Friday, September 21, 2012

Nationalized Insurance

Nationalized Insurance

Over the last several years I've been watching the rabid debate about healthcare reform with bemusement.  The sheer amount of vitriol and invective sometimes blows my mind.  I understand both sides of the issue (which doesn't indicate, by the way, agreement with either particular side, merely that I listen before drawing my own conclusions - something that I really wish some folks would try to emulate).

I can, however, give you my own anecdotal experience, having lived in a country which offers national health insurance, and having used the system myself for the last 20 years.

Japan has a national insurance program, which offers coverage at rates set according to your income and family size.  I and my 4 children are on one policy, my wife receives private coverage at her work.  At today's exchange, I pay almost exactly $1000 per month (interestingly enough,  I paid the exact same amount when it was just me, and the children were on my wife's account at her previous job, and again when she changed jobs and wasn't yet covered at work).  For this fee, I get 80/20 coverage, with nearly 100% coverage for young children.  We can go to any doctor or hospital we please,  and while you may need to wait a few hours at a busy doctor's office or clinic, it's no different than any other patient, and there is none of the "we have an open time next Friday at 11:00" bullshit.

Now, this system is not perfect.  With Japan's rapidly aging society, it is creaking under an increasing load, dropping from 90/10 coverage a few years back, and looks likely to drop even further to a 70/30 copay in the future.  But no one is without insurance.  People don't die because they lack coverage (as long as they take the time to actually sign up, that is).  There are no 'death panels' that the scaremongers constantly harp about, deciding who gets coverage.  Medical quality does not suffer because of the insurance system.

In my personal opinion, offering bare bones insurance for those who cannot afford to get their own would be a major cost, perhaps, but it seems to me that it should pretty much balance out with all the uninsured people who now clog American emergency rooms, receiving care for which they cannot pay, the cost of which must be passed on to other patients, thus making the US one of the most expensive countries in the world in which to receive medical care.  I took an ambulance ride after a motorcycle accident in college, and paid $250 for a 3-mile ride, with another $150 for the gauze they used to wrap my open-break toe, and $50 for the iodine they used on the scrapes on my legs (not to mention the $5000 for outpatient surgery to put one 5mm screw in my toe to hold a bone fragment in place).  I paid a hell of a lot less for a vasectomy here in Japan!

And there is the ethical issue.  I'm sorry, but I'd just like to believe that we won't leave people sick or dying when it is within our power to do something about it.  I'm not talking about 'Kicks' and iPhones for people on the dole, just basic human dignity.

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