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International experts tell senators that single-payer improves national health at less cost

By Mark Karlin
Truthout/Buzzflash, March 11, 2014

Here are two basic facts to remember about the health care system in the United States. First, there is the high cost, as noted in a 2012 report on PBS:

How much is good health care worth to you? $8,233 per year? That’s how much the U.S. spends per person.

Worth it?

That figure is more than two-and-a-half times more than most developed nations in the world, including relatively rich European countries like France, Sweden and the United Kingdom. On a more global scale, it means U.S. health care costs now eat up 17.6 percent of GDP....

Whether measured relative to its population or its economy, the United States spends by far the most in the world on health care.

The U.S. spent $8,233 on health per person in 2010. Norway, the Netherlands and Switzerland are the next highest spenders, but in the same year, they all spent at least $3,000 less per person. The average spending on health care among the other 33 developed OECD countries was $3,268 per person.

That statistic brings up the much-beloved free market criteria of return on investment (ROI), at which the US performs abysmally according to many studies when it comes to health. 

An NPR article in 2013 is entitled, "US Ranks Below 16 Other Rich Countries In Health Report":

It's no news that the U.S. has lower life expectancy and higher infant mortality than most high-income countries. But a ... new report says Americans are actually less healthy across their entire life spans than citizens of 16 other wealthy nations.

And the gap is steadily widening.

"What struck us — and it was quite sobering — was the recurring trend in which the U.S. seems to be slipping behind other high-income countries," the lead author of the report, Dr. Steven Woolf, tells Shots.

He says Americans of all ages up to 75 have shorter lives and more illness and injury.

It should be noted that in this report, the United States is being compared to other "developed" nations.  A recent United Nations Population Divison report ranked the US 40th in life expectancy among all nations in 2010.

In short, the US spends the most on medical care with poor life expectancy results, even including many nations that are not considered wealthy.

The Affordable Care Act (ACA) may have made insurance coverage more inclusive, but it keeps the insurance companies in charge of calling the shots (for those without Medicare, Veterans Care or Medicaid) and adding to the cost of health care through administrative costs and profit.

According to the advocacy organization Public Citizen, a number of experts from single-payer nations recently testified at a Senate sub-committee hearing chaired by Sen. Bernie Sanders (I-VT), a leading supporter of Medicare for all. The spokespersons from Canada and Denmark offered compelling reasons why the US should move from a private-insurance system to a government administered program (such as, well, Medicare):

For example, the Canadian witness, Dr. Danielle Martin, vice president of medical affairs and health system solutions at Women’s College Hospital, compared access to care, quality of care and costs in the U.S. and Canadian systems, and found all were superior in Canada. Martin compared the American average for administrative costs of 31 percent to the 1.3 percent administrative costs paid by Canada (not counting costs for private supplemental plans available to Canadians.) Professor Jakob Kjellberg from the Danish Institute for Local and Regional Government Research, who served as the Danish expert witness, said his country’s administrative costs are only 4.3 percent of total health care spending. 

In short, as has been argued before, private health insurance (which we still obviously have under the ACA) increases the cost of medical care, with nearly a third of that cost eaten up by private insurance non-health related revenue.  To repeat the testimony cited above: 31 percent of US health insurance costs goes to insurers, while in Canada only 1.3 percent of medical costs are administrative.

As far as access to care, to the contrary of what Sarah Palin infamously asserted -- that government care would lead to death panels -- it is private insurance companies who employ staff to decide whether medical care -- sometimes a matter of life or death with chronic illnesses and rare diseases -- should be provided.  Medicare does not employ "profit-increasers" to deny care.

Indeed, a spokesperson for Public Citizen pointedly summarized the hearing:

Today’s panel was a good first step that will hopefully inspire a real discussion about the benefits of single-payer health care in the United States, said Susan Harley, deputy director of Public Citizen’s Congress Watch division. A single-payer, or Medicare-for-all, system would eliminate health insurance companies from the equation, ensuring that only patients and their doctors make decisions about care options.

Although the ACA is to be praised for providing many uninsured people an opportunity to sleep with some peace of mind, it is still a rickety system constructed to ensure the political support of medical insurance companies.

US politicians, including President Obama, regularly boast about the US being the leader of the world in progress and a model for other nations.

Having the most expensive healthcare system, with the worst general outcome ranking for developed nations, looks like the US is a wobbly caboose not a powerful engine.

Medicare for all could solve that problem when it comes to cost-effectively fostering a healthy national population.

Afternote: The Daily Show, as usual, brought home the reality of the dysfunctional national US health care system in this recent segment. Click here.

Mark Karlin is editor of Buzzflash at Truthout.

http://www.truth-out.org/buzzflash/commentary/international-experts-tell-senators-that-single-payer-improves-national-health-at-less-cost


What the U.S. can learn about health care from other countries

PNHP note: The following press release was issued by the staff of Sen. Bernie Sanders of Vermont on March 11.

Other major countries offer better health care at less cost than the United States, according to witnesses who testified on Tuesday at a Senate hearing chaired by Sen. Bernie Sanders. “What this hearing is really about is two fundamental issues. First, the U.S., the wealthiest country on the planet, is the only major industrialized country in the world that does not guarantee health care as a right to its citizens. Should we consider joining the rest of the world? I’d argue we should,” Sanders said. “Second, the U.S. spends twice as much as other countries that have much better health outcomes. What can we learn from these countries?” asked Sanders, chairman of the Senate Subcommittee on Primary Health and Aging.

Citing World Health Organization data, Sanders said the U.S. spends as much as three times more on health care than other industrialized countries. Health care outlays in the U.S. account for about 18 percent of our Gross Domestic Product, significantly more than in France, Germany, Denmark, Canada, Great Britain, Australia, Norway, Taiwan and Israel.

In Denmark, “all citizens have access to care; no one may be denied services on the basis of income, age, health or employment status,” according to Jakob Kjellberg, an economist from Copenhagen. Victor Rodwin, an expert on the French health care system, said “the French have easy access to primary health care, as well as specialty services, at half the per capita costs of what we spend in the U.S.

Other witnesses said the money Americans sink into their expensive health care system does not buy better care. “Canada achieved health outcomes that are at least equal to those in the U.S. at two-thirds the cost,” according to one witness at the hearing, Dr. Danielle Martin of Women's College Hospital in Toronto.

The United States ranks 26th in life expectancy compared to other countries ranked by the Paris-based Organization for Economic Cooperation and Development. People who live in Italy, Spain, France, Australia, Israel, Norway and other countries live 2 to 3 years longer than Americans.

The Affordable Care Act has improved access to insurance, but millions of Americans still lack insurance or have plans with such high deductibles and copayments that they cannot afford the care they need. As a result, some 45,000 uninsured Americans die each year because they didn’t go to a doctor in time.

A major factor driving up health care costs in the U.S. is the high cost of prescription drugs. Hospital stays also cost more. While hospitals in Germany and France charge $3,000 for an appendectomy, for example, the average price for the same procedure in American hospitals is $13,000. Some U.S. hospitals charge $28,000.

“It is time for the U.S. to join the rest of the industrialized world and guarantee access to health care as a right of all people, not just a privilege for those who can afford it,” Sanders said.

http://www.sanders.senate.gov/newsroom/recent-business/us-can-learn-other-countries-health-care


Testimony by international experts underscores benefits of single-payer health care systems

At congressional hearing, experts provide further evidence the U.S. should implement 'Medicare for All'

By Public Citizen National Journal, March 11, 2014

WASHINGTON -- Testimony given today by experts from Canada, Denmark, Taiwan and other countries underscores that single-payer health care systems remove the kind of hindrances to quality care that still plague the U.S., Public Citizen said today.

The witnesses provided compelling evidence to the members of the U.S. Senate Health, Education, Labor, and Pensions (HELP) Committee's Subcommittee on Primary Health and Aging regarding the benefits of efficient, single-payer health care systems in their respective nations.

Citing cost savings and improved access to health care, expert witnesses explained to subcommittee members what's been clear to Public Citizen for years: A Medicare-for-all, single-payer system would remove one of the main hurdles the U.S. faces in the quest to provide quality health care for everyone: high overall administrative charges from insurance companies.

For example, the Canadian witness, Dr. Danielle Martin, vice president of medical affairs and health system solutions at Women's College Hospital, compared access to care, quality of care and costs in the U.S. and Canadian systems, and found all were superior in Canada. Martin compared the American average for administrative costs of 31 percent to the 1.3 percent administrative costs paid by Canada (not counting costs for private supplemental plans available to Canadians.) Professor Jakob Kjellberg from the Danish Institute for Local and Regional Government Research, who served as the Danish expert witness, said his country's administrative costs are only 4.3 percent of total health care spending.

U.S. Sen. Bernie Sanders (I-Vt.), who chairs the subcommittee, is a longtime champion of single-payer health systems and introduced legislation late in 2013, the American Health Security Act of 2013 (S. 1782), to move the United States to a unified system of health care delivery. In addition, U.S. Rep. John Conyers (D-Mich.) has introduced single-payer legislation, the Expanded and Improved Medicare-For-All Act (H.R. 676).

Several witnesses discussed their countries' goals of equity and how universal access to care was well-regarded by citizens. Dr. Ching-chuan Yeh of Taiwan, former health minister of Taiwan and professor at the School of Public Health, College of Medicine at Tzu Chi University, explained how the nation has achieved 99.6 percent coverage for the population and subsequently has seen increases in life expectancy and a drop in the infant mortality rate.

"Today's panel was a good first step that will hopefully inspire a real discussion about the benefits of single-payer health care in the United States," said Susan Harley, deputy director of Public Citizen's Congress Watch division. "A single-payer, or Medicare-for-all, system would eliminate health insurance companies from the equation, ensuring that only patients and their doctors make decisions about care options."

In addition to the national movement to adopt a single-payer health care system, state-based proposals have been put forward in several states (Vermont, New York, California, Pennsylvania, Minnesota, Hawaii and Colorado) that would require a single government payer for health care services instead of a patchwork of private and public health insurers. As explained by the subcommittee witnesses, such systems have a record of providing comprehensive, universal care at a significantly lower cost than we pay for the U.S.'s fragmented system, which leaves millions of people with no coverage.

"Public Citizen supports states moving toward single-payer systems and has outlined a road map for states to achieve the important goal of maximum coverage with minimum cost," Harley said. "However, we need a national system that truly provides health care for all. We are encouraged by today's hearing and look forward to a robust discussion about replicating the best of international models of single-payer here in the U.S.

http://www.nationaljournal.com/library/123291