Universal health care: Taking on the myths

by Christina Geyer on August 27, 2009 · 23 comments

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This is the fifth and last post in my series on universal health care. The first was a description of the health care system in Germany, the second was my experiences in the German and the US systems, the third was reader submitted experienced with universal health care in Germany, and the fourth gave experiences with universal health care around the world.  This post takes a critical look at some of the myths surrounding universal health care.

Universal health care will take away my freedom

Here in Germany, I have the freedom to choose any doctor I want.  I get any procedure I need without having it first approved by insurance.  I have the freedom to choose between any of the over 200 public and private insurance companies (it is true, though, that not everyone can choose private here, but there are still plenty of public insurances to choose from).

In the US, I would get the insurance chosen by my employer.  If I had an emergency and needed to go to the hospital, I would have to call my insurance for approval first.  Where I grew up, despite there being two hospitals within 5 minutes of my house, we had to drive 45 minutes (more during rush hour) to the in-network emergency room (we lived in Oak Hill, Virginia, and had to go to the Kaiser Permanente hospital in Arlington).  I would have to pick an in-network doctor or pay out of pocket.  Is that freedom?

Universal health care is socialist, Nazi Germany and the USSR were socialist, so socialism is evil

Couple things… first, socialism is a word that is hard to define, just read the Wikipedia article to see all the different meanings it has, has had, and can have.  Second, while Nazi does stand for National Socialist, and the USSR also had Socialist in it, they used this term to mean that they were “of and for the people,” more specifically, they were overthrowing the old guard aristocracy.  Second, the Nazis and the Soviets were also extremely patriotic, this was perhaps much more a defining characteristic than being “socialist” was.  Does that mean patriotism is evil? The Nazis and Soviets also had red as a main color on their flags, does that mean having red on your flag is evil? Association does not equal causation.

There are also plenty of legitimate political parties out there that are socialist, like the socialist parties of France, Sweden and Switzerland that have never oppressed people or committed human rights violations.

Thirdly, if socialized medicine is defined as publicly funded, then in the US, Medicare, Medicaid and the US military’s health system are socialized medicine.  The US already has socialized medicine in place.

A big part of the health care problem is all the illegal aliens that are using emergency rooms for primary care.  The cost get passed along, someone has to pay for it.

The costs do get passed along, but a 2006 RAND study “estimates that in the United States about $1.1 billion in federal, state and local government funds are spent annually on health care for undocumented immigrants aged 18 to 64. That amounts to an average of $11 in taxes for each U.S. household.  In contrast, a total of $88 billion in government funds were spent on health care for all non-elderly adults in 2000.”   The RAND study also found that undocumented immigrants tended to visit physicians less frequently than documented immigrants and U.S. citizens.  They conclude that illegal immigrants are younger and healthier on average than the general US population and people with chronic health problems are unlikely to immigrate.

The public option will drive private insurance out of business

It’s hard to say.  It is possible, but almost 100 years of competition with the public option hasn’t driven private insurance companies in Germany out of business.  In the US, Medicare works together with private insurance.  The private insurances have not been put out of business.  There are more than 20 offering prescription drug coverage under Medicare.

We will have long wait times for health care services if we end up with a public option.

It’s possible, if everyone suddenly decides they need to see the doctor and have operations.  Wait times are a result of demand overreaching supply, of there being more patients than there are doctors to treat them.  Demand will probably go up somewhat because more people will seek medical treatment, but I doubt it will be significantly.  Visiting the doctor will still be a hassle, it will still take time, and employed people will need to take time off from work to make doctors visits.  With the ease of getting basic medical information off the internet and over-the counter medicines in drugstores and the supermarket, I don’t think having health insurance coverage will cause everyone to rush to the doctor’s office for every little ailment.

Here’s a chart from a Commonwealth Fund study of wait times between Australia, Canada, Germany, New Zealand, the UK and the US:

Canada and the UK have longer wait times, but Germany does better than the US in all categories.  I’ve read wait times in Japan are even lower than in Germany (Japan also has universal health care).  It is possible to have universal health care without long wait times. Universal health care does not necessarily mean long wait times.

Democrats are proposing a government controlled health insurance system which will control care, treatments, medicines and even what doctors a patient may see / Health care will be rationed! / There will be death panels!

Health care is rationed.  Now.  Insurance companies already control which treatments and medications will be covered and what doctors a patient can see.  They deny access to and payment on certain procedures and medications, which means patients either go without or pay out of pocket. This is rationing.

As for my experience here in Germany, I don’t think my access to care and medications here, in the public insurance system, was any different to my access in the private system in the US.  I paid higher premiums here, but had almost no out of pocket medical costs.  In fact, go back and read the first point I made here again, in Germany’s system, there is less rationing because the patient can choose among any provider and doesn’t need permission from their insurance beforehand.

Members of Congress have their own health care plan

Members of Congress, along with all other federal employees, are eligible for the Federal Employees Health Benefits Program, which is not a single program, but a collection of many private health insurance plans from which enrollees can choose.  My father worked for the Department of Defense Inspector General’s Office and was eligible for the same insurance as members of Congress. We had BlueCross BlueShield coverage when I was young, and Kaiser Permanente when I was in high school.

Medical costs are already so high, we can’t afford to cover everyone

The US pays more per capita for health care than any other country in the world.  More than any country with universal health care.  There are many factors that contribute to this that need to also be addressed in this debate, like the large profit margins for health insurance companies, lack of preventative care for large segments of the population, high cost of malpractice insurance, etc.

BUT, consider that most health care costs occur in the last 2 years of life.  In the US, Medicare covers most of the population over the age of 65, meaning much of these end of life costs are already being paid for by taxpayers.

According to a 2002 Urban Institute paper citing Institute of Medicine work, 18,000 Americans died in 2000 as a result of not being insured.  There are more uninsured now than there were in 2000, chances are there are more dying from lack of insurance.  There is a cost to society for lack of insurance coverage as well.  What price does society pay for not insuring everyone?

The United States is more diverse than other industrialized countries.  There are more immigrants from third world countries.  This is why universal health care would be too expensive for the US.

First, the UK and France also have diverse populations with many immigrants from the third world.  But it’s not just rich, industrialized countries that have universal health care.  Here is the diverse list of countries from the Wikipedia article on Universal Health Care that all have universal health care: Argentina, Australia, Bhutan, Brazil, Brunei, Canada, Chile, China, Costa Rica, Cuba, Hong Kong, India , Israel, Japan, Kuwait, Malaysia, Mexico, New Zealand, North Korea, Pakistan, Panama, Peru, Qatar, Saudi Arabia, South Korea, Seychelles, Sri Lanka, Taiwan, Thailand, Trinidad and Tobago, UAE, Uruguay, and Venezuela, along with virtually all of Europe.

The public plans in some countries provide basic or “sick” coverage only; their citizens can purchase supplemental insurance for additional coverage.

Cost controls will stifle research and innovation

Plenty of cutting edge medical research takes place outside the US, in countries with universal health care.  Way too much to even list.  Just check out a couple issues of the New England Journal of Medicine to see where the authors of the articles are located.  In a quick browse through this month’s journal (August 2009), I saw authors from Switzerland, France, and Germany as well as the US.

As for pharmaceutical companies, out of the top 10 companies, GlaxoSmithKline is a UK company, Hoffman-La Rouche and Novartis are Swiss, Sanofi-Aventis is French, and AstraZeneca is Anglo-Swedish.   Regulation has not stifled research and innovation in other countries.  In fact, cost controls in Japan have led to innovations in cheaper MRI machines made by Toshiba, as one example.

Profits are very positive. Adam Smith once said, “It is not from the benevolence of the butcher, the brewer or the baker, that we expect our dinner, but from their regard to their own self-interest.” As we have seen, profits and self-interest are not bad things.

This is true to an extent, but if, for example, the butcher thought only of profits and self-interest, he might put fillers into the sausages he sells.  He might buy substandard meat and pass it off as high quality.  He might cut corners on health and safety.  A purely profit-driven business is also not healthy, the good of society must be taken into account and society must be protected.  In our butcher example, there are regulations and safety checks made on the butcher by the USDA, a government run program protecting the food supply.

If you think the free market would correct for pure profiteering, because, for example, customers would not buy from substandard butchers, check out the history of the meat industry before standards and regulations were put into place.  Read The Jungle.  Consider the amount of contaminated meat that still makes it to the marketplace now.

Want another example?  Look at what deregulation has done to the banking industry.

In Germany, public insurance companies are non-profit, but managers are still awarded salaries based on how many customers they attract to their insurance.  They still have incentives to keep prices low and customer care high.

The government cannot be trusted to run something as important as health care

Right, because for-profit businesses are looking out for your interests more than a non-profit government program would.  (I’m not saying the government is perfect and incorruptible, just questioning why a profit driven corporation is considered more trustworthy).  As to government ineptitude, I’ll just quote an article circulating the internet (via Coffee from a Cardboard Cup):

“This morning I was awoken by my alarm clock powered by electricity generated by the public power monopoly regulated by the U.S. Department of Energy.

I then took a shower in the clean water provided by a municipal water utility.

After that, I turned on the TV to one of the FCC-regulated channels to see what the National Weather Service of the National Oceanographic and Atmospheric Administration determined the weather was going to be like, using satellites designed, built, and launched by the National Aeronautics and Space Administration.

I watched this while eating my breakfast of U.S. Department of Agriculture-inspected food and taking the drugs which have been determined as safe by the U.S. Food and Drug Administration.

At the appropriate time, as regulated by the U.S. Congress and kept accurate by the National Institute of Standards and Technology and the U.S. Naval Observatory, I get into my National Highway Traffic Safety Administration-approved automobile and set out to work on the roads build by the local, state, and federal Departments of Transportation, possibly stopping to purchase additional fuel of a quality level determined by the Environmental Protection Agency, using legal tender issued by the Federal Reserve Bank.

On the way out the door I deposit any mail I have to be sent out via the U.S. Postal Service and drop the kids off at the public school.

After spending another day not being maimed or killed at work thanks to the workplace regulations imposed by the Department of Labor and the Occupational Safety and Health administration, enjoying another two meals which again do not kill me because of the USDA, I drive my NHTSA car back home on the DOT roads, to my house which has not burned down in my absence because of the state and local building codes and Fire Marshall’s inspection, and which has not been plundered of all its valuables thanks to the local police department.

And then I log on to the internet — which was developed by the Defense Advanced Research Projects Administration — and post on Freerepublic.com and Fox News forums about how SOCIALISM in medicine is BAD because the government can’t do anything right. “

By the way, they forgot to mention the safety provided by the US military, the FBI, CIA and NSA, and health care provided by Medicare and Medicaid, and plenty of other government run programs as well.  Sure, it’s easy to pick out some programs that don’t run perfectly, but think about that in comparison to how many tens of thousands of government programs exist.  Criticizing all government programs based on the perceived dysfunction of a few and advocating an end to all government programs is throwing the baby out with the bathwater.

The US has the best health care system in the world

No, the World Health Organization ranked the US system 37th, between Costa Rica and Slovenia.

Just because the health care system works in _________, doesn’t mean it’s the right system for the US

This one is absolutely, positively, true.  But the US is in a great position right now, in that it can take a look at all the other countries in the world that have universal health care, analyze what works and what doesn’t, and take the best ideas from around the world to shape the US health care system, and maybe, just maybe, make it the best in the world.

What are your thoughts?  (I invite debate, but please, be respectful of myself and other commentors)

Further information:

Read more of my health care series:

  • http://network.diversityhealthworks.com Amri Johnson

    This is a great article. You covered the bases in a way that I think opens up the conversation. Your tone was not at all defensive or extreme and anyone reading it can argue, but if they do, they better be very clear about their facts vs. a rambling barrage of emotional nonsense. Thank you for writing this. It is a very valuable piece.
    .-= Amri Johnson´s last blog ..We have a Wiki http://www.healthculturedepot.com =-.

  • http://twitter.com/randomsubu R Subramanian

    Great write-up! The table comparing wait-times doesn’t look too good for “socialized” medicine except for Germany – but that’s only to see a specialist or for elective surgery. Otherwise, meeting a doctor or being treated in an ER looks much better outside the US!
    As you point out, the US can learn from these other countries, and put together a public-private hybrid that provides coverage for all. If you can’t pay much, you end up waiting to see a specialist, but you will eventually (and I am sure this wait won’t happen in life-threatening situations.) If you can afford it, see a specialist right away. Sounds OK to me!
    .-= R Subramanian´s last blog ..randomsubu: Precisely. RT @LarrySabato tough month for Obama/Dems. But will this last 14mo til Nov ’10? What goes down can come up. Economy biggest key. =-.

  • Suzanne

    I have finally looked at your site and am blown away. Man, you should be writing books!

  • http://atouchofdutch.blogspot.com Isabella

    Again, bravo! Really well done & a great read! Thanks again for taking the time to put these blog entries together 😉

  • Thucydides

    Hello Christina,

    I agree with you on most points that you bring out here. A very well-organized comparison and argument. However, I do believe that the US government will find some way to make any new system there “clunkier” than any existing, well-run program abroad. For example, Congress has generated a proposed bill that runs over 1,000 pages *instead* of examining well-structured *existing* programs like the one here in Germany. To me, it’s a case of bureaucracy trying to force its way past common sense, but we’ll see how it turns out.

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  • Marilena

    This is great. I am going to forward it to my friends here in the US that are scared of changes.

  • Rachel

    I loved your post, but do agree with Thucydides. It’s not universal health care I have a problem with. In fact, I’m ecstatic to be living in Germany and under the health care system here.
    But Congress, especially this one, has been notoriously ineffective. There seems to be very little examining and analyzing and a lot of politicizing.

  • http://theviewfromher.blogspot.com rositta

    See, I knew Canada was bad. It’s more than bad, it’s abysmal as my own experiences tell me, and in this country government should definitely get out of the health care business…ciao
    .-= rositta´s last blog ..It’s That Time Again =-.

  • http://www.regensblog.com Sarah

    But Congress, especially this one, has been notoriously ineffective. There seems to be very little examining and analyzing and a lot of politicizing.

    Just playing devil’s advocate here: cool-headed examination and analysis isn’t nearly the ratings-getter that town-hall screaming and armed demonstrations are. So, if there is actual research happening, it’s surely not getting press.
    .-= Sarah´s last blog ..travel agent recommendations? =-.

  • http://www.amiexpat.com Christina Geyer

    @Rachel and Thucydides: Those are legitimate worries, but I’d rather have something clunky that can be reformed than to have nothing, but that’s just my personal view. And like Sarah commented, clear-headed examination and analysis doesn’t make the news. It’s not sensational enough. Finally, I ran across an article yesterday that gives some food for thought: The Case for Postal-Style Healthcare. It basically talks about how one of the most disparaged government programs, the postal service, is still necessary and given the logistical task they’re charged with, run pretty well. The German postal service does have competition for letter sending, unlike the US, but Germany is a much smaller country and many of these alternative letter carriers operate only in one or a couple cities.

  • http://cndrnh.blogspot.com CN Heidelberg

    There is actually a lot of good analysis going on right now in, for example, the New England Journal of Medicine. It’s true, that is no fun for the media. I think the media is getting to be a bigger and bigger problem in the US – they exaggerate everything (examples: the pre-election love for Obama and the current hate for him) and it becomes self-fulfilling. There definitely needs to be more coverage of the, well, the boring stuff that actually makes up the most important part of what is happening.
    .-= CN Heidelberg´s last blog ..Friedrichstadt, the North Sea, and a little bit of Denmark =-.

  • http://germanpittsburgher.wordpress.com/ GermanintheUS

    Hello, I found your analysis of universal health care very good. I talked about the issue on my blog as well. I mostly discussed wrong statements that certain people throw out in order to create panic and scare people of universal health care.


    Viel Spass beim Lesen!

    .-= GermanintheUS´s last blog ..Meine Lieblingssitcoms =-.

  • Rachael D

    Good summary — too bad emotions about death panels is what people hear over facts. This healthcare issue and politics about it kills me, but perhaps it is exacerbated because my PhD is in health policy…

    The funny thing is, the US government is already the largest payer of healthcare (Medicare for elderly, Medicaid for poor children, Native American Health Service, the VA for Veterans, Tricare for active military familes, and then the numerous gov’t employee plans). This is a fragmented mess– one system could cut overhead. One of the stranger things to me is that the gov’t CAN negotiate good pricing for medications under the VA arrangements but not under Medicare. I don’t get it. Explain to me why, in a “free market” economy that the largest payer of health care cannot negotiate pricing on some of its plans but can on others.

  • carol

    You did a wonderful, pointed recap. I would welcome a change in the health care system here. I don’t know why there is so much resistance to it. Bravo to you for your write-up … very well done!

  • Cecilia

    Love, love, love this article! Everyone is so about “me” in this country that I have barely been able to hear a coherent argument against a public “option”. By the way the key word is “option”. The wait times here are, in fact, a scandal. I have worked in the health care environment for over 20 years and I know that something simple like a colonoscopy can take up to nine weeks…if your insurance covers it. Speaking of coverage…for those folks that do have insurance…have you checked to see what you are covered for and/or how much coverage you have in the event of a catastrophic illness? Can we afford to cover everyone…who will chose who we do not cover? I have a daughter who just graduated from the university. Guess what? She is no longer covered on my policy and has a pre-existing condition. She is a type I diabetic and will now have to pay 576.00 per month to obtain decent coverage. That is a scandal! Let’s see fill the pot hole on the street or help insure all? I’ll pick a human every time. Why are we both negative and unaccountable? Finally, for those who do nothing but complain about the government…we are the government for goodness sakes! Thanks again…really refreshing perspective. C

  • Stephanie Albrecht

    This is a wonderful article and so true. My family and I lived in Germany when my husband was stationed there with the US Army. While we were there my son was born with Down Syndrome, heart defects, and pulmonary hypertension. My son is alive today because of German doctors. Our “oh so smart and superior” american doctors came to my husband and I and told us that the only way to save my son would be to transfer him to a Kinderklinik in Manheim, because there was nothing more they could do for him. So much for American healthcare and education being superior.

  • Dan

    I have a problem with your graph, as we all know people like to complain. In Canada, I have seen people wait in ER for 15min to 4 hours, depending on volume. As for electives and specialist surgeries and diagnoses, the graph only states that people complain. Canadians are renown complainers. The fact is that Canada has a magnificent health care system, not a perfect system. As a Canadian myself, I would be hard pressed to find anyone that thinks the health care system is failing. It has a healthy heart. Unlike the US system

  • http://earthroamer21.blogspot.com/ Kim

    Thanks for these comments! As a former expat (Austria, Germany, Italy and UK) who had entirely positive experiences with social medicine, I find the strident alarmism of America’s far-right exhausting. Perhaps the biggest hurdle for the average American is that so many have bought into the myth that our healthcare system is the best in the world and any changes would result in a degredation of that status. Oh my. Thanks for providing constructive information to this debate. I’m really enjoying your blog!
    .-= Kim´s last blog ..Looking back at a dozen years or so… =-.

  • http://www.a-broad-in-america.com Devon Dudgeon

    I just moved back to the U.S. after seven years in the UK. Both systems have their ups and downs, but even after all that time in the UK, it really felt great to walk out of the doctor’s office and not have to do any paperwork. Not one form to sign.
    .-= Devon Dudgeon´s last blog ..Things I unearthed in the storage locker =-.

  • dan

    You site wikipedia as a source. Thats funny wikipedia is often a liberal mouth piece.

    You down play the Nazi version of socialism. Is it not true that both todays liberals and Hitler wanted the countries GNP to be controlled by the government.

    Heathcare is about 1/6 of the US GNP. Obama and Bush’s bailouts pushed government into the private sector. This all sounds a lot like national socialism to me.

    The one thing Hitler and germans have that we do not have is patriotism. I assume Nazi Wing would never had hated Germans success like Obama has Americas.

    Think that is nonsense, listen to Obama speeches about global policies. He wishes to lower the USs standards to the worlds to let others compete fairly. This is not the americain way, this is not the same policies that made us the world power. Should we give up what we have to make things fair.

    This healthcare plan is not free so do think your pocket book will get thicker. Just name one thing the government does that works.

    1. Social Ser. ouch a failure and on the brink of folding in 2035.
    2. Postal Service, nope having major losses.
    3. Transportation, been to an airport lately?
    4. USDA- How many drugs do they approve only to later be recalled. Food that is passed by government inspectors only to later befund dangerous.
    5. Housing crisis, Fanny Mae and old Freddie started it all. Both are Government ran programs.
    6. Welfare- what a huge mess, fraud and misuse.
    7. State controlled Gambling? how wonderful for those families who have an addict in the home.
    8. US Ports — a total mess less then 20% of shipments from over seas is inspected. God knows what gets in past uncle sam.

    Thats just a few, just name one Government controlled agency that is successful and I will be shocked.

    I can’t wait for Uncle Sammy and Barrack to get their meat hooks into our healthcare system.

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  • Joshua H

    This post was incredibly interesting to read. I spent nine months studying in Austria and was exposed to the health care system. I required visits to a specialist and had countless tests and imaging procedures done. Because I was not a part of an Austrian insurance plan, I had to pay out of pocket (later begrudgingly reimbursed by my American insurance coverage). This worried me. But I ended up spending less than 500 American dollars for everything. This bill would easily have cost me 1500 dollars in America. Not only was the cost completely manageable, but the doctors and nurses were so helpful, so caring and did everything they could to get me healthy. That system clearly worked. America would be wise to take some pages out of that book and stop hiding behind ridiculous excuses and fear tactics.

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