Updated: 8:48 a.m. MT May 15, 2007
WASHINGTON - Americans get the poorest health care and yet pay the
most compared to five other rich countries, according to a report released
on Tuesday.
Germany, Britain, Australia, New Zealand and Canada all provide better
care for less money, the Commonwealth Fund report found.
“The U.S. health care system ranks last compared with five other nations
on measures of quality, access, efficiency, equity, and outcomes,” the
non-profit group, which studies health care issues, said in a statement.
Canada rates second worst out of the six overall. Germany scored
highest, followed by Britain, Australia and New Zealand.
“The United States is not getting value for the money that is spent on
health care,” Commonwealth Fund president Karen Davis said in a
telephone interview.
The group has consistently found that the United States, the only one of
the six nations that does not provide universal health care, scores more
poorly than the others on many measures of health care.
Congress, President George W. Bush, many employers and insurers have
all agreed in recent months to overhaul the U.S. health care system — an
uncoordinated conglomeration of employer-funded care, private health
insurance and government programs.
The current system leaves about 45 million people with no insurance at
all, according to U.S. government estimates from 2005, and many studies
have shown most of these people do not receive preventive services that
not only keep them healthier, but reduce long-term costs.
Davis said the fund’s researchers looked at hard data for the report.
“It is pretty indisputable that we spend twice what other countries spend
on average,” she said.
Per-capita health spending in the United States in 2004 was ,102, twice
that of Germany, which spent ,005. Canada spent ,165, New Zealand
,083 and Australia ,876, while Britain spent ,546 per person.
Key measures
“We focus primarily on measures that are sensitive to medical care
making a difference — infant mortality and healthy lives at age 60,” Davis
said. “Those are pretty key measures, like how long you live and whether
you are going to die before age 75.”
Measures of other aspects of care such as cataract surgery or hip
replacements are harder to come by, she said.
They also looked at convenience and again found the United States
lacking — with a few exceptions.
“We include measures such as waiting more than four months for elective,
non-emergency surgery. The United States doesn’t do as well as Germany
but it does a lot better than the other countries on waiting time for
surgery,” Davis said.
“We looked at the time it takes to get in to see your own doctor ... (or)
once you go to the emergency room do you sit there for more than two
hours, and truthfully, we don’t do well on those measures,” Davis said.
“The area where the U.S. health care system performs best is preventive
care, an area that has been monitored closely for over a decade by
managed care plans,” the report reads.
The United States had the fewest patients — 84 percent — reporting that
they have a regular doctor.
And U.S. doctors are the least wired, with the lowest percentage using
electronic medical records or receiving electronic updates on
recommended treatments.I thought it was interesting the the success of the health system directly cooresponded to the population of the country. The more people a system tries to serve the more room for failureI would agree . The U.S. has alot more people here. When I was at the Mayo Clinic I met several people from other countries ( Including Canada ) I wonder why???
I'm not sure that theory is relevent, Buckeye. Germany did best and
they have a population of 84 million, while Canada was second to last
with a poulation of 34 million. New Zealand was in the middle and they
have a population of only 4 million, so by your theory they should have
been best.
Today in the class I was teaching (Medical Reimbursement) I brought in an article on from the American Health Information Management Association. It had a study on how health care dollars are spent. It stated that over 1/3 of health care cost were administrative. Now I am finishing an additional degree in Health Care Administration and know what the salary ranges are (6 to 7 figures for hospitals), but that wasn't the what ate up the most costs.
It was actually the amount of money spent on documentation, coding and billing (or rather rebilling). Most people don't know that in America over half of the healthcare is provided by the government already. It is under CMS (center for Medicare and Medicaid Services), Veterans Administration and TRICARE for the military and their families.
There are so many rules and regulations for documentation requirements, coding and billing that it can drive a person crazy with what is required. I know people would like to see universal health coverage, but the American Medical Association has a very large lobby.
It would be interesting to know what the average physician pays for malpractice insurance in those other countries.
Another area I did not see taken into account was the huge research and innovations by physicians and drug companies here in the US. Along with the strides taken in new and life saving procedures, the risk increases as sicker patients are taken care of.
Mary B
The Numbers:
Health spending as percent of GDP, 2004:
| United States: | 15.2% |
| Switzerland: | 11.5% |
| Cambodia: | 10.9% |
| Canada: | 9.9% |
| Japan: | 7.9% |
| Mexico: | 6.2% |
| Africa: | 6.1% |
| China: | 5.6% |
| Russia: | 5.6% |
| India: | 4.8% |
| Pakistan: | 2.4% |
| Congo: | 2.0% |
What They Mean:
World spending on health, according to the World Bank and the U.N.'s World Health Organization, was 10.2 percent of global GDP in 2003. This is the equivalent of about .7 trillion, or 0 per person. (The figure counts all money spent by governments, providers, and individuals on "preventive and curative" health services, family planning activities, nutrition programs, and emergency medical aid.) America's health bill that year came to 15.2 percent of GDP, far ahead of all competitors. So far ahead, in fact, that Americans accounted for nearly half -- .7 trillion of the total .7 trillion -- of the world's health spending.*
Health bills for the rest of the world stretch out between 2 percent and 11 percent of GDP. The figure for second-place Switzerland was 11.5 percent of GDP; third-place Germany came in at 11.1, and the United Kingdom 8.0 percent. Japan's 82-year lifespan is the longest of any big country, but it spends only 7.9 percent of GDP on health, half the U.S. rate. Among developing countries, Cambodia, Lebanon, and Jordan spend the most, with health bills at 10.9 percent, 10.3 percent, and 9.4 percent of GDP respectively. Elsewhere, China and Russia spend 5.6 percent each, roughly the developing-country average. India is unusually low at 4.8 percent. Typical figures for Latin America range from Mexico's 6.2 percent to 7.6 percent in Colombia and Brazil and 8.9 percent in Argentina. African health spending is also relatively high, at an average of 6.1 percent. Pakistan's 2.4 percent is the lowest figure for any big country; the lowest anywhere is Equatorial Guinea's 1.5 percent.
Most rich countries have government insurance programs; the United States' approach, of course, has been to use government programs for military veterans, the elderly, and the poor and rely on employers for most of the population. Nonetheless, the American government spends as much on health as most of its rich-country peers. The average rich-country government spends 6.7 percent of GDP on health; America's 6.8 percent is very slightly higher. The national health systems of Canada and Britain cost about 6.9 percent of GDP, and that of Australia 6.4 percent. Germany's government spends the most on health care at 8.9 percent of GDP, followed by Norway, Sweden, France, and Denmark. Burma's government spends least, at 0.5 percent of GDP.
LEV
And your point is?Hillhoney,
You may need to ask a fifth grader.
LEV
Lev, why are you so insulting?If Lorsters article shows that in developed nations healthcare outcomes areAll I can say is 'thank God I live in Australia. I never pay more than 00 a year for medical costs, 00 a year for prescriptions (for the whole family). That would be true whether I am treated as a public (medicare) patient or a private patient. We pay 5 a month for family private health insurance which basically lets us jump the queue and not have to wait for surgery, and covers dental, optical etc. Our co-pay for hospital is nil with our policy and they cover ALL costs above the medicare cover. My knee replacements cost over ,000 each and I paid zip for the hospital, surgeon, physio, anethetist, with a waiting period of 10 days cause that was when his next opening was. I was in hospital for 8 days.
My nephew in Florida was in hospital for 4 hours for a cornea transplant. It cost ,000. with a co-pay of almost ,000. His ongoing medications cost a fortune, and he has to use them for the rest of his life. It will also be almost impossible for him to get affordable medical insurance once he is no longer a student.
I think you guys should all move down here.
Keep in mind, that the WIC program is part of the cost. Keep in mind that the school breakfast and lunch programs for low income school children are a part of the cost. No child need be hungry in this great country of ours. It is a great great expense and i don't mind helping to pay for it. So many other programs are included in the total cost not just doctor and hospital costs.
"Nonetheless, the American government spends as much on health as most of its rich-country peers. The average rich-country government spends 6.7 percent of GDP on health; America's 6.8 percent is very slightly higher. The national health systems of Canada and Britain cost about 6.9 percent of GDP, and that of Australia 6.4 percent. Germany's government spends the most on health care at 8.9 percent of GDP, followed by Norway, Sweden, France, and Denmark. Burma's government spends least, at 0.5 percent of GDP."
That is what i was saying. Graphs and stats really don't mean much if we don't know the whole story. We don't. We just want to act like we do.
LEV
Pammy416,
Altho PM Howard is one of my heroes, i will still prefer to stay here in the land i love, but thanks for the invite. We will get this all straightened out soon. So many people think that everything that needs fixed has to be fixed imediately. In good time just isn't fast enough. Be sure to say thanks to PM Howard and the wonderful people of Australia for their wonderful support.
LEV
Hi All,
One thing that i forgot to mention was the health care cost to the U.S. for not just illegal aliens but also legal aliens that the U.S. pays for. If that cost was gone, as it is in most countries, our cost would be soooo much lower. What i am saying is like all problems so great, many factors are factored into the equasion that we just don't know about or consider. Many people think that we are just to good to people, no matter who they are, but it's costly. What other country allows for an illegal alien to have a child in their country and allow citizenship? No other country. They say that their are about 12 million illegal aliens. Probably none have health care but get excellant health care here in the U.S.
I guess that it is so far working but will certainly get better (healthcare in the U.S.). Like everything we want it and we want it NOW
LEV
Just a note about health care. When I was teaching a medical reimbursement class this week, I shocked the class when I told them that if a person was 65 or older and had lived in this country for at least 5 years, they are eligible for Medicare. Boy did I stir up a hornets nest.Hi All,
One thing that i forgot to mention was the health care cost to
the U.S. for not just illegal aliens but also legal aliens that the U.S. pays
for. If that cost was gone, as it is in most countries, our cost would be
soooo much lower. What i am saying is like all problems so great, many
factors are factored into the equasion that we just don't know about or
consider. Many people think that we are just to good to people, no matter
who they are, but it's costly. What other country allows for an illegal alien
to have a child in their country and allow citizenship? No other country.
They say that their are about 12 million illegal aliens. Probably none have
health care but get excellant health care here in the U.S.
I guess that it is so far working but will certainly get
better (healthcare in the U.S.). Like everything we want it and we want
it <FONT size=7>NOW
LEV
[/QUOTE]Lorster,
When i mentioned the health cost to legal and ilegal aliens, i really wasn't trying to make a political statement about immigration rather trying to make a point that we just don't know what all is included in our total healthcare costs. I really don't give immigration much thought. If a politician is on the television saying "....we certainly can't send all 12 million ilegals home........" i kinda look up from the computer, look at the blue suit on the television and ask, Why not?
LEV
Lorster...i just gotta say...lol.Three cheers, Lorster! I think you've got the solution nailed!
We cannot send 12 million Mexicans back across the border. No
corporation wants to get rid of them because they work cheap, they do jobs
that many Americans won't, they do the jobs well, are hard workers, and
rarely complain. They pay into the system. Yes, they should do it legally,
but they don't. I don't think a wall is going to slow them down. Remember,
they are hard workers and will find a way to get across. I figure if we just
make Mexico part of the good old USA, everyone will benefit. I think the biggest problem lies with American businesses, as well as individuals, who hire these workers and pay them "under the table". That's where the heart of this issue lies. Companies don't want to divulge the dirty little secret of how many of these low cost, untaxed workers they are hiring because it will be extremely costly to have to start paying them the legal minimum wages, pay for workman's comp and employment taxes, and/or benefits for them. Hillhoney, exactly. This is the problem and we have to find a different
solution to it. Many of the Mexican workers work here legally and pay into
the system, but will never collect it. Is that fair? I just don't know if closing
the borders will work. I mean, all they have to do is get on a boat and sail to
a non gaurded area. They will find a way. [QUOTE=Honey] Does anyone have any REAL solutions? It seems insane
to me that my grandparents came here the "old fashioned" LEGAL way
and now people who broke the law to get here are going to be given all
kinds of rewards for it. If that's the way it's going to be, they can jump
the fence and get jobs, healthcare, have their babies here and send them
to schools here, why can't they just do it legally? It seems almost as if
they can walk into your home and set up a home in your living room and
you have eto feed, cloth and pay them![/QUOTE]
What I want to know is why are things so bad in Mexico, that they have to
come here to make money? They have oil, they must have a way to
support all their people. Is the government of Mexico not doing right by
its people? Oh well in Mexico the minimum wage is probably ridiculous, so they can come here, do the same work for probably twice as much. Also, their president (or whatever they call him) WANTS them to all come here - less trouble for him. Crime is also very bad there. I mean, their only real product is tourism. I went to Mexico for the first time this year. We travel a lot and I honestly didn't want to leave the resort complex because it just seemed so unsafe. Also, it's so ass-backwards there. You know how in the airports here they have big display screens that show when and where your flights are? Which gates? Well in Cancun, they have people walking around with megaphones. We were all like "HUH?"Hey, GImpy, does Canada have an influx of Americans running over the border? Do the Canadians run over the border into America?
One thing that really ticks me off is the language thing. If they want to be here, they should learn the language, not vice versa. When someone applies to come here LEGALLY they have to take a test and classes and learn the history and language of this country. Not just run like a chicken across a border and then basically STEAL all of our resources - schools, medical care, protection, etc.
Honey, it's funny you should ask that. I work in a tourism related
field so I come into contact with a lot of travellers, and the last 5
or 6 years I've had several Americans tell me they've tried to move to
Canada to escape the whole Bush thing, but it turned out they couldn't
pass immigration criteria (some of them seemed quite shocked they
couldn't just move in because they wanted to). Some just come up for a
vacation from what they see as an oppressive atmosphere (or to smoke some pot---that one always cracks me up). Also, I've met
a few who got sick and then tried to move to Canada to get the health
care. I know quite a few Americans who have legally immigrated here, especially to the Gulf Islands,
and some that came illegally. But most of our immigrants come from
other countries. I think maybe Canadians have a different view on
immigrants and immigration. It's not all roses up here (and one does
encounter racism) but we don't blame them for our problems. It's part
of our culture to remember we were all immigrants in the past. Maybe we
have more lenient immigration policies? (I actually have no idea).
Now let's see....I know two Canadians who moved to the US but both
times it was to marry an American. Actually, one couple had to come
back to Canada to get married because they were same sex, but then they
moved back to the US. But then they bought a house in halifax so they
could get their medical care here. That's the best of both worlds I
guess. Anyway, emmigrating Canadians I think tend to go to countries other than the US.
So I don't have any statistics but that's been my personal experience.
By the way, the majority of Americans I deal with in my job are really
nice people, so don't take what I say as American bashing (for you
sensitive types). That's just what's happening.
the big house on the hill unless they are into something majorly illegal.
There are 18 people living in a 1 or 2 bedroom apartment because that is all
they can afford. They are not living the American dream, just working it.
There are some success stories out there, but not many. I agree that they
should do it legally, but they don't. And yes, I totally agree that they should
learn the language. The rest of us had to. It is very frustrating to try to talk
to someone that has lived here for umpteen years and never learned to
speak english. If I moved to France, I would learn the language. Right now
the problem is there are 12 million illegal aliens, and most likely more and
we have to figure out how to handle it. It is impossible to send them all
back because this is a revolving door situation. I don't think building a wall
is going to solve it.
Tear down that wall in Berlin and move it to Mexico!
YOu know what? If they're living 18 ppl in a one or two bedroom apt. they chose that. They could probably have stayed in Mexico for that, they don't need to come here and squelch off of our system that we've all paid into for that. They have crappy living conditions in Mexico so they come here and have crappy living conditions that they complain about here and then POOF, it's fixed and we're rewarding them! Geez if only my grandparents had to jump a fence all those years ago.The illegals are not at the root of our health care miseries. We allow a profit to be made on the suffering of others. Some things just should not be for profit. We don't sell babies (legally). Insurance companies and drug companies are just too much into the profit motive. It just isn't right.
The big guys and some of the little guys too seem to forget that 'There but for the grace of God go I.' All bodies break down eventually - no body gets out of this life alive.
That's what I said in a long ago post: Everything is a business! Thank you.This is a really complicated matter, and one that isn't easily solved. That's why the goverment's policy (through several administrations) has been to just look the other way up until now. We simply must start enforcing employment and immigration laws more effectively. While it is true that most illegal immigrants are coming here out of desperation and seeking a better life for their families, with the current methods our borders are wide open to criminals, terrorists, and drug dealers.
That needs to be stopped, if simply for a matter of National Security. It boggles my mind that an administration that is supposed to be so concerned about global terrorists attacking our country tries to sell our ports to Dubai and leaves a welcome mat at our borders. How is that possible? It's possible because it serves this administration's economic policies, which are the overriding factors in all our foreign policy decisions.
I don't know how to deal with the illegal immigrants who are already here. We can't exactly send out a letter asking all illegals to report to the border in a single-file line. I don't think we want to go around like Nazi's breaking down doors looking for illegals either. That's not who we are. But we should be checking employers and requiring proof of documentation for all workers, and if a company is consistently hiring illegals and not paying taxes for them according to federal and state laws, the company should be fined and/or shut down. And the fines collected to be put into a fund to help hospitals and other medical facilities offset the costs for illegal immigrant healthcare.
OMG!!!!! I know what to do with them...SEND THEM BACK!!!!! How hard is it???? And to keep them from crossing over...bullets would seem to work very well!!!Immigrants in the U.S. sent a record billion back to Mexico last year. So why does Parkland Memorial Hospital have unpaid bills, asked the Dallas president of the Urban League at an immigration panel Thursday sponsored by the League of Women Voters of Dallas.
"If people are able to send that type of money back, why can't they pay at Parkland?" said Beverly Mitchell-Brooks, the president and CEO of the Urban League of Greater Dallas.
The provocative but civil panel explored issues ranging from jobs that require bilingualism to proposals to repeal birthright citizenship under the U.S. Constitution. The standing-room-only event at Catholic Charities of Dallas illustrated that immigration – legal and illegal – bubbles to the top of many public-policy debates in North Texas, where immigration has soared since 1990.
Among the panelists was Jennifer Cutrer, Parkland hospital's executive director of legislative affairs. Dr. Cutrer acknowledged that Dr. Mitchell-Brooks asked a "very legitimate question" about the Dallas public hospital she represents.
But Dr. Cutrer also called the immigration debate "complicated," and one that couldn't be dismissed with statements by some politicians that "it is either illegal or legal."
"They don't get it because all they see is black and white. They are illegal ... they don't see the contributions these people make," she said.
The cost of illegal-immigrant health care has been a contentious issue in Dallas County. Parkland Memorial Hospital estimated last year that it provided illegal immigrants about .4 million worth of nonemergency medical care. And Dallas County officials went so far as to send a bill to Mexico and other countries.
José Angel Gutiérrez, a political-science professor at the University of Texas at Arlington, touched the same theme of the complexity of immigration.
"You know fully well that we would not have a League of Women Voters if they didn't break the law," said Dr. Gutiérrez, referring to the women who led the effort for the right to vote.
Blacks also broke laws in order to gain equal rights, he said.
Dr. Mitchell-Brooks stressed that she sees a distinction between legal and illegal immigration.
"Whether we like the laws or don't like the laws, they are the laws," she said.
Dr. Mitchell-Brooks also said she has an immigrant friend who likened illegal immigration to standing in a grocery line for those with 15 items or less and then suddenly, 20 people jump in front of you with 20 items or more.
"There are people here who are still waiting for that living wage ... still waiting in that check-out counter patiently for their turn," Dr. Mitchell-Brooks said.
She also questioned whether it was discrimination when a job description called for "bilingual-only" applicants. "Would it be discrimination to put in a job description: English only?" she asked.
The moderator raised the issue of the Farmers Branch ordinance on the May 12 ballot that would fine apartment owners who rent to illegal immigrants.
"How can we deal with their fear?" asked the moderator, Roger Kallenberg, who added that the Farmers Branch City Council members had been invited but declined the invitation.
"The first illegals were those people on the Mayflower," said Dr. Gutiérrez, as the audience erupted in laughter.
Anne Marie Weiss-Armush, the founder of DFW-International, said other cities, such as Houston, operate an Office of Immigration Affairs. In some cities, the office helps immigrants assimilate by providing information on services and English and citizenship lessons. A member of the Dallas City Council launched a discussion of opening a similar office, she said. That office was never funded.
"It needs to be done equally and fairly for every immigrant that is coming to this city," Dr. Mitchell-Brooks said.
Lisa, I don't have to come to Texas to see what you see. I don't see it on
From what I remember, the first step to becoming an American citizen is applying in your home country to the nearest U.S. Consulate office, for a visa to live and work in the U.S. Some visas are more restrictive than others - some limited in time, some do not allow you to work at all etc etc. The resident alien visa or 'green card' is the visa that permits you to live and work in the U.S. for an unlimited amount of time. The visa has to be renewed, periodically, I think. After you have been on a green card for at least 5 years, you can then apply to become a U.S. citizen. There are all kinds of quotas for visas and citizenship so in some cases you would have a considerable wait. To apply for citizenship involves some expense, accumulating the necessary documents, having the necessary medical reports written up for you etc etc. When your case comes closer to the top of the list, you get a letter calling you in for an interview and the test. In my case the test was not difficult but I can see someone with limited language ability in English would be intimidated by the interview, the officials and the test. Once you 'pass' all the requirements, then you get another letter with a date for your swearing in ceremony. At that ceremony you swear the oath and you are declared a citizen.
Lots of red tape and steps leading to the end result. Once you have worked here illegally, to switch to being legal is difficult.
Forgive me if some of these details are not quite accurate - this is what I remember of the process which for us, was not without its perils. At one point I was denied reentry to the U.S. after a vacation trip home and my husband and I were separated involuntarily then for 8 months. I had our infant son with me - my husband was here in the U.S. trying to sort out the immigration law.
Thanks Marigold, that explains a lot I did not know and I'm glad you and your husband are together now with your child. I assume the red tape you refer too is what keeps most from applying for citizenship. Now it is too late to enforce the laws after so many years of turning a blind eye to this problem. Kind a like closing the barn door after all the cows get out...... Genesis