Health Care in Europe
 

Hi all,

The Antlanta paper reported today that the recently passed Medicare Bill will forbid persons receiving prescription benefits from having 'medigap' coverage and will also shift low-income elderly from Medicade to Medicare - lowering their benefits.

I have written my congressman and Senators to express my opposition.

I am wondering what prescription drug benefits are available to the elderly in the various European countries.

I don't know what prescription benefits Europeans have, but I do know their exact same meds are a LOT cheaper. I buy my prescription allergy nasal spray in France when we go. I pay 13 Euro for it there and it is $68.00 here..same drug , same manufacturer ! I also pick up my allegy tablets 8 E, there , $38.00 here. I stocj up and what I save practically pays my plane fare.

I wrote my senators and reps BEFORE the vote for all the good it did. You should read the message boards at AARP..there are a lot of MAD seniors!

Arrangements differ between countries. Over retirement age in the UK, for example, all medicine is free. European analogies are of limited value in an American context, since:

1. Almost everyone in Western Europe gets heavily subsidised medicine anyway. Retirees, typically, merely get bigger subsidies than most, and the same subsidies as a large proportion of the population (in Inner London, my pharmacist looks truly surprised when I pay for prescriptions, since 90% of his other customers get them free)
2. By the time we're 65, we have about 40 years of heavy tax paying behind us.

However, doubtless you're mostly interested in making your point. Your Social Security people compare things country-by-country at www.ssa.gov/policy/docs/progdesc/ssptw/

I think your last point is key - something that few Americans realize is that our taxes are way lower than those in Europe - both sales taxes - which are often 15% in europe - and income taxes - which in europe can be up to 90% for the wealth.

In the end you get what you pay for - you just have to decide if you want to pay through the government (taxes) or right out of your own pocket.

And while it is true the meds cost much less in Europe - that's because they're almost always bought by the government which fixes max prices. Which our government chooses not to do.

The tax comparisons can be misleading because we may be paying equivalent costs elsewhere, such as heatlh insurance. Some claim that our system is one of the most inefficient of the indutrialized nations. There are other elements to consider. In France, indigent care is also the responsibility of the adult children, whereas in the States, only the spouse can be legally impoverished before the patient receives Medicaid. As for lower prescription drug costs: I don't see the drug companies dropping out of the European market.

Thanks flanneruk,

That's a very interesting link.

<And while it is true the meds cost much less in Europe - that's because they're almost always bought by the government which fixes max prices. Which our government chooses not to do.>

And why is that? It couldn't possibly be because of excessive contributions and lobbying by pharmaceutical companies , could it? Maybe some of the drug company executives would have to give up their 20 million dollar bonuses( Glaxo). And the R and D issue is prectically irrelavant as a lot of research is being out-sourced but the advertising and promotion budgets are being expanded.

To be fair the R&D isues is not practically irrelevant becasue even though it is outsourced the pharma companies still pay for it. As far as letting the government behave the way it does about meds, shame on us for putting up with it. I know this isn't a political board - but if this is a big issue we need to elect a government that is reponsive to the needs of citizens and not just big corporations.

nytraveler puts the blame right where it belongs. One of our founding fathers said we "get the government we deserve". If we are not willing to invest the time and energy to elect representatives that will do our bidding, then we can't complain when our elected officials take care of themselves instead of us.
By the way, was AARP looking out for us or taking care of its health program?

Something to note. Healthcare in any other country could not possibly be better than in the US. The US is the richest country in the world and it spends more per capita on health care than any other country.

As a medical professional I very STRONGLY disagree with the assertion that "Healthcare in any other country could not possibly be better than in the US." In many cases it is better to include fewer infant deaths, better elderly care, lower prescription costs, a much more realistic and non-religious-oriented attitude toward lessening infectious disease spread, etc.
Throwing money at something doesn't necessarily make it better as we continue to prove over and over again in the US. If that weren't the case this thread would probably never have started.

Question for Jody:
I buy my mother's prescriptions, and it sounds like it might be worthwhile to pick up 90 days' (or more) supplies when we are in Spain and France next March. Do your US doctor's prescriptions work, or do you have to get a prescription in the country where you are filling an order?

ira, what is "medigap insurance" and why would it be banned? Is there another side to the story?

<<Message: Something to note. Healthcare in any other country could not possibly be better than in the US.>>

I also would strongly disagree with this statement. So does the World Health Organization, which for several years has done rather comprehensive rankings of healthcare around the world. France is number 1, Italy number 2 (or perhaps it was reversed last year); the USA ranks 37th. See:

http://lists.isb.sdnpk.org/pipermail...ne/000010.html

http://www.huppi.com/kangaroo/L-healthcare.htm

http://dll.umaine.edu/ble/U.S.%20HCweb.pdf

http://www.makethemaccountable.com/m...HealthCare.htm

Also, in my fairly extensive experience with the healthcare systems in both France and Italy, as a patient and more frequently the mother of a patient, the care we have received has been so far superior to that of my HMO as to make the latter seem laughable.

Of course, I understand where the differences in approaches to healthcare lie among different nations; still the statement above is simply not true.

Here in the UK I recently had to have a course of antibiotics. I got out my purse to pay for them and the pharmacist said that I had obviously enjoyed good health for the past four years because they are free for the over 60s.
I get free eye examinations but have to pay for my glasses. My husband is diabetic and gets all his prescriptions free.
The NHS is certainly not perfect but I and my family have always had excellent service from it.

Studies that rank the US health care system relatively low among developed nations almost always penalize countries that don't have a socialist-based system. Rich or poor, anyone that would prefer to be treated for cancer within the context of a socialist healthcare system, as opposed to the US model, is dangerously misinformed. Any healthcare system in which the waiting time for someone on an "urgent list" for an MRI or colonoscopy is typically more than six months, is seriously flawed.

The most important fact about the European system is that it will not be sustainable (demographically or politically) for another generation. Consider the unrest that retirement/health issues have caused in France within the past year. Even the moderate left in both France and Germany concede that something has to give.

The reason that the US refuses to adopt a European-style healthcare system is not because of a conspiracy between the pharmaceutical industry and the Congress, it is simply because more than a critical mass of Americans are satisfied with the current situation. Despite many of the theories proposed in this forum to account for all kinds of US-Europe differences, the reasons for these differences are simple - the majority of Americans prefer things the way they are. Healthcare is no exception.

Healthcare reform in America will have to occur in a different form, such as means testing. Hugh Hefner can afford to buy his own Viagra.

Hi Degas,

Everyone over 65 in the US has to enroll in Medicare.

Medigap insurance is any private insurance plan that covers the difference between what Medicare pays and what you would normally get if you had that private plan.

The new Medicare legislation provides for limited prescription payments. It forbids the sale of new medigap prescription plans after Jan 1, 2006.

From what I read in the newspaper, this is a cost-containment measure, because people who have prescription plans supposedly have higher prescription costs.

As written, the prescription plan requires $3500/year out-of-pocket payments for all but those at the poverty level.

I'm laughing at that statement about the US having the best health system because we spend the most on it. Two words come to mind -- educational system.

I do consulting in the health insurance area and have been doing some work related to the new bill for some clients and have it in front of me. What newspaper is this, out of curiosity, Ira? I read something in the Atlanta-Journal Constitution or something but it didn't look like a good newspaper from what I read, so I thought maybe that wasn't the main paper in town. I didn't see anything about Medigap in that article.

I don't work on Medigap issues that much, but that isn't really true, so either they wrote it wrong or you misunderstood. Some Medigap policies will not exist any more because they are not applicable with the new benefit. There are 10 std. Medigap policies that Medicare defines and only 3 of them have basic drug benefits so I think Medicare may eliminate those three and people cannot buy drug coverage through Medigap policies anymore. Very bad incentives and risk pools would exist if certain benes opt out and buy private drug coverage for better rates, and those companies get the healthiest beneficiaries that way and leave the higher cost pool to the others. Many of the Medigap policies don't have anything to do with drugs and they will still exist and people can still have Medigap policies for other things.

I thought that was a joke when someone wrote that the US must have the best health care because we spend the most per capita. US health care is good for those who can afford it and have insurance but even then it is not necessarily superior. I don't agree with several things written above regarding how great the US system is and how other countries' systems are not sustainable. I also don't agree that other countries' taxes are so much higher than ours on average. I think US citizen's pay very high taxes for what we get and it is shameful that we don't have a better govt health care insurance system. I think we are now the only industrialized country in the world with such a fragmented and poor and privatized health insurance system that leaves so many citizens without health insurance. As I recall, we used to be in a club with only a couple countries -- South Africa and South Korea, but now we are the only one without some form of govt. universal health coverage.

As for the shifting from Medicaid to Medicare, I believe that is true as Medicare is primary carrier for those with dual coverage, although a state's Medicaid program may pay the premiums for someone to be in Medicare. I don't know how it will work if someone had better coverage under Medicaid for drugs, though--possibly it could pick up the difference (that's not really my area).

For ira and Degas...I too read (NYTimes) about this prohibition on any supplemental insurance in this new law.

The rationale, as I recall, is that they want to curtail 'abuse', wherein the beneficiary must pay something out-of-pocket to 'appreciate' the value being received.

There is no doubt that US healthcare is the best in the world for those that can afford it - at the moment that includes the wealthy, most of the middle class and those covered by Medicare who don't have too many Rx and a low income. If you're poor (but not enough for Medicaid) or working class or middle class with a job with bad insurance your healthcare can be pitiful - or none. the reason we rank so low in the list of world countries is primarily because we don't have universal access or good prenatal/infant health coverage.

The "prescription coverage" passed by Congress is basically an indigent plan. What they need to do is pass a plan similar to New York State - which covers many middle class people with a sliding scale of payments depending on your income (not assets)- not just the super low income. With the current plan middle class people will need to become poor (by paying $7000 per year for RX for a couple) before they qualify for benefits - and after they've sold all their assets except their house.

To those who feel "Healthcare in any other country could not possibly be better than in the US" is wrong.
Now, if we burdened the other countries with similar gun laws, forcing their emergency rooms to deal with an equal number of gunshot wounds, and if we also burdened them with an equivalent percentage of single sub-teen mothers (with concomitant high infant mortality), how would things stack up?

I'm sure that I am not the only one who feels that the US healthcare system is the best in the world. The voters in the US would have changed it if the felt differently, wouldn't they?

As to whether voters would change it if they didn't like the current system? The "current" system has been in place for a few days. No vote since the change so that remains to be seen.

In the end, it will depend on the percentage of uninsured or underinsurd people who vote (at least for like-minded representation since voting on the issues themselves isn't going to happen - republic, not democracy and all that.) Just proves it's never wise not to vote. But until it becomes the overriding concern in choosing representation amongst the approx. 25%-30% of the population that actually still cares and votes, then yes it's probably indicative of general happiness with the healthcare system. Ahem... well, so say the statistics.

I had another patient who took an ambulance because he banged his elbow against the door of his car (the accident happened a month ago) Had been feeling fine for 3 weeks and 6 days. Today, woke up, had a twinge of pain in his elbow and called 911. Mind you the guy is 22 years old and healthy as a horse.
Of course didn't think to reach into his medicine cabinet for some Motrin. Got ticked off when I asked why he took an ambulance. ('Yo B****, my elbow hurts). Sent him home with a prescription for motrin and after which he asked me for car fare home. Cost to him $0.00 as he claims he has no money.
Cost to the taxpayer:
Ambulance ride: $600
ER charge: $300
Medication charge: $6.00
Car fare: $2.00 (because he refused to leave otherwise)
Exasperation: Priceless!
If you think this is an anomaly, think again. This is one small but perturbing example of why our healthcare expenses are so high. I am required by law to see and evaluate every single patient who decides to come to my ER, regardless of how baseless their complaint. Guess who pays? You and me.
Examples of why people take the ambulance:
-can't sleep
-had an argument with mom
-wants to get an MRI because he read about it in a newspaper and figured if he took an ambulance, he'd get it
-threw up once 2 weeks ago
-sometimes gets headaches (but doesn't have one now)
-runny nose for 1 day
-stubbed toe against sidewalk crack and on the recommendation of his lawyer to build a case against the city came to get xrays of said toe
Again, these costs just get passed on... to you know who.

I'm with erdoc on this one. Far too many cases of abuse.

Besides, Americans tend to OD on everything. 60% of Americans are overweight. I'll bet 60% are OD on drugs too.

Personally, I avoid drugs as much as possible. I'm over 60, take a Tylenol or two maybe once or twice a month and that's it.

Once when I was in a terrible auto accident, I was put on Tylenol with codeine for a couple of years. That medication always made me feel nauseous, so I was glad to be off it.

We don't need most of the drugs on the market today. However, the drug companies want us to keep buying and buying.

And if I get to a stage in old age when my doctor prescribes too many pills for me? I'm not going to take them and try to die as natural a death as possible.

As one angry young man has said: "Why should I pay for people with one foot in the grave?" Exactly, I don't want him to be paying for extending my life in my old age.

Our life expectancy is 120 years! Why would anyone want to extend their lives in an overdrugged, vegetative state for another 20 or 30 years?

Easytravelr

< we don't need most of the drugs on the market today>

Some one else agrees with you and you'll be surprised when you read the article , who it is!

http://news.independent.co.uk/low_re...=3&dir=505

Christina
>...What newspaper is this, out of curiosity, Ira? I read something in the Atlanta-Journal Constitution or something but it didn't look like a good newspaper from what I read, so I thought maybe that wasn't the main paper in town. I didn't see anything about Medigap in that article.<

It was the Sunday AJC, Christina. Somewhere around P7.

I'm sure that you didn't intend to offend, but the AJC is *the* daily paper in Georgia.

>As for the shifting from Medicaid to Medicare, I believe that is true as Medicare is primary carrier for those with dual coverage, although a state's Medicaid program may pay the premiums for someone to be in Medicare. I don't know how it will work if someone had better coverage under Medicaid for drugs, though--possibly it could pick up the difference...<

That seems to be one of the controversial changes. The new Medicare will limit the available drugs and the Feds will no longer cover the costs.

ira, you got my attention with this statement:" The new Medicare will limit the available drugs"

How will they do this? Do you mean not pay for experimental drugs?

Hi Degas,

I'm not sure what the "limitation" will be, but I think that experimental drugs is part of it.

I think it's called a "formulary", a listing of drugs available to the beneficiary. It hasn't yet been made public, so let's just see what will NOT to be included!

Ira, my provincial health care plan offers a drug plan for seniors that requires they pay 1/3 of all drug costs up to a certain maximum, after which costs are covered unless the drug doesn't meet certain criteria. In addition, seniors above a certain minimum income must pay an annual premium to participate in the plan. I wonder how this would compare with the new American plan.

Erdoc, my province charges a flat rate for ambulance services unrelated to motor vehicle or work accidents. (It's about ten times the cost of a taxi.) For motor vehicle accidents, etc. the fee is much higher (about six times the flat rate) as those services are covered by private auto insurance or workman's compensation. So that's one solution to the problem of ambulance use abuse under a publicly funded scheme.

Meanwhile, I understand your ire, erdoc, but remember the public isn't always equipped to judge what is an emergency and what isn't. I only went to get my DVT treated at the ER after an alert pharmacist pointed out that what I had likely wasn't, as I thought, a mere pulled muscle. Had I waited until my GP could have seen me, it would have been way past 'too late.'

Hi Sue,

Do you know the maximum that must be paid?

We will have to pay about $450US per year for Rx, except for the very poor.

Ira

Direct comparisons are difficult, given the exchange rate and the differing restrictions applied to the two plans, but assuming the income of the person involved is above a certain amount, and assuming sufficient drugs are prescribed that the maximum co-pay per year is required, the amount seniors in my province will be paying will be about the same as their counterparts in the US(actually your seniors will be paying a little less given current exchange rates.)

I tend to agree with SMueller that direct subsidies of drugs, as is apparently done in France, isn't sustainable. Careful compromises are going to be needed between public and private sponsorship if the twin goals of both efficiency and sustainability are going to be met, and interestingly enough the US and Canada both seem headed in that direction. But given the nature of compromise, it also means that nobody is going to be happy.

Thanx, Sue

I didn't read the complete thread but I don't think we can say you pay for it one way or the other.

Pharmaceutical companies make differing amounts in different countries depending upon the laws.

For instance, in Canada the price of drugs is not determined as a result of government purchasing. It's determined as an average of, I believe, prices in six other countries (don't remember which).

Interestingly, some companies have decided to charge lesss than what is allowed. I'm not sure about the details as I don't live there and haven't been able to get somebody to explain it to me.

What you can be sure is that when something is run by the government it will be inefficient and when it is run by private enterprise they will make as much as they can.

We just have to decide which poison we want.

I almost tend to feel I would rather the government poison since it's much easier to keep your eye on one place. Also, if you don't like what you see you can vote them out next time.

If we have the best, why do I always hear references of sending people to specialists in Switzerland, France, Netherlands, etc. Aren't they ahead of us sometimes in medical advances, research and forward thinking ?

Ira

I have just been reading a nytimes.com article about your new plan. I misunderstood what you said. Clearly the total cost for the average US senior per year is going to be a lot more than US 450.

The example given in the nytimes article is someone whose present drug cost is US 6000 per year. Her premium would be US 420 per year (35 per month). A major goal of the plan is to exploit the ability of the private insurer to negotiate a better price - in the example quoted, 4800 per year instead of 6000. The insurance plan itself, after deductible, would pay 1500, for a total savings to the individual quoted of 2700.

But the total per year, for that individual at least, would be 3300, not 450. Granted, this is an isolated example, not an average, but still....there is something out of whack here. Either our taxpayers are paying a great deal more for our plan than I thought, or drug prices are vastly different (I know they're cheaper here, but that much?) or both.

Sorry about the ire, Sue. You are right, the public isn't always well equipped to decide what is or isn't an emergency. However, I see so many egregious examples on a daily basis; literally taxpayers dollars being flushed down the drain and it makes me very angry when I see very hard working people struggling to pay their taxes to fund these people. I don't suppose you've ever taken an ambulance to get a Tylenol have you? Literally not kidding. "I ran out of Tylenol at home, and it's $4 at the pharmacy" As for charging these people, they are what is nicely put as "judgement proof". Forget about sending them a bill, they're already living off the dole. :p

I am bemused by the automatic US response of "we have the best healthcare system in the world".My family's experience suggests otherwise.

My mother had the misfortune to trip over a loose paving stone on a trip to NY a couple of years ago. She broke her hip.

Fortunately, she had extensive travel insurance to cover the enormous medical bills incurred in carrying out the necessary hip replacement.

I naively expected that standard of care and treatment would exceed the care/treatment which she has received in (private ) hospitals in the UK where she has previously had knee replacements.

This was not the case. My mother was horrified by the cleanliness of the hospital (a familar concern in NHS hospitals here in the UK but less so in private hospitals) and the standard of nursing care. She was literally horrified by the fact that she could see armed guards taking gunshot patients to surgery. She was released far earlier than would be the case in the private sector (particularly tricky as she then faced a 7 hour flight home).