U.S. Health Care Situation Isn’t Unique
We can learn much from the successes and failures of other countries to help us develop a better health care system.
Gregory L. Weiss is a medical sociologist who lives in Salem.
Whatever our positions on health care reform, perhaps we might agree that some of the discussion about it has been profoundly disappointing. Frequently, conversations have included misrepresentations of the U.S. and other health care systems; statements made with extreme authority although they are contradicted by substantial, objective research; and attempts to find luring — although inaccurate — sound bites (such as “socialized medicine” and “death panels” and “government takeover of health care”) to incite masses of people.
Groups as wide-ranging as the American Medical Association, the AAEP and Consumer Reports magazine have all published lists of the most significant lies or myths being propagated by opponents of significant health care reform.
One such myth is that we are too different as a nation to learn from the health care experiences of other countries. In fact, there is much we can learn from the successes and failures of others to help us develop a more affordable, efficient and just health care system.
What can we learn? First, every developed country has faced the same set of difficult circumstances that we now face: rapidly increasing and intolerable health care costs, an inability of many to access medical care, and questions about the optimal degree of autonomy versus regulation for patients and medical providers. Every other developed country has acknowledged the problems and significantly reformed its health care system.
Second, every other developed country has determined that health care is a basic right. Ask yourself this: What do the following nations have in common?
Argentina, Austria, Australia, Belgium, Brazil, Canada, Chile, China, Cuba, Denmark, England, Finland, France, Germany, Greece, Iceland, Ireland, Israel, Italy, Japan, Kuwait, Malaysia, Netherlands, New Zealand, Norway, Panama, Peru, Portugal, Romania, Russia, Scotland, South Africa, Spain, Sweden, Switzerland, South Korea, Sri Lanka and Taiwan.
The answer: All of these countries and dozens more have declared health care to be a basic right, and all offer universal health care. The U.S. is the only developed country that has not made such a declaration and does not offer universal care.
In these countries, no one goes without needed medical care due to a lack of financial resources, no one declares bankruptcy due to medical bills (more than half of all U.S. bankruptcies are due to medical bills), and no one dies prematurely because medical care could not be afforded (an estimated 25 percent of the uninsured in the U.S. die prematurely).
Third, countries have developed a wide range of health care systems. A few countries have found socialized medicine (universal coverage provided by the government, which fully owns and operates the health care system) to be ideal.
England, Spain and the Scandinavian countries have single-payer, publicly funded systems with a high degree of government involvement. Canada and Taiwan have single-payer systems, but services are delivered by private providers. Germany, France and Japan require the purchase of health insurance from a variety of publicly regulated, nonprofit plans or from a private plan, but the government pays a portion of the costs based on income.
Fourth, the U.S. is the only developed country in the world to emphasize profit within the health care system. We spend much more on administrative overhead than any other country. (If the U.S. spent the same percentage of its “health care dollars” on overhead as does Canada, we would save $350 billion dollars per year.)
We have the highest rate of medical malpractice suits and defensive medicine in the world. Billions of dollars are lost annually to medical fraud. Every other developed country has configured its health care system in such a way to maximize the number of health care dollars that actually go to health care rather than to investor profit, administrative overhead, defensive medicine and medical fraud.
Fifth, no country has created a perfect health care system. An obvious example is the oft-reported pattern that patients in other countries must wait longer for medical services. But, consider the following:
n While the data differ from country to country, generally, patients in other countries not only do not wait longer for primary care, they get appointments more quickly than we do in the U.S.
n Patients in many of these countries do wait longer for certain diagnostic procedures and elective surgeries. In some cases the extra wait is minimal, and in some cases much longer. This is largely due to an under-investment in expensive high-technology equipment and procedures as a way to limit overall medical costs.
n But, most countries spend half or less as much of their GDP on health care as does the U.S. Given the high percentage of the GDP the U.S. spends on health care, we have demonstrated a willingness to spend more on these technologies so as to minimize patient wait times. This is exactly what several other countries are starting to do.
Finally, around the world, health care systems with universal coverage are enormously popular among people of all political viewpoints. When people in Canada are asked, an overwhelming percentage prefer their system to ours. When people in the U.S. are asked, a majority prefer the Canadian model.
The perception that other countries really admire the U.S. health care system is contradicted by every imaginable source of data. When elected, even very conservative leaders in other countries do not attempt to eliminate universal coverage.
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