Caution that recent events, like California’s health proposal and government negotiation with pharmaceuticals, points us towards the Japanese health system:
Through its universal health insurance program, Japanese bureaucrats are charged with the responsibility and power to ensure a “minimum standard of care for all.” Rules of the game, and in particular what is covered and how doctors get paid, are mainly set by the central government in Tokyo.Sound familiar? It should, as this is the direction we would be headed in within the U.S. if recent state level universal coverage proposals and federal prescription drug purchases for Medicare beneficiaries are enabled. The Journal article lists many of the downsides to the system, particularly in light of cancer coverage:
“¢ “Japan saves by requiring less training of doctors and paying them less”
“¢ Japanese “doctors say they have little time for patients”
“¢ Until recently, many Japanese cancer patients weren’t even told that they had the disease””family members “often felt it was cruel to burden the patient with information” about the cancer diagnosis.The Journal article further indicates that new classes of chemotherapy drugs and the spread of the Internet have “spawned a new class of activist cancer patients.” This patient activist movement has grown largely in response to the central government’s reluctance to embrace and approve a new class of promising cancer drugs.
Related posts:
- Health insurance doesn’t automatically lead to health care
- Tradeoffs for covering the uninsured
- The American Cancer Society and the uninsured
- News Media Misreport Health Survey
- Government-run health care
- Malinda Markowitz: Time for a sea change on health care
- Single payer truths, from Ontario’s Ministry of Health
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Or we could continue with our system in which the supply of providers is strangled and legal feat is used to limit vast swaths of health care provision to this limited number of providers. Resultantly, millions of citizens go without access to care, rural and urban areas are grossly underserved and existing organized provider groups continue in their attempt to manipulate a credulous (not as credulous as in prior decades) populace into supporting the continued provider first system under the guise of patient advocate. Even the most ardent clinician supporter of the current training system and its results must realize that the inertia of the health care crisis (from the perspective of the populace) is gaining momentum by the day. There is only so much that one can blame the trial lawyers, drug companies and other assorted spooks until the populace realizes that they do not have to tolerate the system put in place by the implementation of the findings of the Flexner Report.
I’m not stumping for the Japanese system (I’m actually with Kevin when it comes to suspicion about something for nothing government interventions). But the bit about whether Japanese docs tell patients about
ummm, chopped off the rest of my comment …
my point was that the bit about Japanese docs not disclosing cancer diagnoses had nothing to do with how medicine was funded and everything to do with broader cultural norms in that part of the world.
Anon at 2:19 – I agree. This is prevalent in other parts of the world as well, such as Russia and China. In fact, I heard of some Russians and Chinese in the US – not those who’ve lived in the US for a while, but very recent immigrants – who are asking their American doctors not to tell the truth to their relatives.
Either the system is patient centered, or it’s geared toward another goal (like cost control).
If we’re patient centered, high cost and high quality care will be reuslts.
If we’re cost centered, we eventually get to a point where we tell patients “your care is too expensive, so we’re just going to relieve your suffering and stop treating.”
We’re trying to find the middle ground and it’s going to be tough to mix these diametrically opposed philosophies.
I’m pretty sure that Japanese docs are the highest paid in the world second only to America.
I heard that a big reason for this is that Japanese doctors are allowed to sell the drugs they prescribe, much like american oncologists used to do wtih chemo drugs.
That gives them a huge revenue stream.
Actually, the Japanese health system is quite a good one — I used it for almost 5 years and I was very impressed. It is certainly far better than the one that I use in the U.S. now.
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