4 ms·

Why is there never a comparison to Japan? They are 1/2 the size of the USA, have a privatized health system, and it's pretty damn awesome. They also have price

by kuwze 9y ago

Why is there never a comparison to Japan? They are 1/2 the size of the USA, have a privatized health system, and it's pretty damn awesome. They also have price controls which make things a lot easier to comprehend.

doh 9y ago
Spot on. Noah Smith made the comparison couple of months ago [0]. [0] https://www.bloomberg.com/view/articles/2017-09-19/want-a-better-health-care-system-check-out-japan https://www.bloomberg.com/view/articles/2017-09-19/want-a-be...
- em3rgent0rdr 9y ago
  sounds like that isn't fully privatised but is rather a hybrid.
DaiPlusPlus 9y ago
Isn't it redundant? I understand Japan's system is somewhere in-between Switzerland and Singapore's.
erentz 9y ago
It seems like Japans system would just be Medicare, as it is today, for all. That is just take out the line that limits Medicare to those over 65. Medicare still allows for private insurance to cover the gap between what Medicare pays and covers. As I understand it Bernie’s plan is a bit more than this and would expand Medicare to be a full single player plan. At this point though it seems we have more than enough comparisons and data telling us to do something. They’re all going to be nearly night and day in terms of comparison to what we have currently.
dv_dt 9y ago
I think the essential ingredients for controlled healthcare costs is a) the principle of universal healthcare b) government control of procedure and drug costs. No one is as expensive as the US per capita for healthcare. All the other nations beating us have wildly mixed healthcare delivery systems from full public to hybrid public/private - the hybrids are all administered differently. The characteristic they all seem to share in common is those two features. Even the worst of the modern nations systems beats the US cost and universality of coverage, and quality, by a large margin. Japan seems to have a mixed private/public insurance system, but has government control of the fee schedule. https://en.wikipedia.org/wiki/Health_care_system_in_Japan https://en.wikipedia.org/wiki/Health_care_system_in_Japan "The government has well controlled cost over decades by using the nationally uniform fee schedule for reimbursement." "Fees for all health care services are set every two years by negotiations between the health ministry and physicians. The negotiations determine the fee for every medical procedure and medication, and fees are identical across the country. If physicians attempt to game the system by ordering more procedures to generate income, the government may lower the fees for those procedures at the next round of fee setting" "Public health insurance covers most citizens/residents and the system pays 70% or more of medical and prescription drug costs with the remainder being covered by the patient (upper limits apply)." For Singapore: https://en.wikipedia.org/wiki/Healthcare_in_Singapore https://en.wikipedia.org/wiki/Healthcare_in_Singapore "Singapore has a non-modified universal healthcare system where the government ensures affordability of healthcare within the public health system, largely through a system of compulsory savings, subsidies, and price controls." Notice the "price controls"... It really doesn't seem to matter strongly exactly what mix of private/public does the actual administration. To capture first order cost savings better than what the US pays you need to control the fees.
greggman 9y ago
The Japanese health system is pretty horrible in my experience. The good: * It's cheap Prices for services are set by the government IIRC. Needed an MRI, was covered by insurance. Asked for copy of data. $25 for a CD with all my MRI data and free open source software included to view it. * It's easy to use Go to any doctor you want any time. Just show up at a doctor's office and hand over your insurance card The bad: * The doctors are not qualified I've had many experiences with quack doctors in Japan. First doctor I went to 20 years ago gave me an ultrasound and then declared I had hepatitis. Another doctor I went to for hives on my forehead just said "I don't know what that is". No referral, nothing. Another doctor was telling every patient to breath through a respirator for 5 minutes. Every patient was using the same respirator, same mouth piece, no changing of anything. Many doctor's offices are filthy. Machines are covered in goop (caked on bodily fluids?). Now that I have a smart phone I've started documenting this. Lots of foreigners complain no matter what the symptoms they're given the same 3 to 6 medicines. Break an arm, get the flu, catch a cold, always the same 3 to 6 medicines. * Nurses require zero training To be a nurse just show up. Becoming a nurse in Japan requires no more training than working at fast food. * If you want to good doctor for surgery you must bribe them If you need some serious surgery you research who the best doctor is then hand them an envelope with $$$$-$$$$$ and beg them to take your case. This is a common topic on Japanese TV dramas and no, the dramas are not making it up. I have several friends who've needed one kind of surgery or another who paid the bribe. * Long waits Went to a major hospital in Kanagawa. Hospitals in Japan are not like Hospitals in the USA. In Japan you can go to the hospital for every day medical issues (colds, flu, etc...). Had to wait 2.5 hours in a room with about 300 other sick people. I will say I don't know how common that is. Waits that long have only happened to me twice as I've only gone to a hospital for service twice. They're just something I haven't experienced in the USA partly because I don't know a single place in the USA that has a waiting room that big. I did experience similar in the UK, the long waits part not the 300 people. Doctors offices have normal waits (5-10 mins) I'm not trying to defend the USA's system. It's got lots of problems. I like the good parts of the Japanese system. It's just not all roses. The Japanese have pretty good health but I tend to guess it's genetics+lifestyle+diet and not so much because of health care.
- nradov 9y ago
  In Japan it's effectively illegal to be fat. That probably has a greater impact on average lifespans than anything in the healthcare system. https://www.pri.org/stories/2009-11-10/fat-japan-youre-breaking-law https://www.pri.org/stories/2009-11-10/fat-japan-youre-break...
oldmandutch 9y ago
And they are a (mostly) homogenous society. Racist, structurally rigid, and dying (birth rate below replacement).

by kuwze 9y ago

doh 9y ago

Spot on. Noah Smith made the comparison couple of months ago [0]. [0] https://www.bloomberg.com/view/articles/2017-09-19/want-a-better-health-care-system-check-out-japan https://www.bloomberg.com/view/articles/2017-09-19/want-a-be...

em3rgent0rdr 9y ago
sounds like that isn't fully privatised but is rather a hybrid.

DaiPlusPlus 9y ago

Isn't it redundant? I understand Japan's system is somewhere in-between Switzerland and Singapore's.

erentz 9y ago

It seems like Japans system would just be Medicare, as it is today, for all. That is just take out the line that limits Medicare to those over 65. Medicare still allows for private insurance to cover the gap between what Medicare pays and covers. As I understand it Bernie’s plan is a bit more than this and would expand Medicare to be a full single player plan. At this point though it seems we have more than enough comparisons and data telling us to do something. They’re all going to be nearly night and day in terms of comparison to what we have currently.

dv_dt 9y ago

I think the essential ingredients for controlled healthcare costs is a) the principle of universal healthcare b) government control of procedure and drug costs. No one is as expensive as the US per capita for healthcare. All the other nations beating us have wildly mixed healthcare delivery systems from full public to hybrid public/private - the hybrids are all administered differently. The characteristic they all seem to share in common is those two features. Even the worst of the modern nations systems beats the US cost and universality of coverage, and quality, by a large margin. Japan seems to have a mixed private/public insurance system, but has government control of the fee schedule. https://en.wikipedia.org/wiki/Health_care_system_in_Japan https://en.wikipedia.org/wiki/Health_care_system_in_Japan "The government has well controlled cost over decades by using the nationally uniform fee schedule for reimbursement." "Fees for all health care services are set every two years by negotiations between the health ministry and physicians. The negotiations determine the fee for every medical procedure and medication, and fees are identical across the country. If physicians attempt to game the system by ordering more procedures to generate income, the government may lower the fees for those procedures at the next round of fee setting" "Public health insurance covers most citizens/residents and the system pays 70% or more of medical and prescription drug costs with the remainder being covered by the patient (upper limits apply)." For Singapore: https://en.wikipedia.org/wiki/Healthcare_in_Singapore https://en.wikipedia.org/wiki/Healthcare_in_Singapore "Singapore has a non-modified universal healthcare system where the government ensures affordability of healthcare within the public health system, largely through a system of compulsory savings, subsidies, and price controls." Notice the "price controls"... It really doesn't seem to matter strongly exactly what mix of private/public does the actual administration. To capture first order cost savings better than what the US pays you need to control the fees.

greggman 9y ago

The Japanese health system is pretty horrible in my experience. The good: * It's cheap Prices for services are set by the government IIRC. Needed an MRI, was covered by insurance. Asked for copy of data. $25 for a CD with all my MRI data and free open source software included to view it. * It's easy to use Go to any doctor you want any time. Just show up at a doctor's office and hand over your insurance card The bad: * The doctors are not qualified I've had many experiences with quack doctors in Japan. First doctor I went to 20 years ago gave me an ultrasound and then declared I had hepatitis. Another doctor I went to for hives on my forehead just said "I don't know what that is". No referral, nothing. Another doctor was telling every patient to breath through a respirator for 5 minutes. Every patient was using the same respirator, same mouth piece, no changing of anything. Many doctor's offices are filthy. Machines are covered in goop (caked on bodily fluids?). Now that I have a smart phone I've started documenting this. Lots of foreigners complain no matter what the symptoms they're given the same 3 to 6 medicines. Break an arm, get the flu, catch a cold, always the same 3 to 6 medicines. * Nurses require zero training To be a nurse just show up. Becoming a nurse in Japan requires no more training than working at fast food. * If you want to good doctor for surgery you must bribe them If you need some serious surgery you research who the best doctor is then hand them an envelope with $$$$-$$$$$ and beg them to take your case. This is a common topic on Japanese TV dramas and no, the dramas are not making it up. I have several friends who've needed one kind of surgery or another who paid the bribe. * Long waits Went to a major hospital in Kanagawa. Hospitals in Japan are not like Hospitals in the USA. In Japan you can go to the hospital for every day medical issues (colds, flu, etc...). Had to wait 2.5 hours in a room with about 300 other sick people. I will say I don't know how common that is. Waits that long have only happened to me twice as I've only gone to a hospital for service twice. They're just something I haven't experienced in the USA partly because I don't know a single place in the USA that has a waiting room that big. I did experience similar in the UK, the long waits part not the 300 people. Doctors offices have normal waits (5-10 mins) I'm not trying to defend the USA's system. It's got lots of problems. I like the good parts of the Japanese system. It's just not all roses. The Japanese have pretty good health but I tend to guess it's genetics+lifestyle+diet and not so much because of health care.

nradov 9y ago
In Japan it's effectively illegal to be fat. That probably has a greater impact on average lifespans than anything in the healthcare system. https://www.pri.org/stories/2009-11-10/fat-japan-youre-breaking-law https://www.pri.org/stories/2009-11-10/fat-japan-youre-break...

oldmandutch 9y ago

And they are a (mostly) homogenous society. Racist, structurally rigid, and dying (birth rate below replacement).