Here is some interesting reading about the myth of “socialized medicine” which those awful European governments impose on their people. 

By Trudy Rubin
Philadelphia Inquirer Opinion Columnist

One of the most bewildering aspects of the current health-care debate is the failure to learn key lessons from health systems abroad.

Conservative talk show hosts decry the alleged evils of “socialized medicine” in countries with universal health coverage; they warn grimly of rationed health care. Yet there’s nary a peep from Rush Limbaugh or Glenn Beck – let alone Congress – about countries such as Germany, France, Switzerland, or Japan, where coverage is universal, affordable, and top quality, and patients see private doctors with little or no waiting.

And, oh yes, their health costs are a fraction of our bloated numbers: The French spend 10 percent of GDP on health care, the Germans 11 percent, and they cover every citizen. We spend a whopping 17 percent and leave tens of millions of Americans uninsured.

If you want a very readable short course how European systems really work – as opposed to the Fox News version – take a look at The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care, by T.R. Reid, a former Washington Post foreign correspondent. You might also watch a fascinating 2008 Frontline series, available online, in which Reid was an adviser: Sick Around the World: Can the U.S. Learn Anything From the Rest of the World About How to Run a Health Care System?

So far, the answer seems to be “No,” not because there aren’t valuable lessons, but because politicians won’t relinquish their myths about European health systems. Reid takes up that task.

Myth No. 1, he says, is that foreign systems with universal coverage are all “socialized medicine.” In countries such as France, Germany, Switzerland, and Japan, the coverage is universal while doctors and insurers are private. Individuals get their insurance through their workplace, sharing the premium with their employer as we do – and the government picks up the premium if they lose their job.

Myth No. 2 – long waits and rationed care – is another whopper. “In many developed countries,” Reid writes, “people have quicker access to care and more choice than Americans do.” In France, Germany, and Japan, you can pick any provider or hospital in the country. Care is speedy and high quality, and no one is turned down.

Myth No. 3 really grabs my attention: the delusion that countries with universal care “are wasteful systems run by bloated bureaucracies.” In fact, the opposite is true.

America’s for-profit health insurance companies have the highest administrative costs of any developed country. Twenty percent or more of every premium dollar goes to nonmedical costs: paperwork, marketing, profits, etc. “If a profit is to be made, you need an army of underwriters to deny claims and turn down sick people,” says Reid.

In developed countries with universal coverage, such as France and Germany, the administrative costs average about 5 percent.

That’s because every developed country but ours has decided health insurance should be a nonprofit operation. (We once thought that, too, until private insurance companies began buying up nonprofit health insurers like Blue Cross and Blue Shield and converting them into profit-makers.) In France and Germany, health insurance is sold by private insurers, who can only charge fixed rates in the nonprofit health field, but can sell other forms of insurance for a profit.

These countries also hold down costs by making coverage mandatory and by using a unified set of rules and payment schedules for all hospitals and doctors. This does NOT mean a single-payer system or a government-run health system. But it does sharply cut health costs by eliminating the mishmash of records and charges used by our myriad insurance firms, who use all kinds of gimmicks to shift their costs.

A unified system makes it possible for France and Germany to use digital records; every insured person has a smart card that includes all his or her health information, further cutting the number of bureaucrats. U.S. companies oppose such efficiencies, Reid says, “because they spend money on proprietary systems and no one wants to get together on a common system.” Can we afford this stubbornness?

For those who think we could never make the switch to such systems, take note that Switzerland shifted from private health insurers to nonprofits in 1994. And it’s hard to see how we can cut costs without reining in our private health insurers.

None of these European plans have to be adopted wholesale. Yet there’s no sign we’re even examining them for useful lessons. Some U.S. senators on the Finance Committee bought Reid’s book, but have you heard anyone talk about European health systems? Of course not.

It’s easier to embrace our myths and pretend Americans know best about managing health care. But that’s the biggest myth of them all.

This opinion piece appeared in the February 28, 2010 Philadelphia Inquirer.

During Thursday’s heath care summit, Senator Kyl said he believes consumers are better able to make choices about their health insurance than Washington.  Senator Kyl doesn’t like the idea of a Washington bureaucrat setting standards for health insurance plans.  What do you think?  Here are some choices you have if you are looking for individual insurance in Arizona.

I was just looking over coverage options for a 55 year old healthy woman and here are a few of her choices:

BCBS of Arizona:  Monthly premium: $148/mo with….
$5,000 deductible: She will pay the first $5,000 of her health insurance bills.
She gets three doctor visits per year for a co-pay of around $40.
60/40% co-insurance (She pays 40% of her bills after she has paid the deductible and until she hits her $4,000 maximum-out-of-pocket.)
So if she gets sick she pays $5,000 (deductible ) plus $3,000 (co-insurance) during the year.  This protects her against catastrophic costs by limiting her yearly out-of-pocket costs to $8,000.
 
 Or she can pay $198/month for a similar plan – except that it allows for six doctor visits per year for a co-payment.

Another company, Assurant, tells insurance agents to discourage clients from including doctor visits for a $35 co-pay.  They say that customers will save about $100 per month with their premium if doctor visits come under the deductible.  This means the consumer is buying coverage in case of large medical bills. The idea of going to the doctor to stay healthy is out of the picture.  The consumer only goes to the doctor if she is seriously ill – and she pays the full doctor bill, which is applied to the deductible amount ($5,000).

Senator Borasso, from Wyoming, said that people with catastrophic coverage (like the plans described above) are the best health care consumers because they think twice about getting care.  He was implying that people with more comprehensive coverage tend to use the health care system too much. This is known as “consumer-driven heath care” and it is the mantra of health insurance companies.  We can control health insurance costs by putting more and more of the cost onto consumers.

What do you think?

You don’t automatically get your Medicare coverage unless you are receiving Social Security or Railroad Retirement payments.  I’ve recently talked to four people who did not know they had to sign up for Part B before their 65th birthday.  They swear they never received any notification from Medicare or Social Security informing them they needed to apply for Part B.  Or perhaps the notice got lost in all the junk mail that looks official but isn’t.

People who started receiving Social Security or Railroad Retirement benefits at 62 will receive their Medicare card about three months before their 65th birthday.  And the Part B monthly premium ($110.50) will be taken out of their Social Security payment (or Railroad Retirement payment) starting in the month they turn 65.

Everybody else must apply for Part B because Medicare doesn’t assume you want or need Part B.

If you are working and have good health insurance through your employer, you don’t need Part B (and you face no penalty when you enroll later). If you work for a small company with lousy health insurance and a high deductible, it might be worthwhile to compare your Medicare options with your employer’s coverage.

If you want Part B you will need to call Social Security at 1-800-772-1213.  You may be able to apply for Part B over the phone – or you may be told you must go into the local Social Security office to fill out paperwork and show them an original birth certificate.

Medicare Part A covers hospital charges, home health care, hospice, and skilled nursing facility charges.
Part B covers everything else incuding:  doctor bills, ambulance, emergency room charges, lab tests.
Part D is drug coverage and is purchased through an insurance company.

If you don’t sign up for Part B before your 65th birthday, you will have a delay in getting your Medicare coverage.  If you go three months past your 65th birthday without signing up for Part B, you will pay a late-enrollment penalty and you may have to wait 6 months to a year to get coverage.  So mark your calendar to enroll in Part B before the month in which you turn 65!

Once you have your Medicare Part A and B you need to make decisions about your Medicare coverage and your Part D drug coverage.  For more information on this, I’ve prepared a video at  http://medicarechoicesofarizona.com