Wednesday, July 29, 2009

Healthcare in Chile and the USA

In Chile, you have nearly Universal healthcare including a thriving private sector-ISAPRE-and FONASA-the public plan. Chileans pay 7% of their income and then make a choice to enter the FONASA or ISAPRE system-and have further choice to elect greater coverage in private plans.

I'm not saying Chile has the best system in the world but it does seem odd and a bit sad that I am less likely to die here because of a needed operation. A friend of mine recently had an operation, a much needed femoral bypass. It cost about $12,000 usd cash, no insurance-that includes everything and a 5 star room to boot.. The average "list price" in the US is $50,900 according to this website. Apparently it can be done as cheaply as $18,900(huh?). Perhaps that's a good place to check before your next operation in the USA folks.

What I know is that the US is falling in status from a number of lists.

The World Health Organization's ranking
of the world's health systems
(Top 50)
In 2000, The US was still barely ahead of...Cuba. Chile beat the US by 4 places(and has improved its system under Bachelet while the US has deteriorated. The US also beat Slovenia by one place.
The U.S. spends 16 percent of gross domestic product (GDP) on health care, compared with 8 to 10 percent in most major industrialized nations. According to the World Factbook
(which is suspiciously updated only to 2005) The US was #2 in healthcare spending by GDP so i would guess it's now easily in 1st place(yay!!!)

The saddest statistic must be infant mortality. Nationmasters, I see, no longer lists the US there but there are other sources like here. And now I see, Nationmasters sources from the CIA Factbook-better you don't see that I guess. Anyway,

Since ranking a fairly respectable 12th in 1960, the U.S. fell to an all-time low 29th in the world in infant mortality in 2004, according to the report Recent Trends in Infant Mortality in the United States from the Centers for Disease Control (CDC). The U.S. infant mortality ranking has been falling steadily, from 23rd in 1990, to 27th in 2000. The U.S. infant mortality rate of 6.78 infant deaths per 1,000 live births in 2004, compared unfavorably with the lowest rates of 3.5 per 1,000 reported in Scandinavian and East Asian countries. Overall, 22 countries had infant mortality rates below 5.0 in 2004.

But wait, this is 2009 and those are statistics from 2000-but according to our new link here, the US is now #37!
37. United States 6.37 deaths/1,000 live births

Uh oh, Cuba is #35 on that list, no wonder the US government no longer reports it. But we're still a place ahead of Croatia, by god. Wait, this is bad-South Korea has less babies die at birth than the USA????

Well, how how about life expectancy-surely a great country like the US places well there.

172. United States 78.00 years

There are 37 countries with better life expectancies out of the total 208 listed, including Bosnia and Puerto Rico... interesting as well is that many countries are improving while US stats get worse.

160. Chile 76.96 years
161. Cuba 77.08 years

The point was never that Cuba-or Chile-has better healthcare but that those countries improve while the US continues to fall.

Continuing on, I looked for other categories but saw this:

Healthy Life Expectancy (UN 1997/1999)
Health Performance Rank By Country(UN 1997/1999)
WHO ranking of the world's health systems (2000)
Total Health Expenditure as % of GDP (2000-2005)
Global Hunger Index by country 1990-2008
HDI - Human Development Index 1975-2005
Refugees, asylees, internally displaced persons, by country - 2007

See the pattern? Old statistics on what I've just discussed but new, bright shiny statistics where the US "shines".

I meant to write more but this is an exhausting subject. The US healthcare "plan" every day seems to need a motto like If you're wealthy and 84, we would rather you live in a coma and have a heart transplant than save the lives of babies. If you're 50 and healthy, you will be charged an unbelievable amount-the price of a current mortgage so although your mortgage payment may be low, that extra money will be replaced by an inadequate insurance policy-which, of course, if you ever actually have to use it-you'll be cancelled.

Although they say 46 million Americans are uninsured(I would guess it's much higher-people don't know their insurance is inadequate until they need it), the United States spends more on health care than other industrialized nations, and those countries provide health insurance to all their citizens. Here's a lot of scary facts here.

And here's a story about a 35 year old and his 35 year old wife. The story is a good one but here's an excerpt:

She told me that she had just opened a letter from our health insurance that informed us that our monthly premium was increasing from $534 to $738 next month.

A $204 increase per month? $2448 more per year? A 38% increase in one month?

.....They came back again and explained that it was 38%. 17% was an annual increase. The rest was due to my wife and I both turning 35 this year.

A 21% increase for turning the ripe old age of 35.

A 38% increase in on month. From $534 per month to $738. $204 more per month. $2448 more per year.

That's $8,856 a year for two 35 year olds-how much for two 50 year olds? Here's the problem-the money spent on health insurance or healthcare is not being spent other places. This is a serious problem for the economy and the USA. Forget that new house or new car, buy health insurance. The best way to get healthcare if you're middle class is now to become poor so you can get medicaid. I have never in my life used any type of government assistance. I went to college, got my degree, raised my son, paid my taxes, bought a small house(before I cancelled my insurance, it was more than my mortgage payment so I sold my house), bought cars and generally helped the GDP like all good Americans. So I'm very sad. If I ever return to the US, my choice is to divest myself of all assets(I saved for retirement, silly me) and try to hop on the government 'dole' for the first time in my life or just hope I never get sick(I'm healthy but that seems unlikely) or I have the "freedom" to die-even if diagnosed with an easily curable form of breast cancer.

A few thoughts in answer to what I hear from the opposition to healthcare reform in the US. I know they're scaring you but they're not telling you the truth.

1.I hear this "in Canada, my friend's grandmother died because of the lines"

A. This is not Canada. None of the plans proposed look anything like Canada's. In Canada, they do have healthcare priorities. The 5 year old will be in line ahead of the great-grandmother. A 5 year's life is more important to me than my own at 54 and I would hope 84. In the US, the middle class child is more likely to die than a well to do 84 year old. So I believe Canada is correct. But please stop comparing US healthcare to any portion of any healthcare plan around the world that has nothing to do with the US. The rich and privileged in the USA will always have the best healthcare. Always.

2. But I don't want rationed healthcare, I want to keep my doctor!

A. You can keep your doctor under ALL plans proposed. Younger, healthy people here in Chile are mostly in the ISAPRE private sector. Those that are older or not healthy use the public FONASA option. I want a choice too. The choice not to die because of non-invasive breast cancer.

3. But America is about Freedom!

A. The freedom to live if you have the money and the freedom to die if you don't. The freedom to pay more for healthcare. Health care spending is 4.3 times the amount spent on national defense. Except suicide is illegal. Yet suicide rates are increasing

October 21, 2008

U.S. Suicide Rate Increases

Largest Increase Seen in Middle-Aged White Women

The rate of suicide in the United States is increased for the first time in a decade, according to a new report from the Johns Hopkins Bloomberg School of Public Health’s Center for Injury Research and Policy. The increase in the overall suicide rate between 1999 and 2005 was due primarily to an increase in suicides among whites aged 40-64, with white middle-aged women experiencing the largest annual increase. Whereas the overall suicide rate rose 0.7 percent during this time period, the rate among middle-aged white men rose 2.7 percent annually and 3.9 percent among middle-aged women. By contrast, suicide in blacks decreased significantly over the study’s time period, and remained stable among Asian and Native Americans. The results are published online at the website of the American Journal of Preventive Medicine and will be published in the December print edition of the journal.

Imagine that-I wonder if that has anything to do with increasing medical problems and healthcare costs in middle age.

4. There won't be any doctors!

A. Yes, there will. I know many doctors here in Chile. A personal friend is a cardiologist. And here's a website from US doctors for US healthcare reform. And let me direct you to their list of questions and answers. Granted, they would like a single system which the US is unlikely to get.

And it looks more likely by the day, that there will be any real reform passed. I am sad. sad for me but sadder still for all the young people that have no idea how bad things can get.

5. I don't want socialized medicine!

A. The most unbelievable really. In answer, I saw President Obama read a letter from an older woman which read in part "I don't want socialized health care and hands off my Medicare!" Really?

Medicare is socialized healthcare, by most definitions. So this woman is saying "I want it for me but no one else!" She made it to 65, the hell with the rest of you.

If you are against "socialized" , you must be against Medicare and fireman. Against a police force, against street cleaners and snow plows. Against the post office(it takes 3 weeks here to send a letter from one end of the country to the other-the miracle of privatization), against the dog pound(don't get me started on the stray dog problem here). The list is endless.

Yes, the US is spoiled in many ways but healthcare here is better.


Ms. Campbell said...

Laura, they are never going to let you visit the U.S. if you keep this up. lol

Anonymous said...

Hey...I stumbled upon your blog and what I've read so far is pretty interesting. I'm an American too and I unfortunately don't live in Chile (though I'd really want and love to cause I'm ridiculously interested in the country and all of its recent history) but I always love finding news from Chile in English (my Spanish is okay, but not stellar).

Laura said...

Glad you stopped by. I'll try to continue with Chile posts-I get off track now and then...did you check the Latin American News Review? The link is on my blog and he has great feeds from different countries.

james said...


Are the insurance plans offered for expats affordable?

Looks like the climate in and around concepetion is stellar?

Thinking of visiting to relocate (retire)

Laura said...

Expat insurance is possible from many big companies but those that get residence status in Chile can apply to fonasa or isapre which is a percentage of your pay/income. I didn't use insurance, medical services are mostly much cheaper there. I paid cash as did others I knew.

The weather and where to live-everyone has an opinion. Concepcion lost a lot of people in the tsunami after the earthquake and had more damage. Most coastal towns did. One friend has a place on a cliff overlooking the ocean-he watched the town destroyed but he was safe.

Visit, travel to as many places as possible. Winters in the central area are like the NW US, rainy. Summers hot and dry with very little rain. research, research

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