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 Published Monday, May 22, 2006
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Health questions? Query a caddie
by Stephen Butler
When I asked him about his experience of the British National Health Service last week, my caddie at Saint Andrews golf course in Scotland said, "It's a good system, but it doesn't work."
Monty Python couldn't have said it better. In the course of a week of golf, I made it a point to ask every caddie or walking tour guide about his or her experience with the government health care delivery system.
Why? Because to compete in a global economy, we will have to offer something similar in the years ahead.
Caddies, by background and temperament, are opinionated, so it didn't take much to get them started on what they liked or disliked about their health insurance. Predictably, they said that the biggest problem was a long wait for emergency treatment unless you had a head injury.
Some complained about the fact that the national system covered everyone for free but that some people felt compelled to improve their options (and hopefully, the service quality) by paying for a conventional insurance policy that opened the window to more extensive on-demand private services.
Improving options could be important in a system where decisions are routinely made while recognizing that one heart transplant may cost the same as 30 hip operations. There is a limited amount of money available, and some of the regions or autonomous "states" of the NHS wind up with substantial deficits they struggle to control.
In the news was a story about a patient who had just won a lawsuit after having traveled to France for her hip replacement. The court agreed that she had experienced an "unreasonable delay" of six months and forced the NHS to reimburse her for her French operation.
What interested me about this story was the cost of the hip replacement in France -- $8,000 -- a procedure that would approach $50,000 in this country.
What are we doing wrong? A look at the British system helps us understand the shortcomings of our own a little better.
Our hip operations cost $50,000 because of one major contributing factor: Hospitals need to build into their costs enough to pay for the "free" services they provide to the 41 million people who are uninsured and go bankrupt.
Uninsured medical treatment is by far the largest cause of personal bankruptcy in this country. We have what amounts to a national health service, but it is paid for by insured citizens rather than by all taxpayers. Large corporations who shoulder the entire cost of premiums can't compete with companies operating in countries where the health care cost is spread out over all taxpaying citizens.
One would wonder why struggling U.S. companies have not proposed a national health care system or at least a government subsidized program similar to that recently adopted by Massachusetts.
The cost of health care is one thing. The cost of health insurance is something else. Take our cost of health care and tack on another 50 percent to arrive at the cost of insurance.
Why? Because about one-third of the cost of insurance is spent on administrative services and only two-thirds is spent on pills, hospital rooms, nurses and doctors. The administrative portion is high because we employ an army of people to selectively approve or deny coverage.
The objective is to keep costs as low as possible in an effort to compete effectively with some 300 other competitors and to have plenty left over for expensive advertising and pay for senior executives. Adding 50 percent to supposedly reduce a cost through competition reminds me of that phrase from the Vietnam era, "Sir, we had to bomb the village to save it."
At Medicare, by comparison, this administrative expense component is less than 5 percent.
The average full-time caddie in Scotland earns about $30,000 to $40,000 a year. I asked them what their tax rates were: They ranged from 17 percent to 25 percent. This was the total income tax, including their health care coverage.
It sounded reasonable to me. It also sounded like a good life.
One caddie was in his 70s. Others had quit their "day jobs" for the opportunity to stroll around the golf course twice a day -- a job offering exercise, fresh air, social contact, lots of laughs considering golf games like mine and finally, to the extent that it does indeed work, "free" health care.
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