2013 Symposium: Is There A Country That Had A National Health Programme That Actually Works Efficiently?

Cartwright:  No.  Any national run health programme suffers from vast inefficiencies and healthcare rationing.  The National Health Service in Great Britain has long been plagued by problems like lack of doctors and long wait times to see a doctor.  What happened?  People got tired and started finding private insurors and private doctors.  Did it cost more?  Yes.  Did they get better treatment?  Yes.  Was it more efficient for the patients?  Yes.  Take a look at Canada as another example.  If you’re old and you get sick, you’re not going to get the same level of treatment and care as someone half your age.  They figure you’ve lived long enough, so why bother spending money to keep you alive a few more years.  So, the death panels decide who lives and dies.  This isn’t speculation; this is fact.  I can point to examples of personal friends from Canada who relied on the system and they’re dead.  Is this what we deserve here in America?  No, but it’s what we’ve got now with Obamacare. 

North Carolina:  Singapore, a sovereign city-state and island in Southeast Asia, has a well-established national healthcare system that works efficiently through both government providers and a private healthcare delivery system.  It consists of the finest medical facilities and highly trained physicians in the world with 13 private hospitals, 10 public government hospitals, and a number of specialist clinics that cater to different patient needs at variable costs.  The global consulting firm of Watson Wyatt deems Singapore’s program as one of the most successful healthcare systems in the world in terms of its efficiency in financing and its total health outcomes.  In order to keep healthcare costs in check, the government systematically adjusts their procedures and carefully regulates the supply and prices of healthcare services in the country.  The government does not directly regulate private medical care costs, as private costs vary according to market demands and depend upon medical specialties and the services provided.  The system is classified as non-modified universal in which the government ensures affordability of healthcare within Singapore’s public healthcare system itself.  It relies on compulsory savings, subsidies and price controls.  Savings are accumulated with compulsory savings plan through payroll deductions, which act as subsidies within Singapore’s nationalized health insurance plan known as Medisave.  Within the Medisave plan, citizens accumulate funds on an individual basis and those funds can be used within a family and extended family.  Most Singapore citizens have sizeable savings within Medisave and are able to choose from three levels of subsidy with any related healthcare appointment.   Patients are free to choose providers within the government or private healthcare system and can avail themselves of walk in consultations at private clinics or any government polyclinic.  In emergencies, patients can seek aid through the 24-hour Accident & Emergency Departments located in the 10 public government hospitals.  Seventy to 80 percent of Singapore’s citizens access medical care within the public health system, and government spending on healthcare is only 3-4 percent of GDP (Gross Domestic Product).  This low percentage is due to limited government expenditures in the private system.  The binding principle of Singapore’s national health care system is that medical services are not free, regardless of subsidy level, and the same rings true for the public healthcare system. This mechanism is in place to decrease the overuse of healthcare services. Actual out-of-pocket expenses vary for each medical service and subsidy level utilized.  Though expenses are usually small, even at higher subsidy levels, costs can accumulate and become substantial for patients and families. At lower subsidy levels, the subsidy is almost nonexistent, and patients are treated as private patients, even within the public system.

Singapore’s ranking (sixth in the world with actual healthcare outcomes) is ahead of other developed countries, which include the United States, and its standing is even more significant in that it spends less on healthcare than any other high-income country, as shown in its Gross Domestic Product figures and costs per person. According to the World Health Organization, Singapore has one of the lowest infant mortality rates in the world, as well has high life expectancy from birth. All of these results are achieved at a fourth of the cost of American healthcare and half the cost of Western European countries. Government policy makers and health officials from around the world need to examine Singapore’s system to discover ways to achieve affordable and superior healthcare for all citizens.

Orlando:  The efficient operation of health care systems is not a matter of binaries, but rather one of degrees. There is no system of any kind which works with 100% efficiency; resources are bound to accumulate at some point where they will not do the maximum amount of good. The question is really how efficiently a system works. In short, what country gets the greatest quality of care for the lowest price?

It is certainly not the American private, for-profit health care system. American healthcare spending is 60% higher than spending in other developed nations. Most of this money is going to an increasingly consolidated hospital system, about 30%, according to the Center for Medicare and Medicaid Services. Hospitals charge excessive fees for two reasons. First, they know they can. For most people, the amount of money they are willing to spend to preserve their lives is however much they have plus however much they can borrow. If your car breaks down and a repair shop wants $20,000 to fix it, you have several options. You can shop around to find a better price, replace your car with another one, you can attempt to fix it yourself, or you can do without a car. The free market works well in these instances, because the availability of options enables you to negotiate a fair price for the service to your car. If the problem is with your heart and not with your car, though, your options shrink dramatically. You might be able to shop around, unless the problem is keeping you in a hospital bed, or, as in the case of hospitals, if the nearest competing hospital is miles away and reflects thousands of dollars in ambulance fees. The free market doesn’t work here because you don’t have those options. Many hospitals don’t even bother discussing fees before-hand, because there is no cost that is too high for life-saving treatment.

Second, hospitals charge higher fees because they have to. No one gets turned away from a hospital because they don’t have insurance or sufficient means to pay, despite the fact that many people who need medical care have neither of those things. So, many people, 2 million people to be exact, according to insurance price analyst company Nerd Wallet, are forced to file bankruptcy because they cannot pay their bills. This does not count the number of people who receive medical care and die with no next of kin and no estate to speak of. Hospitals need to recoup these losses somehow, and they do so by increasing their prices.

A semi-public healthcare system, like that found in Canada, sees costs that are about 50% lower per capita. Government can collectively negotiate for life-saving medical treatments, reducing their price. Hospitals can provide services knowing that their bills will be paid, which will enable them make reasonable cost projections and lower their prices. Consumers are encouraged to get medical guidance about preventative care and diet, which are both the lowest cost and the most effective ways to improve health care outcomes. Of course, the Canadian system isn’t perfect. Wait times in an emergency room are around 4 hours on average, and 50% of patients can’t see their family or personal physician on the same or the next day. That’s a 15 minute longer wait on average in an emergency room than in the United States. The savings, though, could be as much as $4,000 dollars per person. That’s certainly a much more efficient health care system.

Washington, DC: One of the biggest debates in the USA over the few last years was the introduction of Patient Protection and Affordable Care Act, or commonly known as ObamaCare, a national health care plan which aims to provide medical insurance to all Americans. It is well-known that the American healthcare system, while employing some of the best specialists and technologies in the world, is probably among the worst in terms of cost and efficiency. While it spends an enormous amount of money per capita, many people simply cannot afford to access the American healthcare system.

ObamaCare has provoked vigorous debate in the country because many people are cautious about government getting involved into healthcare. However, there are many examples in the world where countries have nationally run health-care programs with great success. In his seminal book “The Three Worlds of Welfare Capitalism,” Gosta Esping-Andersen provides an excellent analysis of different welfare systems, including healthcare, of developed countries. He established three systems: liberal (such as in the United States, Australia, and Canada), corporatist-statist (Germany, Austria, France, and Italy), and social democratic (Scandinavian countries). All of these systems have different approaches to providing social benefits to people (including healthcare), with liberal system being the least involved, and social democratic the most. As a result, Scandinavian countries have the most comprehensible health care systems which offer affordable and very effective medical help to their citizens, no matter their income levels.

Moreover, other countries which encourage extensive government involvement into healthcare system also enjoy an excellent level of medical help to their people. Japan, Hong Kong, and Singapore boast some of the most efficient health care systems in the world; and one of the unifying characteristics in all these countries is close government control.

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