revolution they so fear. This once great nation has lost its ethical compass and too many are afraid some one will get something for nothing. What one acquires by birthright is free and still this person rages against inheritance taxes. The debate should be transparent and I suggest these questions: is healthcare a right (I say it is), is education a right (I say yes), do we embrace the "Golden Rule?" (I say yes). I don't see any more French, Canadian, or socialist democracies coming here for healthcare than I see our citizens leaving to save money on health care. What is the good society and what is America for its citizens? This is the needed debate.
Looking forward to this presentation and hope it will be more than just a recitation of hackneyed statistics. It is essential that we get health care reform right this time and I hope that your soultions address the issues in a balanced approach. Insurance companies, pharmaceutical firms, trial lawyers, hospitals, physicians, politicians and American patients all share culpability for the failure of our system and must share collective responsibility for its salvation. The debate cannot be framed as a "liberal" vs "conservative" argument for both sides have merit in what they say. Measured, respectful discussion of all views is what we truly need and what this issue has been lacking. We cannot afford to get this wrong again!
As a well-insured chronic patient, retired economist, concerned citizen and informed voter, i follow your leadership Dr. Lobosky. Our collective health as our society's goal is for reformers to aim this national debate.
At least we are beginning to talk about the fact that our healthcare system has FAILED. That is a good start. Until a few years ago, I thought we might never come out of denial.
Fareed thinks health insurance in the US is market-driven. Think again. We don't need more government, we need people to shop for their own health insurance and punish bad service providers by taking their business elsewhere. You can't punish bad service if your health insurance is tied to your employment.
http://www.hoover.org/publications/hoover-digest/article/7298
Please let me know if you're looking for a artlcie writer for your weblog. You have some really great posts and I believe I would be a good asset. If you ever want to take some of the load off, I'd love to write some content for your blog in exchange for a link back to mine. Please send me an email if interested. Many thanks!
Health care costs are highly inflationary and truly reflect the value of the depreciating dollar. Patients have unlimited access to health care with no responsibility. Over utilization means more work and more providers need to be employed.
Hospitals are open 24/7. Staffing for night time calls is expensive.
Americans want maximum certainty in the diagnosis and that usually involves use of high tech diagnostic work up. This is expensive. Now add to it the threat of lawsuits. Doctors constantly do defensive practice driving up the costs of medicine. For example In India, a patient comes with acute appendicitis the diagnosis is made clinically and most of the times it is correct when done by an experienced surgeon. No threat of law suit, no need for elaborate CAT scan and investigations galore. If the patient is otherwise healthy he is taken to the operating room and the appendix removed. Contrast that to the same patient in the USA, Patient has A CAT Scan, multiple investigations later the patient undergoes the same surgery with similar outcomes at a much higher price. Why is that?
In India the patient has to come up with the money from his pocket. So he will opt for the least expensive route. In America, the patient is hardly responsible for any copay. The American or anyone else in the American's shoes will opt for the best Cadillac treatment. As it turns out in both cases the out come is no different. However i do not suggest that Americans pack their bags and go to India for every surgery. There is no recourse in India when things go bad. However health care is very complex and highly specialized care is advanced in USA. This advanced care is expensive. Does this care justify the prohibitive cost? Most americans live longer and have more medical problems and taking care of all these problems is more expensive.
Most of the advances particularly in oncology, cardiology are made in the us. Research and patents make it more expensive.
Government rules and regulations are ever increasing burden. For example JCAHO, state and federal health authorities constantly find ways to fine health care facilities to make money for their broken budgets. It takes several full time employees to be in compliance with the law.
Have you ever thought of how much it costs to dispose a bucket of medical waste?
Increasingly the only way out seems to close down the hospitals particularly in inner city minority neighbourhoods where the predominant payor is government insurance or self pay. This is the market at work. In fact its in the best interest of the richer private hospitals that these county hospitals are open as long as possible. It was a open secret that THe Cleveland Clinic used to pump money into an indigeneous county hospital that used to take care of all the trauma, so that the trauma patients would not show up at the Clinic.
Going forward we need to have a basic system of basic universal care with no frills at a discounted price to all americans. Plastic surgery and other high tech specialized care to those who can afford it.
I was told by a friend that something called "Penny Health" is offering health insurance plans starting just $1 a day. That is some thing we all can agree.
Ricky: that's all well and good, but
(1) what do they cover? Am I going to sign up for this plan, pay a dollar a day, but still end up with tens of thousands of dollars in unpaid bills because they don't cover this, they don't cover that, they only pay 50% of this, they only cover that if you follow all the requiremegnts listed in 100 pages of fine print....
(2) who actually qualifies for this coverage? do they summarily deny anyone with a hint of a pre-existing condition, anyone whose grandparents didn't all live to 100, anyone who's seen a doctor for anything more significant than a sore throat? After all, *those* are the people that need health care the most!
(3) And even if they do accept you, are they going to practice rescission, looking for the flimsiest of excuses to disqualify anyone who files a claim for anything more serious than a sore throat? This has been a huge problem with insurance companies – they're perfectly happy to keep taking your money as long as you're healthy, but as soon as you submit a large claim, all of a sudden they drop you because they research your record and find that you mistakenly omitted some detail in your medical history, or one of your premiums a few years ago was paid a few days late.
After all, there must be *some* catch that enables them to keep costs down. It's a simple fact that a small fraction of patients result in a large fraction of total health care costs; any rational insurer trying to keep costs down will do so by doing its earnest to exclude that small fraction of patients from coverage. That way they only have to pay out 50% of total costs, but make 90% of patients happy (of course, the other 10% are the ones that are denied claims for thouands of dollars!).
Fareed,
I watch you show every Sunday without fail because of your clear insight, candor and your independent approach to the problems that ail our country. I will watch very closely this special on Saving Health Care. I am interested in hearing the analysis of what others in the world are doing but recognizing that most of the countries with great health care systems aren't nearly as large as the United States of America. I don't think you can compare Germany, Austria, Western Europe, etc with America. They don't nearly have as many people, nor do they have as many people who have NO ACCESS to preventive care much less a way to PAY FOR acute care when they need it. So I believe that America has it's own unique problem with our health care SYSTEMS. Yes, I said systems with an "S" because we don't have one system for all of us. We have SIX (6) systems: 1) Employer Based Private Insurance 2) Medicare 3) Medicaid 4) Active Duty Military (Tri-Care), 5) Veterans Administration Health Care and 6) The hodge-podge system of care for the Uninsured (free clinics, emergency room, mobile clinics, or NO CARE AT ALL. Each of the six are different and most don't work together to have any level of continuity.
So I will be bothered if your special doesn't address how different all of these systems are, and how much they cost us all. There are some fundamental questions an American Health Care System should answer: How do we lower the cost of insurances and health services to individual Americans and to the Government's programs? How do we improve the quality of care people receive, because truthfully not all Americans receive high quality health care? How do we get Americans to be in better health in general? i.e. lower obesity, lower cancer rates, lower disparities, etc. If we don't answer these questions, we are kidding ourselves about any potential solutions.
Also, we have to discuss the lack of access. When people don't have access to insurance coverage, the don't get preventive care nor do they get treatment when they are ill. This drives up cost for us all. The Patient Protection & Affordable Care Act is in place to help to solve some problems in Health Care namely make purchasing insurance coverage more affordable (2014), expanding access to the services in public programs (medicare/medicaid), focus on Prevention & Public Health (nutrition, tobacco free living, obesity, etc), Improve Quality of Care delivered and stop the fleecing of America by the Insurance Industry(making lots of money but not providing services or adding value to beneficiaries. I think these things are noble and most Americans don't know this about the law, but I hope you take the time in you special to explain what the law is achieving for Americans now and how much more it will provide in the future.
I work in healthcare and you points are excellent about multiple systems. I would like to see CNN provide more in depth coverage on the issues you raised because no one has shared their complexities with the general public. Physician leaders like yourself and many hospital CEOs understand what is happening among the vsrious systems and what the potential the ACA has, but most people don't and are highly swayed by th misinformation disseminated by FOX and the GOP field.
you forgot the 7th ..those of us who are under 65 and do not have employer based health care but must try to find iinsurance out in the open market...very very difficult in your 50' s ..Many companies do not want to add you to their employee rolls as statistically 50-60 year olds will raise their health care insurance premiums
Perhaps if there weren't so many pharmaceutical commercials on GPS, people wouldn't think there is a pill for everything. Can't take a crap? Take this. Can't get it up? Take this. Eat garbage and sit on the sofa all day? Take this! Really Fareed?
Why the Swiss? Americans know the cheese and the secret bank accounts that hide ill gotten gains.
Why not Israel's health care system? Population of Israel and Switzerland are comparable. Americans admire
Israelis and trust their judgment. Christians associate Israel with Christ. Israel has the highest ratio of physicians to population in the world. Physicians don't flee Israel. What were you thinking?
I have an issue with the graphic you displays on Your Money this past Saturday. It displayed Canada as being 6th out of 7 in health care quality. And displayed and average cost of 3800/person. I just wondering how this study was conducted.
My mother has been dealing with pancreatic cancer over the last year. (fortunately she is doing really well).
With all of her treatments, appointments, hospital stay, prescrips, scans etc. she has only had to pay for gas to and from her appointments. And did not have to wait to be seen. She is also getting treatment from one of the best cancer specialists in Canada/world.
I too had my experiences with health care in the two countries.
I had ACL reconstruction in Canada and the US. In Canada I paid for nothing. Surgery, knee brace, prescrips, physio, hospital all free. In the US, even with solid coverage, I still paid somewhere around $4200. I can't imagine what the cost would have been without coverage.
The one advantage the covered US health care had was that I has seen my doc on Tuesday and went in for surgey that same Friday. A the procedure is elective and non life threatening, in Canada I had to wait. I was told it could be up to three months, but went in after three weeks. Which was fine as I could rehab my knee to avoid atrifi.
So I was just wondering why Canada rated so low, and what the criteria of your studay was.
Thanks
T Raddcliff
There needs to be an edit post feature as I didn't reread my post before submitting and see tons of typos
You use the word "free" quite often with respect to Canadian health care. But, in fact, its not free. Its paid by taxes, yours and mine. I think that the idea that some start thinking health care is for free causes those who may see some benefits of a socialized health insurance system to be repelled, so your choice of words can actually turn off the people you are trying to convince.
A fellow Canadian.
You're right that Canadian health care is not "free" by any means.
However, the information in Fareed's graphic could not be any more clear: Health care in Canada is by no means free, because people pay for it through their tax dollars (just as people in the US pay for it through Medicare taxes, and health insurance premiums deducted from their salaries).
However, the cost per person in Canada is about half of what the cost per person is in the US.
Yes, the people pay for their healthcare either way. And Americans pay twice as much as Canadians do.
There's no problem with auto care in the US. Auto care/repair is affordable and accessible. The reason is that your auto insurance doesn't include 3 oil changes with a $60 deducible provided you go to an in-network oil changer; one transmission overhaul provided you get prior approval from a Progressive Insurance case manager; etc. etc.
A root cause of the problem is that health insurance premiums are reasonable if properly underwritten among groups. But that other stuff......
My question Fareed is can enormous amounts of money be saved by providing health care for all those who are in jobs that they hate but stay for the healthcare that they get from their job. they could go and do something interesting because they have health care and let someone else have the job they left. Is that a reasonable benefit, does it make any sense
Stop calling it ObamaCare... That is a derogatory rightwing term
The 2014 mandate will decrease healthcare cost with the electronic health record. It will also improve quality
we need to stop expecting that electronic medical records will save money. look at the VA system: been using its EMR for last 10+ years and still losing money so it has to cut benefits left and right. look at Kaiser: EMR for years, and still increasing premiums even more than some bluecross/anthem plans.
suddenly there are more than 100 EMR vendors selling these programs to doctors and hospitals for billions of dollars. these systems don't talk to each other and have caused even more headaches and errors. more and more studies indicate doctors with EMR do NOT give better care than those without. in england, the whole EMR thing has been abandoned because of its cost and ineffectiveness.
EMR is one of those good intentions that may not lead to good outcomes.
I like what the Tiawanese is doing, but the U. S. wil never agree to something like that because the Americans are idivisually money hungry and lazy. They want you to pay them thousands of dollars so they can live lavish lives, not caring abuut their customers. Things have gotten so bad that these doctors will tell you anything or prescribe you any kind of medicine, especially if you have no money. A person can be dying and need a triple by-pass, but if you don't have the money and can't pay. As a doctor I'm not operating on you
The following blog details our positive health care experience as Americans in Switzerland between 1966-1982. We watched your CNN special on health care and are puzzled. What we experienced then seems to be what you are reporting as Switzerland's recent reform. Did we have this experience because we were foreigners and it was required of us for a work visa?
http://bjm-muesli.blogspot.com/2009/07/observations-on-health-care-reform.html
Why has no one looked into the fantastic universal health care we have here in Hawaii. We LOVE it and have for the last 36 years. It is employer paid and the employers like it because it is a tax deduction the same as the insurance on their company vehicles. For our 6.5% unemployed, there are state programs because we are smart enough to realize that an insurance premium is less expensive than trips (many trips) to the ER which can run $2000-$4000 each–at least.
Our state legislature drafted a bill that said that no matter what stupid mindless thing the mainland did our health care would stay the same. Our former-congressman-now-governor (who stayed on the mainland too long) threatened to veto it, and he received a record number of emails, phone calls and letters telling him to leave our health care alone. (The email I sent just said "May I have my vote back please".)
We can not figure out why the mainland is fighting universal health care. I guess it must be that they just don't know what they are talking about.
I know some people object to the use of "Obamacare" and find it an offensive derogatory term. I, for one, am delighted that the republicans insist on branding HCR "Obamacare", because as history proves it to be the turning point for a very long struggle to an enlightened civilized advancement of health care for America, Obama's name will forever be attached to it and he will always be credited with it's passing. Something I am certain that the republicans will expend copious amounts of effort trying to rebrand in the future in an effort to reverse their record on it. This deights me to no end.
Life expectancy fact that was given is misleading. If you correct for homicides and accidents, the US has the highest life expectancy.
Interesting point, any statistical support for your assertion? Are homicides and accidental deaths a meaningful proportion of a 300M population. Didn't think so.
Dear Patricia
Did u take the trouble to look it up?
USA
Accidental deaths 118kpa.
Homicide deaths 16kpa.
Total 134kpa.
=Approx 0.044%pa
If you assume there will be 1.5% of the population having natural deaths per annum you can see 0.044% would add about 1/30th or 2 and 1/2years to life expectancy. BUT WAIT!
Whilst the US is way ahead in homicide rates, for accidental death rates I just looked up for Britain and France as typical and they look exactly the same as the US. So reduce the 2 1/2 years by 118/118+16 and you see that homicide rate adjustment alone only add 3 or 4 months to a US life.
So Patricia why did you waste our time?
Is that why you're called Crock-er?
Cheeryble
I live in British Columbia, Canada. Our healthcare system is not perfect BUT we have healthcare for everyone. Every province has their own means of supporting the system. We pay monthly premiums to the province. My husband and I (couple coverage) pay $120.00 per month. That gives us all the medical care we need, including family physician and specialists, even medical emergency surgery if required. My senior mother, lower income, pays nothing. My disabled son pays no monthly premium for healthcare but both my mother and son have the same benefits my husband and I enjoy. We don't get bills from the healthcare provider each year...it's just the monthly premium we pay. My daughter worked in California and the red tap was ridiculous. My sister lives in Florida and is a victim of the healthcare system. Her doctors suggest a surgery and because she is on a school board healthcare program she opts for surgeries that are ridiculous and unnecessary and a number of them have been unsuccessful. This does not happen in Canada. Yes, you do have to wait for "elective surgery" but when you weigh what my sister's unwarranted surgeries have been, the doctors and system are making $$$$$. Albeit our doctors are not entrepreneurs and do not enjoy the same annual incomes as US doctors do but there is a reason for this. We have the same level of doctors but it is not a money making propessision along with the insurance companies. Despite what we have heard on the American media that we have "dealth panels", those are ignorant comments and from uneducated sources. When ANY member of my family required EMERGENCY medicine, we/they were at the top of the list. I am a HR professional for 30 years and very familiar with initiating healthcare plans. I worked for a US company and the cost of healthcare in the US compared to Canada on a per employee basis based on payroll was absolutely ridiculous. The other interesting fact is that our doctors – from family physician to specialist(s) SHARE test results, unlike in the US where each doctor performs his/her own tests. This eliminates redundancy. We also explore physio therapies, etc. rather than resorting to surgery because it's available immediately. As I said, our system may not be perfect but it is a far better system than what our wonderful neighbours to the south are experiencing. I happened to have listened to family members and friends in the US and so long as they have their healthcare, they don't extend the generosity to those who have not. Fortunately, our mindset is very different and we are all equal.
i have friends who work in the health care system in canada and several things very different between canadian and american patients:
-canadians rarely ask their doctors about newest meds they want to try.
-canadians appreciate the care they get and don't get on rating websites to complain about their doctors and hospitals, or worse call their lawyers for bad outcomes.
-canadians take only what they are given and don't demand more and more and more.
-canadians pay more in taxes and seem to be ok about that.
-canadian doctors don't have average student loans of $250,000 upon graduation.
-canadian hospitals rarely have to deal with strikes and demands from unions to pay hospital workers with high wages and benefits.
- etc.
those are some of the differences.
Congratulations on an outstanding program on health care. I am an American now living in Canada. I will take the canadian system anytime, every time. No system in perfect....but the US system is very imperfect. I hope our US political leaders are watching your program
Thank you
Your program was outstanding, thank you so much for this factual presentation. I do not understand why this country does not consider a healthy and educated society of utmost importance. Keep talking Fareed, people are listening, maybe the politicians will begin to listen too. One can only hope.
Thank you.
Great health care program – can you also speak about the different legal systems in the same countries versus the USA
Fareed's program was excellent, but failed to address a major problem in our health system– the lawyers and thel legal burden on the system. Talk about no value add and ambulance / hospital chasing lawyers trying to get rich quick. As a CEO of a small senior health care company, we spend significant amount on liability insurance and are still exposed.
Excellent program. Glad to see Camden featured. Please do more to education the public in an in-depth manner on the ACA. See Dr. Gunn's comments for additional thoughts. Someone has got to override the misinformation out there and help the public understand what the ACA is trying to do across these disparate systems.
I was so happy to a honest look at health systems in different countries and they have worked. Obviously, there is no perfect solution. But, we should know if we have the highest cost, we clearly don't have the best solution and ought to looking at what others do. The ACA is a step in the right direction but more can be done. Unfortunately, too many only talk about repealing what has been done before it has even had a chance to work. And those naysayers never have any real answers for alternatives. And usually have no real knowledge about the systems in other countries that they condemn.
I believe a single payer approach for high cost medical expenses with personal responsibility for routine expenses (with assistance for those who need it) is a good combination.
I hope this show will repeat many times.
A great program presenting honest facts and possible solutions. The program looked at some great health care models that are working in other countries with better outcomes and for less money.
I lookk forward to a national health care system similar to what Taiwan utilizes.
It is worthy to note the glaring omission of any mention of the effects of medical malpractice suits on health care delivery in the U.S. This demonstrates the bias of this program and the obvious support for a single-payer, gov't-controlled system. This is further apparent in the way that the moderator 'glossed over' such significant issues of rationing and the liklihood of lengthy waiting periods for necessary care. While the Camden example was interesting, it was unclear whether the investigatory team was paid, or if they were a group of volunteers. Certainly, such disclosures would impact the feasibility of expanding similar programs. When will we see fair and honest programming that actually educates the public?
Medical malpractice payments are what percentage of the 2 trillion dollars of HC spending in this country? One percent, two percent, ten percent? Ten percent is 200M dollars, do you or anyone think that medical malpractice awards in this country even approaches 200M? Very unlikely. You are more likely attempting to throw out "facts" to divert attention from much needed reform, reform that will cost HC companies billions but save thousands of American lives.
An enlightening and informative commentary however, I am somewhat surprised Canada’s Health Care model was not really discussed in the comparison evaluations. Great Britain’s system appears quite efficient with the exception of their “high taxes”. However, is it reasonable as to what they will and not pay for?
Perhaps we ought to be looking at Taiwan’s model after all.
Britain simply has decided....and got used to....spending a relatively modest proportion of GDP on the health service.
May be some waiting for non urgent procedures but certainly not for vital treatment. It's a trade-off which needs to be made when the US is being bankrupted. As it can be measured as better than the US there's a lesson there.
BTW all Brits that I know seem happy with things there. The fact is that unlike Americans they really don't think much about healthcare......it's always been there for them, so they can concentrate on more important things like enjoying themselves instead of working themselves to death to pay for the myth of the world's best healthcare.
Cheeryble (John Wickenden)
ps mention should be made of truly inventive new practices that I know of like Britain's telephonic and online self diagnosis....they seem to work. Not to mention the fantastic new ambulance practices in France whereby ambulance crews are matched to the call, spend much more time on site when necessary and then with extra knowledge about the patient sending the patient to the very best hospital for their particular treatment meaning a great saving in messing around and later changes....all good for the patient.
Cheeryble
The program failed to address the significant cost of the litigious society we practice medicine in – which adds to the cost of medicine via defensive medicine, and malpractice premiums.
Additionally, the description of the NJ "model"medical system experiment was quite misleading. Many of the patients who over utilize the Emergency Department are no pay patients (patients' whose cost of health care is not paid for, and is eaten by the hospital and physicians involved in their care, since no one is turned away), so implying the idea that NJ hospitals were making 12 million dollars from the patients in the subsidized housing building is misleading.
The program also omitted the HUGE concepts of cost shifting in the American medical system as well has the faults of an EMPLOYER payed insurance system. But this is well covered by NPR in a This American Life episode. Google it
Hgh health care costs are squeezing America's corporations and its workers. High HC costs leaves less for other forms of employee compensation and our corporations less able to compete against foreign companies who do not have this burden.
There are a few points about your special that I would like to address. 1. The increase in cost of healthcare apparently rose in the past several years- In reality, the value of money has decreased. The cost of health insurance for a family has gone down in terms of Gold, Gasoline, and Food. 2. I agree with you that there is not a free market in healthcare. Largely prices are fixed by A. The Government and B. The Insurance Industry (In back room negotiations with healthcare organizations and providers). Unlike Lasik, which you mentioned, this does not create a market for healthcare, but a monopoly in-a-sense. If every provider had to publish their price publicly and charge everyone the same, and not interact in back-room deals with insurance companies- there would be a true market. The Insurance-consumer relationship should be strictly that, relationships between your insurance company and the consumer should not have anything to do with the physician and the price. Same with drugs- drug companies should have nothing to do with insurance companies- they should sell their products direct to the consumer- also would eliminate the high prices and the conflict of interest between the doctor and the drug company. 3. Not everyone should have healthcare- People die. People make choices, and people suffer the consequences of these choices. There is a great market for charity that would and should take care of people who cannot afford healthcare. People make this argument that things are too important for the free market- just look at two areas- the hamburger and the rhinoceros horn. The government does not regulate the hamburger and it is plentiful and inexpensive. The government does regulate the rhinoceros horn- illegal in fact to traffic- very expensive and hardly available. If the rhinoceros horn is so valuable, there should be no problem 'saving' the rhinoceros, except for the government. (It is just a big cow, albeit feistier).
Mr. Zakaria. I am the author of the World Atlas of Experience. As a imaginary cartographer I draw maps of ideas, to illustrate complex situations. Healthcare is such a domain. I can chart it. Check my site and google my book. If you're interested, please get in touch. Regards, Jean Klare
Great program, Fareed. Objective, rational, & nicely articulated presentation of the massive inefficiencies in our healthcare system & the huge economic (& opportunity) costs that have resulted. I previously read Dr. Atul Gawande's pieces in The New Yorker (which you nicely summarized), & believe that Dr. Gawande's approach – identification of and outreach to the small percentage of patients accounting for hugely disproportionate share of healthcare spending – is one critical piece, & hope (& believe) this approach will be adopted, embraced & fine-tuned by payers and providers over the next few years. But we must somehow find a catalyst for motivation to move toward a single payer system, and to correct perverse incentives in our healthcare delivery system (such as a fee-for-service approach) which encourage overdiagnosis & excessive tests & procedures. The healthcare debate (surrounding the Affordable Care Act) has made one thing crystal clear: There will be too much political opposition (from entrenched vested interests) for substantive nationwide structural change in the healthcare delivery system of this sort, regardless of the projected savings. So, it seems to me that significant, meaningful reforms must be planned & implemented in a few key states (or geographical areas) which are more progressive (politically, & with respect to healthcare delivery), & less likely to encounter political resistance. Oregon, Washington State, & Vermont are a few possibilities. These changes could then be implemented nationally.
Excellent reporting. I also found the Time Magazine article (March 26) excellent. Thank you so much for sharing your expertise with us. I sincerely hope this special will be replayed every 3 days so so between now and when the Supreme Court rules. Our citizens need to know the facts, not what they hear from those who have a political agenda.
I am 47 years old and have a pre existing condition and had to go on Medicare because my husbands insurance denied me coverage. I have a 21 year old son in college and my 57 year old husband just lost his job and health benefits for himself and my son. The Cobra payment would have been $16,400 a year for the two of them and obviously, this was not an option. I ended up getting my husband on a high deductible plan through Healthy NY and put my son on his college insurance. What will happen when my husband no longer meets the qualifications for Healthy NY and when my son is out of college?
With that said, I would like to know why the Republicans (and some Democrats) are so against health care reform? It is so blatantly obvious that our system is broken and is bankrupting many Americans. My assumption is that there are many corporations and special interests groups that are funding these politicians campaigns that will have a lot to lose if we switch over to universal type health care. Can anyone explain this to me?
I also wanted to mention that being that no one is hiring in my husbands field, he is going to have to work as a subcontractor and become self employed. This is going to make affording health benefits almost impossible. If we went to universal type health in America and it was funded through our taxes, wouldn't that relieve employers of the huge expense of having to provide health benefits to their employees?
Every American deserve to see this report. Thank you for your excellent, well researched report!
Great special very informative. I found it quite interesting the Swiss model which has has a great outcome is very similar to Obama's health care law. I also found it interesting that Taiwan who reformed their system went with the single payer system. Though I am not sure it would work in the US. the fact the doctors are getting paid low and work 11 hours a day may not work here. Though I think a single payer as an option would help to reduce the waste in the private insurer. The fact that Private insurers spend 30% on non medical related cost is also a problem and should be controlled. Finally 5% of patients account for 50% of the costs sound slike we need death panels (only kidding but these numbers need to be fixed.
I am bipolar. I live on SSDI. Because I get insurance and not welfare, I can't get Medicaid. Medicaid in the state of Texas is the only way I can afford Abilify and see a psychiatrist. I had to pay blood cash that took the food out of my mouth for a psychiatrist to give me a perscription over the border in Nuevo Laredo - I live in Laredo. Know what the home base of NL is? The Zeta drug cartel. I had to go into their territory to get an American pharmaceutical drug that I couldn't afford here. And people will ask, "Oh, was it the right drug no matter what it said on the label?" And my answer is think for a second. I'm in cartel territory. You think the products there are inaccurate? Yeah, it's the right medicine.
But this is what I have to do because I've been in two minor car accidents in a year, and I need a dopamine modulator to help me concentrate because I won't get in the car without it. Bipolar disorder does a lot of things to your brain, but it doesn't take away your morality.
Dear Mr. Zakaria:
As the author of two major works on this subject, and as a consultant and speaker deeply involved for 22 years with these issues, I can say with substantial authority that your piece was excellent and dead on. You were very wise to include T.R. Reid, whose work (The Healing of America) should be read by every American who is still able to form an independent opinion based on fact instead of political sloganism. I speak also for my coauthor Kathleen Bartholomew in applauding your work. We would also advise those who attack your conclusions to have the intellectual honesty to reexamine the basis of any such demurrer. For instance, one columnist/blogger who has already weighed in in the negative had the temerity to assert that he had "blown away" the factual assertions that we are providing less than half the quality of care of the rest of the industrialized world, and that our longevity and infant mortality rates are abysmal compared with other nations. You may rail against those facts as must as you desire, but they are still facts. John Boehner discredited himself with me en toto two years ago when he made the absurd statement that "We still have the best healthcare in the world." Sorry, John...not on this planet. We can't scare away the reality of the disaster this great non-system has become. It's time to blow away the counterproductive party demagoguery (and both sides are guilty) and join minds as American on the real issues in order to produce something we have never had: A true healthcare system that is affordable, efficient, and stable. We have nothing even remotely resembling that today.
John J. Nance
Kathleen M. Bartholomew
WHERE IS THE VIDEO OF THIS? I'd like to show it to some colleagues. (I work in politics in Germany.)
Magnificent points altogether, you simply won a new reader. What may you suggest about your post that you made a few days ago? Any certain?
Remarkable issues here. I am very satisfied to look your post. Thanks a lot and I'm having a look ahead to touch you. Will you kindly drop me a mail?
This is really a remarkable thing that we must take our future with the gps system taht takes part in the safety in our driving.
Please tell me when this will be on again. My whole family is interested in seeing this! Can we watch it online?
I grew up and worked in the NHS. In the UK, we find it unconscionable that a developed nation such as the US wouldn't provide healthcare for it's citizens. It's not a political issue of conservative versus liberal, it's a human rights issue. There was no such thing as 'death panels'. If you needed treatment right away, you got it, if you could wait, you did. There was no fear that if you lost your job, you lost your healthcare. You didn't have to worry that if you got sick, you potentially could go bankrupt in order to pay for treatment. Yes, we paid more in taxes, and that's where the real battle is in the US. Those who make more money don't want to pay higher taxes. It all comes down to money, forget about looking out for the interests of others.
Link disabled. I need to see this doc again, and to pass the link to other interested parties. The item will not play
Dear Mr. Zakaria, I watched your well researched piece this past Sunday (July 1, 2012). I am a practising pediatrician based in Los Angeles, having grown up in India. I graduated from medical college in India, 22 years ago. I liked the intellectual honesty in your show. It is appalling to note that the economic fate of a catastrophic illness for an individual is no different in the U.S., the lone superpower on this planet, compared to an emerging economy like India. It appears that the vested interests in the healthcare industry would like to keep the American public in the dark about the intellectual aspects of the argument for universal healthcare and play to the emotions of the opponents to perpetuate the misguided notion that people's freedom about healthcare choices are being taken away by the government. Strategies to forge meaningful public-private partnerships in the quest for universal healthcare coverage and affordability, would be a good start, as envisaged in the Affordable Care Act.
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There is no country in the world that currently provides universal healthcare which has legal costs associated with malpractice or the cost of education to become a physician comparable to the United States. American public is not ready to pay a 50% income tax (although those making over 250$/yr are being forced into it), but they expect the government to somehow provide them with high quality healthcare. Physicians are under growing costs of regulations, but no private insurance companies or legal systems that allow frivolous medical law suits are being regulated to any reasonable extent. When did a clerk for an iansurance company gain the clinical understanding of what medication or procedure to approve for a patient they have never laid their eyes on? The system is a mess and needs reform, and public deserves access to healthcare without a doubt, but aren't we approaching this from the wrong end?