Four Bad Examples of Health Care Systems

What do Russia, China, Turkmenistan, and the United States have in common? Their health care systems are the four listed by Foreign Policy as systems policy makers interested in reform “should avoid at all costs.” From their description of the US system:

The United States has the rare distinction of being both one of the world’s richest countries and having one of its least-functional health care systems.

Americans spend around one in every six dollars on healthcare. But, in aggregate, they’re not getting much bang for their buck. People in the United States are as likely to die from diseases like lung cancer as citizens in all OECD countries – which, on average, spend less than half as much per capita. Some 47 million lack any health insurance coverage. An estimated 600,000 people file for bankruptcy every year because they cannot pay their medical expenses. Indeed, the United States is the only rich country without universal coverage.


  1. 1
    Mr. Jeffersonian says:

    I can’t believe the likes of Rush Limbaugh and Glen Beck would arrogantly boast about having “the best health care system in the World” when the facts are all there for everyone to see. It is so nauseating  if not insulting.

  2. 2
    Ron Chusid says:

    It would be different if the US came out doing well in any rankings. Many of the rankings can be misleading due to factors beyond the health care system influencing results but any attempts to correct for this continue to place the US at the bottom of industrialized countries. If you consider subspecialty care then there are probably specific areas where the US is at the top but you cannot ignore the fact that such care is denied to many people, or those who receive it often wind up in bankruptcy, even if they have private insurance.

  3. 3
    Fritz says:

    Our society was not founded on having systems.  Which is probably the problem.

  4. 4
    Ron Chusid says:

    The government was formed in a different era when the concern was keeping together different state governments  in a single federal government as well as to keep the power of  the federal government limited. They weren’t concerned with setting up systems for handling national problems, especially problems which weren’t even an issue at the time.

    The Bush years gave us the worst outcome of this. The efforts to keep the power of the executive branch limited were undermined while they were unable to deal competently with complex problems where a strong  government might have been useful.

  5. 5
    Fritz says:

    Health seems to me to be a problem that should be handled locally (or by state) completely.  I can understand defense being national.  Maybe transportation.  But health care is person-by-person.    This seems to me to be a place where different states could have completely different solutions — ranging from complete British-style takeover to lassez-faire.  And, yeah, I would devolve Medicare and Medicaid to the states — although that might take some time.
    OK, there I am being impractical again.

  6. 6
    Eclectic Radical says:

    “And, yeah, I would devolve Medicare and Medicaid to the states — although that might take some time.”
    In many ways, this is how the system actually works. The federal government gathers and distributes the funding, but the state governments (often through county governments) act to administer the programs. In practice, Medicaid is a ‘state’ program rather than a federal program in many ways. The federal government pays for it and provides broad guidelines, but Medicaid can vary quite a lot from state to state. In California, they actually call it ‘Medi-CAL’ and administer it entirely as a state run agency. Only the money comes from the Federal government.
    In California, the actual enrollment is done at the county level, by county employees. My father used to work as a Medi-Cal eligibility worker for San Bernardino County.
    Every other state plays with Medicaid in some way as well, in many ways it is 50 different federally funded state programs rather than one ‘big government’ federal program. So a lot of what you want is already the case.

  7. 7
    Ron Chusid says:

    While Medicare is more of a federal government program than Medicaid, even Medicare does have some local variations. The actual day to day work is handled by intermediaries–insurance companies which handle paying the claims and the other routine functions. In the past it seemed to be more state by state, or small numbers of states. In recent years there have been cases of this being handled with groups of states lumped together.

  8. 8
    Fritz says:

    I would not have the Feds (in the long run) involved at all in Medicare or Medicaid.  Let the states fund health programs as they want.

  9. 9
    Eclectic Radical says:

    “I would not have the Feds (in the long run) involved at all in Medicare or Medicaid.  Let the states fund health programs as they want.”
    The states don’t have the money, for the most part. Their tax-base is smaller and in most cases their tax rates are already artificially low because of their dependence on Federal government money. This is especially true in ‘red states’ where Republicans cut state taxes and rely on the Federal pork barrel even as their national legislators call for spending cuts in the House or Senate… and then write up big pork bills.
    I’m not saying Democrats don’t pull down the pork. But I am saying that ‘blue states’ tend to have more realistic tax policies.

  10. 10
    Fritz says:

    Eclectic — the money doesn’t magically appear.   The sum of people are the same.  And, yeah, I would nuke the Nixon “revenue sharing” stuff.  But you knew that.
    Federal taxes would go down and state taxes would go up.

  11. 11
    Eclectic Radical says:

    The total sum of the people in the country are the same, certainly. However, the tax base of Montana and the amount of money Montana gets from the Federal government are nowhere near the same. California, New York, and Texas (assuming they got their budgets in order) could support significant health care plans. Wyoming, Rhode Island, and North Dakota could not. Not without assistance from other states.
    Some of this is the reason we have a Senate and not just a House. Everything isn’t about population density, and the most populous states may be in a position to take care of all their own needs… but many of the smaller states are not. Nor are most of the Southern states, which have drastically devastated economies and lots of poor people o0n public assistance of some kind as it is.

  12. 12
    Fritz says:

    I could see that argument about some of the poor southern states, but I think Wyoming, etc., could cope well.  As for the poor southern states, I think it would be appropriate to have charity drives for people in better off states to help.  Why should “Save the children” go to Africa instead of Mississippi?

  13. 13
    Eclectic Radical says:

    Wyoming has the smallest tax base in the country. This means fewer people to cover, but it also means fewer people available to share costs. 50 pools of shared costs is a slight improved over the thousand or so we have no, so I wouldn’t write it off totally if every state produced a good plan. Generally speaking, the one thing the Federal government is very good at is shuffling money around. So I still think Federal funding is best way to go, even with state run programs.

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