Ricochet is the best place on the internet to discuss the issues of the day, either through commenting on posts or writing your own for our active and dynamic community in a fully moderated environment. In addition, the Ricochet Audio Network offers over 50 original podcasts with new episodes released every day.
Is European Medicine Possible without American Research?
Bernie Sanders said during the debate that he wants to give America a Scandinavian-style medical care system.
As my Scandinavian and Italian relatives attest, medical care in Denmark and Italy is comparatively easy to access, inexpensive, and excellent. My niece received splendid care for a concussion and shattered ankle in Rome, and my uncle only had to pay for a $25 fee to get a copy of her records transferred to her doctors back home.
Once she got back to the States, having the follow-up care here in the U.S. (even with health insurance) set my uncle back ten grand.
Here’s my question: If I imagine my niece’s care as consisting of various medications, diagnostic tests (MRIs) and surgical techniques (e.g., laparoscopy) performed by Italian doctors, how much of this would be possible in the absence of the research, development, and innovation that takes place in the US?
Is there evidence that our system, retaining as it does a profit motive for medical innovation, produces more than its share of innovation and invention?
Published in General
I had a patient from Sweden who said the praise of socialized medicine is false. It is not a good system.
I’m sure that if you were to visit Cuba and got ill or injured, you would get top notch care. I the Cubans I met during Operation Sea Signal would tell you otherwise.
On the other hand, I lived in Germany for almost 10 years, and I can say unequivocally that as a patient and a consumer, everything was as good or better in Germany. Prices were cheaper, waiting lines were shorter, conversations with doctors were longer, facilities were cleaner, and so on.
But this isn’t due just to some kind of German efficiency: most Germans are required to pay about 15% of their gross income for health insurance, and the system is still heavily subsidized from general taxes and indirect sources such as the church tax (which helps fund the many church-run hospitals).
As to the question of whether medical progress would have been so great were it not for our American free-market system, I think the real answer is quite depressing.
When pharmaceutical companies and device manufacturers choose what products to develop, the main source of income they are trying to tap into isn’t the “free market” American consumer, it’s Medicare.
And for many of those same companies, the European markets are actually very attractive. Even though they have price controls, the pharmaceutical companies still make a comfortable margin on each pill sold. And the fact that everyone in those countries has insurance (and is typically not price-conscious) means the companies can still make a great profit on volume.
So in the end, much of the developments in the healthcare field are not from “free market” forces as much as guaranteed, state-subsidized customers.
Having gotten sick in Europe and knowing some folks there my conclusion is that basic care is pretty good. If you have something serious it’s another story, particularly for cancer. Cost controls mean many medications and treatments available in the U.S. are not available and cancer detection tends to be later which is why the 5 year survival rates for most cancers in most European countries are 15-20% less than in the U.S (I used to have the data handy but can’t find it now).
The systems also vary significantly from country to country. The UK is actually the only pure single player system (along with Canada) with the rest being a mixture of private and public. My Spanish friends tell me that while there is a public system that they all pay for it’s pretty bad and they use private doctors and purchase private insurance.
Another question you might ask regarding things like MRIs is how available they are and what are the wait times compared to the U.S. I have a friend in Quebec with some pretty terrible stories about wait times there – stuff that we would never put up with here.
At times I wonder if death is better than our third party payer system.
Denmark has a population of about 5.5 million people and per capita GDP of about $45,000.
It’s roughly equivalent to Minnesota, with 5.4 million people and per capita GDP of just under 60,000.
What is stopping Minnesota from instituting Denmark-style health care?
INCORRECT: The UK has parallel private health care separate from the NHS.
As far as I’m aware, there are only three countries on Earth that prohibit private health care: Canada, North Korea, Cuba.
Paging George Savage.
Mis. Thanks for correction. How did this come about in Canada?
I don’t know how it happened, but I can guess at a reason why. I suspect that Canadians’ easy access to American medicine made it less important for people to fight for an alternative fee-for-service system in Canada.
A couple of factors to keep in mind, apart from the smallness and comparative cultural and ethnic homogeneity of European countries:
1) Their systems, as you suggest, rely heavily on American innovation, which is largely driven by the profit motive.
2) They are much less litigious than we are.
I had major surgery in Switzerland. I had a baby in Liechtenstein, and stayed in the very pleasant small hospital for at least 5 days recuperating. I don’t think we paid anything. I had another baby in Austria, and then one in Holland. All good experiences of high levels of competence and care.
Ten or twelve years ago our son broke a leg skiing in Austria, involving an on-slope rescue and an ambulance. If there were costs involved, they were negligible.
Broken wrists and other minor incidents in the US have cost our family many thousands of dollars, plus a lot of bureaucratic aggravation.
We’re definitely doing it wrong.
That’s huge.
For example, for one test I am familiar with, in Europe the rate of positive results is between 20% and 30%. For the same test, we see less than 5% positive results. Our clinicians are terrified of missing anything, and therefore order tests probably on up to ten times as many people. That adds up.
Two words. Pierre Trudeau.
If the polls are correct, his son is about to become Prime Minister:
Be afraid.
There’s an assumption (which I tend to share) that most medical research is done in the US – is there any way to quantify this? Are there medical breakthroughs elsewhere which enable US medicine as well?
What happened was that in the early 80s the socialists complained that doctors were allowed to charge extra for services technically covered by provincial health insurance. i.e. If a doctor thought the service he provided was worth more than what the province would reimburse for the service (like, say, cuz the doctor had invested in some expensive equipment not used by his competitors), he would tack an extra charge on to the patient.
The solution to this “problem”, in 1984, under Pierre Trudeau, was to make it illegal for doctors to charge for any “medically-necessary” service. i.e. Anything other than plastic surgery.
(Aside: Later that same year, Brian Mulroney and the Tories were elected government. Coincidence? They apparently thought so, since they didn’t repeal Trudeau’s law. Sigh.)
I hear that North Korea has cured all disease.
Re: Bolded phrase—that sounds so familiar!
Would you prefer a Dutch-style (or Austrian, or whatever) system in the US?
MRI wait times for most of those countries are ridiculous compared to the US.
I live in Orlando, and there is a significant amount of European and Canadian “health tourism” based on people who need moderately advanced tests but who don’t want to wait six weeks to a month. We even get a number of Canadians who got tired of waiting for non-critical scans.
If that had happened in Canada, you would have been on the hook for the full cost. Canada’s socialist health care doesn’t apply to tourists.
Refugees, yes. Tourists, no.
Yup. MRIs are included on the list of “medically-necessary” services that it’s illegal to charge money for. As such, it is illegal for someone to simply buy an MRI machine and start charging a fair rate for scans…
…unless you’re a veterinarian. There’s no law against charging to give an animal an MRI scan.
(Aside: Other things not considered “medically-necessary”, and therefore you are allowed/required to pay for ’em with your own money: dentistry, optometry, physiotherapy, psychiatry, podiatry, prescription drugs.)
If you don’t mind me asking, do you or have you worked for a pharmaceutical company or some kind of biotech? A close relative also works in the pharmaceutical industry and he takes a completely different view that what you have said here.
I don’t think it’s possible in the US.
European non-spending on defense depends on American military might.
Likewise, take away American innovation, and the quality of care in socialized systems will rapidly decline.
But dramatic reform is definitely in order, including tort reform.
Also there are aspects of the Dutch system that I hate, such as mobile euthanasia units.
Greater levels of social solidarity over there mean it will take longer for the whole thing to fall apart, but eventually economic pressures together with a habituation to euthanasia will mean increasing levels of rationing and general de-humanization.
It’s entirely possible for states to run their own health care according to a “european” model.
The Netherlands has a population of about 17 million people, and a per capita GDP of about $44,000.
That’s roughly equivalent to New York State, with 19 million people and a per capita GDP of about $76,000.
Why doesn’t New York State have Dutch health care? It chooses not to.
Well, states are different. I don’t say it’s impossible at the level of states, but at the federal level.
Federal mandates make it very difficult for innovation at the state level, though, don’t they?
Hear, hear. Our system actually has a proportionately larger share of government funding than Germany.
When I (US citizen) was at SFU (Uni in BC), I remember having to have to doc fill out insurance forms which I sent back to my dad (in the States) to submit a claim.
I also remember that physios got 6 visits and then had to beg for more.
Didn’t it start out as New Amsterdam?