Healing of America (Thanks to Jade-Anna) – Flashcards
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Who is Nikki White and why do you think Reid mentions her in this book?
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Nikki White was a 32 year old woman diagnosed with contracted systemic lupus erthyematosus, that died due to her inability to pay for her healthcare. She had too much money to qualify for healthcare help but not enough to cover much needed drugs. Reid mentions her because our failing healthcare system ultimately lead to her death.
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What led Reid to write this book? What is his story?
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eid made it his mission to see how other countries provided organized healthcare systems that are universal, effective and affordable to everyone. Reid himself was injured in the Navy in 1972. His shoulder caused him to seek the help of doctors once he could no longer participate in desired activities such as golfing and therefore got different opinions from different doctors all over the world in order to see how other healthcare systems worked and to perhaps also help his shoulder.
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What does Reid say and feel about the use of the term "socialized medicine"?
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No one really knows the exact definition but has been a term used against universal healthcare since Truman tried to put in place a national health care system in the US. "Socialized medicine" is meant to suggest that anybody advocating universal access to healthcare must be a communist.
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2 flaws in "socialized medicine argument"
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Most national health care system are not socialized; Healthcare is of high quality, reasonable cost using private insurance plans, doctors, and hospitals. Americans like government run medicine
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What is the principal thesis of the book?
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Healthcare in different countries and how America can learn from other countries to improve our current healthcare system
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Why did Reid discuss Gen. Eisenhower?
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Eisenhower at the time of his presidency was faced will trying to fix America's road systems (transit infrastructure) which at the time were mainly 2 lane highways; slow commute. While American troops were in Germany for WWII they discovered a much faster, efficient road way system: this involved 4 lane highways, overpasses and ramped interchanges to avoid intersections. Eisenhower chose to adopt this system from the Germans in order to best benefit Americans. At the time did not seem a big deal to copy an idea from another country yet U.S. doesn't want to adopt healthcare ideas from other countries. Idea of American Exceptionalism we don't need to borrow ideas from others.
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Bismarck Model
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Healthcare providers and payers are private; They cover everyone and do not make a profit; May pay a fee for service but then gets reimbursed a few days later (may be in full or in part) Ex: Germany, France, Belgium
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Beveridge Model
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healthcare is provided and financed by the government through tax payments; no medical bills it is a public service; Ex: Great Britain, Italy, Spain
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National Insurance Model
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Provider of healthcare is private but the payer is government; Runs insurance program that every citizen pays into. Ex: Canada, Taiwan, South Korea
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Out of Pocket Model
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No System countries patient pays Ex: Cambodia, India, Egypt
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How does the US Healthcare system compare to these models?
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For most working people under sixty-five, we're Germany, or France, or Japan. In standard Bismarck Model fashion, the worker and the employer share the premiums for a health insurance policy. The insurer picks up most of the tab for treatment, with the patient either making a co-payment or paying a percentage.
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How does the US Healthcare system compare to these models?
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For Native Americans, military personnel, and veterans, we're Britain, or Cuba. The VA and much of the Pentagon's Tri-Star system involve doctors who are government employees working in government-owned clinics and hospitals. Following the Beveridge Model, Americans in these systems never get a medical bill. The Indian Health Service also provides free care in government clinics.
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How does the US Healthcare system compare to these models?
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For those over sixty-five, we're Canada. U.S. Medicare is essentially a National Health Insurance scheme, with the near-universal participation and the low administrative costs that characterize such systems. Americans with end-stage renal disease, regardless of age, are also covered by Medicare; this group had enough political clout to get what it wanted from Congress, and the "dialysis community" opted for coverage under the government-run NHI system.
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How does the US Healthcare system compare to these models?
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For the 45 million uninsured Americans, we're Cambodia, or Burkina Faso, or rural India. These people have access to medical care if they can pay the bill out of pocket at the time of treatment, or if they're sick enough to be admitted to the emergency ward at a public hospital, or if they have access to a charity clinic.
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How does the US Healthcare system compare to these models?
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And yet we're like no other country, because the United States maintains so many separate systems for separate classes of people, and because it relies so heavily on for-profit private insurance plans to pay the bills. All the other countries have settled on one model for everybody, on the theory that this is simpler, cheaper, and fairer. With its fragmented array of providers and payers and overlapping systems, the U.S. health care system doesn't fit into any of the recognized models. In general though the other models cover everyone the quality is high and the costs is lower in comparison to the US.
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What did Reid mention was the most frustrating finding in his global quest?
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"But for all their problems, the other industrialized countries tend to do better than the United States on basic measures of health system performance: coverage, quality, cost control, choice. This was the most surprising and infuriating discovery of my global quest—that the United States of America performs so poorly in this fundamental area of human life."
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According to Reid, what is the paradox?
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We are the most powerful and richest country yet not the healthiest we lag in successful completing the tasks of providing healthcare to everyone. We've wasted our shining medical assets because of a health care payment system—or, more precisely, a crazy quilt of several overlapping and often conflicting systems—that prevents millions from receiving the treatment they need and that undermines the quality of care for millions more.
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Can you describe the major point(s) Reid made in discussing?
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Coverage-US healthcare does not cover everyone; And those that have coverage may have an insurance that is very limited so that it won't cover a major medical expense.
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Can you describe the major point(s) Reid made in discussing?
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Quality-For all the money America spends on health care, our health outcomes are worse on many basic measures than those in countries that spend much less.
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Can you describe the major point(s) Reid made in discussing?
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Cost- US spends a lot more; providers (doctors, pharmacists, etc.) make more here than overseas; profit-making health insurance here; overseas considered charity or public service); lawsuits and malpractice against doctors occurs more often in US overseas very rare.
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Medical loss
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That is, when health insurance actually pays for somebody's health care, the industry considers it a loss.
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Adverse selection
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Term refers to people who refuse to buy health insurance when they're healthy but go shopping for a plan after they've been diagnosed with a serious disease.
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Individual mandate
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everybody pays for health insurance, through either a private company or a government program.
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Guaranteed issue
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Everyone has coverage; however in US insurance companies allowed to pick and choose to avoid adverse selection.
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Describe a Vital Card. How is it used?
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This carte vitale—the "vital card," or the "card of life"—contains the patient's entire medical record, back to 1998. Embedded in the gold metallic square just left of center is a digital record of every doctor visit, referral, injection, operation, X-ray, diagnostic test, prescription, warning, etc., together with a report on how much the doctor billed for each visit and how much was paid, by the insurance funds and by the patient. Everybody in France over age fifteen has this card—a child's medical records are maintained on his mother's card—and it is the secret weapon that makes French medical care so much more efficient than anything Americans are used to.
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How did the French healthcare system evolve?
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France's health insurance system, based on the "sickness funds" of the classic Bismarck Model, began in 1928 with a fund that covered only low-wage workers in certain industries. The egalitarian impulse in French society demanded that others get the same kind of benefit, and the system gradually expanded to cover every resident of France (although it wasn't until 2000 that the final 1 percent of the population got coverage). Today, everybody must belong to a health insurance fund; it's illegal to opt out, no matter how healthy you think you are.
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What model is it?
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France's health care system is a variation on the Bismarck Model, a system that would be familiar to Americans. It is not "socialized medicine." Rather, it is largely a system of private doctors treating patients who buy health insurance to cover most of the cost.
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What does it have in common with the US system
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As in the United States, most French doctors are in the private sector and charge patients on a fee-for-service basis; there's a specific charge for each office visit, injection, X-ray, and so on.
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What does it have in common with the US system
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As in the United States, the French buy health insurance through the job, with the employer and the worker splitting the cost; the monthly premium is withheld from the worker's paycheck.
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What does it have in common with the US system
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As in the United States, patients generally have to pay a fee, or co-pay, at the time of treatment; unlike the United States, the French patient will later have most or all of this co-pay reimbursed by the insurance fund. As in the United States, there are both public and private hospitals; the French for-profit hospitals tend to specialize in certain illnesses and procedures.
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How does the French system differ from the United States?
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For the most part, French workers don't have a choice of health insurance plans; they get the one that was set up for their line of work, or their geographic region, and stick with it for life.
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How does the French system differ from the United States?
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French's main is not profit, so they don't care about making an investor money just looking to pay for the patient's care and provide healthcare
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How does the French system differ from the United States?
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Almost no limitation on patient's choices no "in network" or "out of network"
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How does the French system differ from the United States?
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French insurance funds can't turn you down for coverage, regardless of preexisting conditions.
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How does the French system differ from the United States?
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They can't terminate your coverage when you lose or change your job. (When a French worker loses her job, she keeps the same insurance plan; the government pays the employer's share of the premium.)
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How does the French system differ from the United States?
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They can't deny a claim; once the doctor submits a bill, insurance has to pay it. There's no deductible;
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How does the French system differ from the United States?
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French insurance pays from the first euro billed. The long delays in reimbursement that are common for American insurance companies are illegal in France. Doctors and hospitals are generally paid within a week, and the patients must be reimbursed for their costs at the end of each month.
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How does the French system differ from the United States?
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Since the French insurance funds don't spend any money on marketing, on filtering out unwelcome customers, on reviewing and denying claims, or on paying dividends to stockholders, they are significantly more efficient businesses than American insurance companies. French administrative costs generally run below 4-5% while in the US, insurance giants spend almost 20% of income on administration.
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How does the French system differ from the United States?
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As a general rule, the French don't have to wait in line to see a general practitioner or a specialist; waiting times are usually about the same as those for people with insurance in the United States. EXCEPTION: Pediatricians who are generally in short supply.
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How does the French system differ from the United States?
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There's no such thing as the "innetwork" and "out-of-network" lists developed by U.S. insurance companies; under French law, every health facility is "in-network." Any patient can go to any doctor, any specialist, any surgeon, and any hospital or clinic in the whole country, and the insurance system must pay the bill.
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How does the French system differ from the United States?
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If you feel sick, you can call an ambulance to take you to the doctor or hospital of your choice—for free.
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How does the French system differ from the United States?
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The French don't have the "gatekeeper" system, common in the United States and several other countries, in which you have to get a referral from a general practitioner before you can go to a specialist.
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How expensive is the French system?
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France spends about $3,165 per capita each year for a health insurance system that covers everybody; the United States spends more than $7,000 per capita and leaves tens of millions without coverage. France's spending runs just under 10 percent of its total national wealth (as measured by gross domestic product); the United States is spending about 17 percent of GDP on health care.
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How expensive is the French system?
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Premiums are dirt cheap, particularly for the employee. A single person making $20,000 per year paid $12.25 per month in 2007; her employer's share of the monthly premium was $208. In addition to this required insurance, the French can also buy supplemental health insurance, either from nonprofit cooperatives (mutuelles) or from for-profit insurance companies; because this coverage is even cheaper than the sickness funds, almost 90 percent of workers buy it.
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How do patients pay?
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The French system expects almost every patient to pay something almost every time he has medical treatment. Most French patients, in fact, pay the full charge for their treatment at the point of service.
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How do patients pay?
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If they live below the poverty line may only pay $7.80 for a visit The poorest of the poor pay nothing.
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How do patients pay?
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Those that do pay a fee for services rendered are usually reimbursed in full or in part
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Describe the French concept of solidarite.
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Whenever the French talk about health care, they invoke the concept of solidarité, the notion that all French citizens must stick solidly together to help one another in time of need. "The solidarity principle," explains Professor Rodwin,"requires mutual aid and cooperation among the sick and the well, the inactive and the active, the poor and the wealthy, and insists on financing health insurance on the basis of ability to pay, not actuarial risk." When sick everyone is equal.
