Newsweek’s Howard Fineman writes, in his latest column, about the hospital care he received for a severe bout of food poisoning during his recent trip to Argentina. His conclusion, after covering health reform in the United States for a year, is that the health-reform debate here needs to be about cost.
Yes, cost. And quality. And access.
Fineman was treated in a private hospital in the resort town of Bariloche, where he was visiting his daughter. “I got great care at a tiny fraction of what the cost would have been in the U.S. — even correcting for cost-of-living and currency values,” Fineman writes.
He estimates the hospital bill in the United States would have been $10,000 to $15,000. Later in the article he says:
In figuring the bill, let’s say that, since the Argentine peso is worth about one forth [sic] of a U.S. dollar, the “real” cost of my care in Bariloche was $6,000. That is still about half of what I would have paid back the United States.
A tiny fraction? About half? What’s the difference when you’re talking about a model for reforming the $2.5 trillion U.S. health-care economy? Nonetheless, he seems to argue that the Argentine hospital’s lower-tech approach to care suited him just fine.
He notes in an off-handed comment that “most Argentines rely on a rickety public system” while those who are “better off rely on private, for-profit hospitals.” Two-tier medical care is what most socialized health systems produce: There’s a rickety public system with waiting lines and limited access to new technologies, while those who can afford to pay privately buy their way out, either at private hospitals like the one Fineman was in, or by traveling to the United States, as the premier of Newfoundland did when he flew to Florida for heart surgery last month. When interviewed about escaping the Canadian system for the U.S., Premier Danny Williams said unapologetically, “I did not sign away my right to get the best possible care for myself when I entered politics.”
There are many reasons that care may be less expensive in Argentina than in the U.S., even at a private hospital. Just for starters: Argentina has a lower cost of living and lower wages; its legal system does not expose doctors to huge medical liability costs; many fewer citizens have access to the latest medical technologies; and they spend a fraction of what the U.S. spends on research and development of new medicines and technologies that the rest of the world relies on.
I’m glad that Howard was able to get good care in Argentina. I’m also pleased that he sees the importance of cost: If health care and health insurance were more affordable, millions more would have insurance. And I’m pleased that he has now seen what happens when you have a centralized, government-run health-care system: Rich people buy their way out.
Last spring I was in Guatemala for a conference of the Association of Private Enterprise Education, and I visited a state-of-the-art hospital in Guatemala City that is one of a network of six private hospitals operated by the Grupo Hospitalario Guatemala. This, too, was a private hospital catering to an affluent, private-paying clientele.
The hospital was as modern and as well equipped as you would find in any American city, with nuclear-medicine diagnostic equipment, cardiac surgical centers, neonatal intensive-care units, four operating rooms, and much more. Most doctors are board-certified in the United States. This is in sharp contrast to the crowded, poorly equipped, and understaffed public hospitals in the country’s universal health-care system.
All payment at Grupo Hospitalario Guatemala is private, and prices are posted up front, with payment plans available. Prices often depend upon convenience and amenities — MRIs cost less at night, for example. The most common surgeries are for gastric bypass. A private hospital suite costs about $85 a night, with a one-to-one nurse-patient ratio. Surgical charges are about 25 percent of prices charged in the U.S.
The real solution in the U.S. is to give people an incentive to understand the cost of the care they are receiving and get the best value. That is the path to a health-care system that provides good-quality, affordable care to everyone. And that is precisely the opposite of the approach that Congress currently is taking with its health overhaul legislation, turning us instead toward a system of government control that will inevitably lead to the two-tier medicine that we see in other countries that have traveled this path — and that those who support this legislation surely would decry.