This is the fifth in a series of posts on life, culture, and politics in the U.S. and E.U. by Robert Entman, who spent 2012 as a Humboldt Research Prize Scholar at Freie Universität in Berlin. Read more posts here.
During our year in three different European countries, my wife or I had occasion to obtain medical care in each. Of course I didn’t do a systematic study but I saw no evidence that the taxpayer-funded and government-administrated European health care systems resembles the nightmare of many Americans’ imagination. From everything I saw, Europeans don’t experience nasty old clinics with long lines of miserable patients endlessly hassled by bureaucrats so they can get access to nameless overworked and under-trained doctors using outdated technology and drugs. Instead the experience of visiting a doctor is much like it is in America, only better and cheaper.
In our experience with routine medical care in Germany, France and Spain, care was competent, wait times and lines were shorter than in the US, and doctors paid close personal attention. For instance, on every visit, doctors left their desks and personally called out the name of the next patient and escorted him or her into the exam room. That’s never happened to us in the US, where clerks or nurses usher you around until the doctor comes into the exam room. It’s not a crucial difference, but it does illustrate the distance between stereotypes and reality.
Here’s one case study: I had a chronic problem that the doctors I’d seen in DC and North Carolina hadn’t been able to help much, so I thought I’d seek a Euro-perspective. Berlin’s Charité Hospital is one of the leading medical research and teaching centers in Germany. By searching on the internet, I found the name of a doctor who specialized in my malady and had given papers at conferences in the US and participated in international research grants—he was obviously plugged into the latest developments in the field. Like so much else, medicine, at least in affluent countries, is globalized.
It happened that this particular G-I specialist was also Chief of the Internal Medicine division. I contacted his office for an appointment and got one within a couple weeks, without needing any referral. Try getting an appointment with the head of Internal Medicine at a major American teaching hospital and see if you get seen, without a referral, within two weeks.
Subsequently, I had two long office visits with him and three multi-hour tests. These yielded useful information that helped control my symptoms a little better. Here’s the key point: At my final visit, I had to ask my doctor’s secretary to please send me a bill. There was no upfront demand for my insurance papers or co-pay as is inevitable in the US. During my total of five visits, nobody had asked me to pay anything, or even raised the issue of billing.
The day after my fifth visit, I was leaving Berlin for Paris. The secretary was saying goodbye and even after telling her I was moving to Paris I had to remind her that I needed to pay. She said they’d figure it out and send a bill to my Paris address.
The total cost of the two doctor visits—with the chief of internal medicine at one of Germany’s leading medical institutions, no less—and three lengthy test procedures was 104 Euros, or about $130. In the US the cost would easily be 10 or 15 times greater.
Finally, the doctor at Charité wrote me a prescription for a particularly expensive drug that I take every day (a PPI if you must know). In the US, I had to make a special appeal to my insurance company to cover this drug and still had to pay a $40/month co-pay. For 90 pills (three months worth) I pay $120, and the insurance company paid about $1000, or $9.33 per pill. In Berlin, the total cost of 98 pills (three months plus one week’s worth)—with no payment by an insurance company—was $135, or $1.38 per pill. In other words this same drug cost nearly seven times more in the US than in Germany.
The cost differential arises because the US is the only affluent country that allows drug companies to charge individual patients whatever they can get away. This functionally results in American consumers and taxpayers subsidizing drug company profits (and, to be sure, drug research) for the entire world. Recognizing the serious market failures in the pharmaceutical industry, most every country regulates drug prices. US policy is one of my pet peeves, and one of many reasons Americans pay so much more for medical care.
Most importantly, US spending doesn’t yield better medical care or—and this is the bottom line—longer life. Below are life expectancies in some of the top countries in lifespan that are most comparable to US in affluence. The US ranks about 33rd among all countries, according to the World Health Organization (2011), tied with Denmark, Chile, Bahrain and Costa Rica at 79 years and just ahead of Cuba, Czech Republic, Colombia and Barbados at 78:
World Bank, 2012
| RANK | COUNTRY | (YEARS) | GDP per capita (equivalent purchasing power)* |
|
1 |
Japan |
83 |
$35,178 |
|
1 |
Switzerland |
83 |
$53,367 |
|
4 |
Hong Kong |
82 |
$51,946 |
|
4 |
Australia |
82 |
$44,598 |
|
4 |
Italy |
82 |
$33,111 |
|
4 |
Canada |
82 |
$42,533 |
|
14 |
France |
82 |
$36,104 |
|
15 |
Spain |
82 |
$32,682 |
|
33 |
USA |
79 |
$49,965 |
The US spends hugely more as a percentage of GDP on health care:
Beyond paying way more for prescriptions:
These aggregate data don’t deny that in certain respects Americans might be getting their money’s worth. For instance it’s often assumed that US spending enables more advanced medical treatments and higher survival rates for diseases like cancer. However, it turns out to be extremely difficult to compare survival rates while controlling for the many differences among countries’ populations, including their getting cancer in the first place (US ranks seventh in cancer incidence).
There isn’t much empirical basis for assuming that Americans benefit in any way from their higher spending. But there is quite a bit of evidence that the excess spending is the cost of having a political system so uniquely and thoroughly dominated by wealthy organized interests, such as the pharmaceutical and insurance industries, whose lobbies heavily influence public policy agendas, options and decisions. The Rube Goldberg-like Affordable Care Act, though a step in the right (European) direction, reflects above all the less democratic nature of the US political process when compared to the governments of Western Europe.
Americans pay for their inferior democracy thrice over: their health care system costs more yet delivers inferior care and shorter lifespans. The health of democracy reflects and shapes the physical and fiscal health of its citizens.
