New Zealander contrasts American health system

By Cherry Sokoloski
North Forty News

Is the United States health care system really the best in the world? While many Americans would like to believe that, more and more research is saying this is not the case.

On a personal level, some folks who have moved from other industrialized countries find that the American system does not compare favorably with health care back home.

Karen Garrick, her husband, Dorian, and their three children are New Zealand citizens, but they have lived in Fort Collins for four years. Asked to compare the U.S. health insurance system to the national plan in New Zealand, Garrick said she definitely prefers the New Zealand approach. In the United States, she said, health insurance "costs a lot of money, and you don't get much for it."

Dorian Garrick is a professor of animal breeding at Colorado State University. While the university pays some benefits for him, the family foots the bill for their health insurance. The Garricks have a high-deductible health insurance plan, considered low-cost by American standards. They pay $660 per month for their plan.

For that amount, the Garricks receive very little coverage, since their deductible is $2,000. They pay about $80 for each doctor visit, all their lab fees, and dentist and optometrist bills for the entire family. There is no prescription coverage.

New Zealand options

Karen Garrick described the New Zealand system as two-tier. In contrast to the United States, New Zealand has both public and private health care systems. Everyone is eligible for the public program - and almost everyone uses it, according to Garrick. However, about 35 percent also pay for private insurance. This allows them to use private hospitals and to avoid waiting time for nonurgent surgeries. In both systems, most doctors are private practitioners and patients may choose their own doctors.

Those who use only the public system in New Zealand pay no insurance premiums. The system is paid for with income taxes, which Garrick said are somewhat higher than U.S. taxes.

For the added advantages of private health insurance, the Garricks would pay about $50 a month if they were living in New Zealand today. Private insurance covers much less in New Zealand than in the United States, however, since all people - even those with private insurance - avail themselves of the public system for routine care.

In New Zealand, there's also a small payroll tax that covers all medical costs resulting from accidents. Unlike the Workers Compensation program in the United States, this program is not limited to accidents in the workplace, and it pays part of a person's salary if he or she is injured and unable to work. By comparison, it is common in the United States for people to become seriously ill or injured while insured, then to lose that insurance after the illness or injury makes them unable to work and unable to afford the premiums. Medical bills are the reason for 50 percent of personal bankruptcies in this country.

Children big winners

Children and pregnant women are big winners in the New Zealand system. Health care during pregnancy and delivery are free, including the hospital stay for those who use public facilities. For young children, immunizations and some health checks are free. Visits to the doctor cost nothing for children under 6, while visits for older children cost about $20.

Other free services in the public system include hospital stays, treatment for acute or chronic medical conditions, dental care for children up to 18, breast cancer screening for women over 50 and most lab tests and X-rays.

Prenatal and postnatal care could be the reason for New Zealand's better record when it comes to infant mortality. New Zealand ranks 35th in the world, according to a CIA web site, while the United States ranks 43rd. America is beat out in this category by all of Western Europe as well as countries such as Canada, Cuba and Taiwan.

In New Zealand, prescriptions are free for children under 6, according to the New Zealand Ministry of Health. All others pay a co-payment that cannot exceed $15. Prescription drugs are subsidized by the government, as well as doctor visits, ambulance services and visits to physical therapists and chiropractors.

According to Garrick, adults in New Zealand pay about $30 for a doctor visit. Nursing home care is free at a public facility, if a doctor says it is necessary. For people with private insurance, private nursing homes are available as well.

The New Zealand system is not perfect, Garrick is quick to point out. "People always want more than what they have," she said. She said public hospitals in New Zealand tend to be short-staffed, and the wait times are a problem that the country is trying to address.

Nonetheless, she finds American health costs "outrageous" and a deterrent to getting adequate, timely health care, even for families like hers with insurance.

"I don't think anything about going to the doctor in New Zealand," she said, "but here I wouldn't go for a minor problem. I tend to wait until I have several small problems."

Brits do better

In May, a survey of health problems in the United States and Great Britain again put the spotlight on the American health care system. The study, published in the Journal of the American Medical Association, showed Americans to be far less healthy---regardless of education and income--than their counterparts in England. In fact, the survey found that richer Americans' health status resembled the health of low-income English citizens. The study included only non-Hispanic whites, ages 55 through 64, to eliminate the influence of racial disparities.

According to the study, Americans have higher rates of diabetes, heart disease, stroke, lung disease and cancer. This, despite the fact that the United States spends $5,200 per person on health care while England spends about half that amount.

"Everyone should be discussing it: Why isn't the richest country in the world the healthiest country in the world?" asked a co-author of the study, British epidemiologist Michael Marmot.

Other studies have also put the United States in an unfavorable light. In 2000, the World Health Organization rated health systems throughout the world and ranked the United States 37th in overall performance.

Glenn Pearson, a Fort Collins physician who is pushing for universal health care in the United States, attributes at least part of America's poor showing to its health care insurance system. The effects can be direct or indirect, he noted. One obvious fact is that uninsured people in the United States are not receiving adequate health care.

Pearson noted, however, that other factors such as stress and lack of community are also related to health. "We spend twice what every other nation spends on health care, so we have markedly less money to spend on every other thing that brings joy and health to a society," Pearson said.

For instance, he noted, the average vacation in the United States is two weeks, compared to an average of eight to 10 weeks in Europe. Long hours make it difficult for Americans to spend time with family, friends and neighbors. Also, about 15 percent of Americans report "job-lock"--being stuck in a job they don't like in order to keep their health insurance. This, Pearson said, adds stress and decreases job satisfaction, leading to poorer health.

Another difference between the United States and other industrialized countries is the support for new mothers and babies. In Canada and Europe, Pearson pointed out, new mothers have free home visits by nurses and midwives. Larimer County has such a program, the Nurse Family Partnership, but it is limited to low-income, first-time mothers.

The U.S. health care system is often compared to that of Canada, with disparaging comments about wait times in Canada and Canadian citizens crossing the border for surgeries. However, when Robert H. LeBow, author of the 2004 book "Health Care Meltdown," interviewed both British and Canadian citizens, asking them if they would like to switch their health care systems with that of the United States, the answers were overwhelmingly negative. LeBow did acknowledge that wait times for nonemergency surgeries and fewer heroic measures during end-of-life care are common in countries with national health plans.

LeBow noted in his book that Canada has borne the brunt of negative advertising concerning health care systems outside the United States. However, he stated, most Canadians like their universal health care system.

"There is much we could learn from Canada if so many of us weren't so convinced that we had 'the best health care system in the world,'" said LeBow.