Discussion leader: Charlie Goodyear

Summary :

USA Healthcare System
-17% of GDP (was 7% in 1971) vs. 9% Canada,10% UK, 10% Germany
-Coverage :
+50% Employer (155 million people, cost $20,000/family, employee pays
+14% Medicare (+/- 55 million people)
+12% Medicaid, Veterans, Native Americans (+/- 50 million people)
+ 7% ACA purchased (+/- 20 million people)
+ 8% Emergency Room, Other
+ 9% Uninsured (+/- 30 million people)- 80% US citizens
-Drug costs : $1000/per person/year vs. OECD $500
-Estimated 100-130 million people have “pre-exsisting conditions”
-Life expectancy below OECD countries, Infant mortality higher
-Reasons for higher costs vs OECD countries :
+ Technology and drugs ( eg more MRIs per capita, no drug price controls)
+ Obesity (35% vs 19% OECD) and chronic illnesses (32% of Medicare costs
cover the last two years of life)
+ Much higher administrative costs (4% of GDP), double the staffing vs Canada
-Healthcare costs a major factor in personal bankruptsy( !0 million have bills they can’t
pay )
Canada Healthcare System
-Single payer system covering 100% of the population -no co-pays or deductables
-Doctors and hospitals privately owned and managed within system rules
-Managed by Provincial governments who pay all doctor and hospital charges
-System funded 50/50 with Federal government
-Provinces set prices and proceedures that comply with Federal requirements
-No private insurance allowed except for drugs and dental not covered by System
-Heavy involvement in drug pricing and approval, cost benefit analysis
-Essentially no US type media drug advertising
-Doctors earn about 2/3 of what US doctors earn/year
-Lower availability of medical devices (eg. 75% fewer MRIs per capita than US)
-Open heart and transplant surgery restricted
– Major problems: waiting times for referral to specialists (+/- 16 weeks ), doctor
choice limited, long delays for elective surgery
United Kingdom Healthcare System
-Single payer system covering 100% of the population-no co-pays or deductables
-Doctors are government employees and hospitals are government owned
-Managed by major regional authorities (ie Britain, Wales,Scotland, etc)
-Drug prices controlled by the government, strict cost/benefit analysis. No US
type media drug advertising
-Drug prescriptions cost about $12/ each, free for children.

– No dental coverage for adults
– Doctors earn about 2/3 of what US doctors earn
– Individuals may purchase insurance coverage with doctors in private practice
– Major problems: Long wait times (+/- 10 weeks for general surgery), limited availabiliy
of new(expensive) or experimental treatments, cost/benefit analysis, lack of mental
health services, very long delays for elective surgery
-Per capita costs $4K/year vs US $10K/year
-Many say “Underfunded but not broken “
Germany Healthcare System ( An alternative to “single payer” ??)
-An insurance based system with non profit and for profit insurers
-Covers 90% of population- required participation for all but highest earners
-Funded by 50/50 contribution by employers and employees -15% of earnings
up to about $70K/year (2014 data)
-Private doctors and hospitals but highly regulated
-No deductables and low co-pays -children are free
-Managed by regional authorities via “sickness funds” that are used to control
total costs
– Drug prices are controlled, cost/benefit analysis, no US type public advertising
– Doctors earn about 2/3 of US doctors/year
– Per capita costs less than 1/2 of US
– Surveys indicate significantly higher public satisfaction with the system vs US,
Canada or UK
( The relationship between the insurance companies, doctors, hospitals ,employers,
employees individuals and the regional government bodies is unclear and needs
further analysis and understanding)

Comparisons of Health Care Systems in the United States, Germany and Canada




Single Payer Healthcare

Universal Coverage

The article below on drug cost shows how complicated healthcare is to understand, much less manage.  Factors such as age of population, availability of new drugs, the number of insured, etc. all interact.

Still, negotiation is an important factor.  The article states that many western countries (all government run healthcare) will only pay for improved outcomes.
But it’s not purely rational.  If some exotic drug will save your life, it’s worth a lot to you but maybe not so much to society if it starves other healthcare services.  The payers are subject to political pressure from interest groups.  Not simple.

The False Promise of ‘Medicare for All’

Cost is only part of the problem. Single-payer systems create long waits and delays on new drugs.