Little-Acorn
03-25-2010, 01:10 PM
The wires have been full of China's government's recent attempts to reform Health Care in their own country. And unsurprisingly, the reports have been long on praise... but short on specifics. See a typical example at http://www.china.org.cn/government/central_government/2009-04/06/content_17559519.htm .
"Finally China will 'give' universal health care to its subjects", runs the usual headline, give or take a few quote marks. But the devil is in the details... along with a number of 500# gorillas in the room.
My wife is from China, born and raised in Shanxi province southwest of Beijing, who went to college in Bejing itself. She's now a naturalized American citizen (the requirements for which she fulfilled BEFORE she got married). When I commented to her that her former country must love the latest developments in the U.S. with universal Obamacare, she stared at me and replied that China wouldn't touch it with a ten-foot pole.
She was very familiar with medical care, and how it was paid for, in China a decade or more ago, because she and her family lived it every day, year in and year out. And since coming to the U.S., she has kept in close touch with friends and family members in the Olde Countrie, as China goes through the massive injections of capitalism the country has recently had, and the results of it.
In years past, she says, the larger cities had a system that was basically free health care for all city residents, unlimited. If you got sick, you went to a government-paid hospital, paid an up-front fee of 0.05 yuan (slightly less than a penny in American money), and all ensuing care, medicine, procedures, and even hospital housing and meals were free.
That was in the cities. Rural areas (which contained most of the population) in China got no government support at all. You bought a private insurance policy, if available. Mostly people just went to the local doctor and paid cash from their own pocket... or did without.
But what caused the new "reforms" China has been studying and recently implementing, was the huge migration of the country's population from rural areas to the cities. Health care in those cities was becoming extremely costly for the government to pay for. Bottlenecks and shortages were rampant, and rationing was routine, with mounting bribery and fraud, and a thriving black market.
The government is now congratulating itself for "reforming" the system. Finally everybody, rural or urban, is getting "universal health care".
BUT....
Their so-called "universal" program bears a striking resemblence to what the U.S. had fifty years ago, except for who is "providing" it. Everybody has a government-provided insurance policy - but it has a 1,000-yuan deductible (about $70 US dollars), which is about a month's wages for the average Chinese city-dweller, and far more for farmers and other urban residents. Prices being what they are for domestic consumers in China, most routine procedures cost no more than that, so people seeking medical care usually wind up paying for all of it out of their own pockets.
The next 1,000 yuan in costs, if you're employed by a large (and govt-controlled) company, is matched by your employer, so you essentially get a 50% co-payment for costs beyond the first 1,000 yuan. If your company isn't large (as most people's companies aren't), they don't match it, so you wind up paying 100% of the second 1,000 yuan also. There goes another month's (or more) wages, straight out of your own pocket.
And once you've paid for all that out of pocket, for the rest of your medical costs for that sickness or injury, the govt insurance pays for 90% while you pay 10%. Relatively few people incur medical conditions that require such complex, expensive medical procedures, but when they do, the government "helps" them.
So, with the highly-touted "reform" the govt is putting in place, government has changed from its old levels of assistance (no help for the majority of Chinese who live outside large cities, but virtually 100% payment for the small percentage who used to live in the cities) to new levels (no help for anyone, except the relatively few who get very seriously sick or injured).
In other words, after long experience, China has shied away from its former genuine "free universal health care" for city dwellers, now that city populations are exploding. In its place, the have implemented a policy very similar to American "Major Medical", where the private citizen pays virtually all his own medical costs except for the occasional very complex and costly major procedures. The only difference is, the Government is the provider of this Major Medical policy, instead of private insurance companies as in America.
Bottom line: China has found genuine "Universal Health Care" (where a single payer pays for ALL medical procedures large and small, all medicines, hospital rooms, doctor fees and everything else) to be completely unworkable, with costs going through the roof, shortages crippling the system, and mounting rationing and fraud creating huge black markets that make criminals out of people who only wanted normal medical care. And they have done away with that system completely.
In its place, they have set up the system that the U.S. had for years, before all the talk of socialized medicine began, medical costs were driven by people looking for the best care at lowest cost for themselves and their families, and insurance had a sound, rational basis.
Somehow I don't think these facts will be printed anytime soon in the flowery publications the Chinese government is putting out about its wonderful "reforms". And they certainly won't be printed in the U.S. mainstream press.
But get a Chinese citizen (or former citizen), bring them to a place far from the Chinese government's attentive ear, and ask them what's really going on, and how the new "reforms" in that country affect him and his family.
You'll get an earful... of truth, for a change.
"Finally China will 'give' universal health care to its subjects", runs the usual headline, give or take a few quote marks. But the devil is in the details... along with a number of 500# gorillas in the room.
My wife is from China, born and raised in Shanxi province southwest of Beijing, who went to college in Bejing itself. She's now a naturalized American citizen (the requirements for which she fulfilled BEFORE she got married). When I commented to her that her former country must love the latest developments in the U.S. with universal Obamacare, she stared at me and replied that China wouldn't touch it with a ten-foot pole.
She was very familiar with medical care, and how it was paid for, in China a decade or more ago, because she and her family lived it every day, year in and year out. And since coming to the U.S., she has kept in close touch with friends and family members in the Olde Countrie, as China goes through the massive injections of capitalism the country has recently had, and the results of it.
In years past, she says, the larger cities had a system that was basically free health care for all city residents, unlimited. If you got sick, you went to a government-paid hospital, paid an up-front fee of 0.05 yuan (slightly less than a penny in American money), and all ensuing care, medicine, procedures, and even hospital housing and meals were free.
That was in the cities. Rural areas (which contained most of the population) in China got no government support at all. You bought a private insurance policy, if available. Mostly people just went to the local doctor and paid cash from their own pocket... or did without.
But what caused the new "reforms" China has been studying and recently implementing, was the huge migration of the country's population from rural areas to the cities. Health care in those cities was becoming extremely costly for the government to pay for. Bottlenecks and shortages were rampant, and rationing was routine, with mounting bribery and fraud, and a thriving black market.
The government is now congratulating itself for "reforming" the system. Finally everybody, rural or urban, is getting "universal health care".
BUT....
Their so-called "universal" program bears a striking resemblence to what the U.S. had fifty years ago, except for who is "providing" it. Everybody has a government-provided insurance policy - but it has a 1,000-yuan deductible (about $70 US dollars), which is about a month's wages for the average Chinese city-dweller, and far more for farmers and other urban residents. Prices being what they are for domestic consumers in China, most routine procedures cost no more than that, so people seeking medical care usually wind up paying for all of it out of their own pockets.
The next 1,000 yuan in costs, if you're employed by a large (and govt-controlled) company, is matched by your employer, so you essentially get a 50% co-payment for costs beyond the first 1,000 yuan. If your company isn't large (as most people's companies aren't), they don't match it, so you wind up paying 100% of the second 1,000 yuan also. There goes another month's (or more) wages, straight out of your own pocket.
And once you've paid for all that out of pocket, for the rest of your medical costs for that sickness or injury, the govt insurance pays for 90% while you pay 10%. Relatively few people incur medical conditions that require such complex, expensive medical procedures, but when they do, the government "helps" them.
So, with the highly-touted "reform" the govt is putting in place, government has changed from its old levels of assistance (no help for the majority of Chinese who live outside large cities, but virtually 100% payment for the small percentage who used to live in the cities) to new levels (no help for anyone, except the relatively few who get very seriously sick or injured).
In other words, after long experience, China has shied away from its former genuine "free universal health care" for city dwellers, now that city populations are exploding. In its place, the have implemented a policy very similar to American "Major Medical", where the private citizen pays virtually all his own medical costs except for the occasional very complex and costly major procedures. The only difference is, the Government is the provider of this Major Medical policy, instead of private insurance companies as in America.
Bottom line: China has found genuine "Universal Health Care" (where a single payer pays for ALL medical procedures large and small, all medicines, hospital rooms, doctor fees and everything else) to be completely unworkable, with costs going through the roof, shortages crippling the system, and mounting rationing and fraud creating huge black markets that make criminals out of people who only wanted normal medical care. And they have done away with that system completely.
In its place, they have set up the system that the U.S. had for years, before all the talk of socialized medicine began, medical costs were driven by people looking for the best care at lowest cost for themselves and their families, and insurance had a sound, rational basis.
Somehow I don't think these facts will be printed anytime soon in the flowery publications the Chinese government is putting out about its wonderful "reforms". And they certainly won't be printed in the U.S. mainstream press.
But get a Chinese citizen (or former citizen), bring them to a place far from the Chinese government's attentive ear, and ask them what's really going on, and how the new "reforms" in that country affect him and his family.
You'll get an earful... of truth, for a change.