Friday, October 9, 2009

Health Care Systems in the Developed World by T.R. Reid

There are a few common building blocks of health care system architecture that all developed countries (except the United States) have agreed upon. Each country uses one system that applies to everybody. Young, old, employed or unemployed, military or civilian, sick or well, aboriginal or immigrant, private citizen or public minister, newborn or about-to-die- everybody is included in the same system and covered by a single set of rules. All other rich nations have embraced this principle, because they think it's fairer if everybody has the same access to the same level of care. They find that a single system is much easier to administer, with one set of forms to fill out, one book of rules, and one price list.

A unified system is a powerful force for cost control. As the only buyer of medical services, it has enormous market clout in negotiating fees with doctors, hospitals and drug companies, facilitates communication and control within those professions and makes digital record keeping easier and more effective. It also helps to eliminate the gamesmanship and cost-shifting that permeates the American health care ( forcing veterans to use only VA hospitals, charging privately insured patients more to cover the cost of those on Medicaid, overcharging for diagnostic tests to cover shortfalls in other departments, for example). Such systems also create incentives for preventive health measures- such as regular check-ups, health education and use of the most effective treatments as well.

Another basic building block in the health care systems of every country- except the United States- is the principle that financing health care must be a non-profit endeavor. The health insurance plans of all the other nations of the developed world exist only to pay people's medical bills, not to make a profit. Private Insurance companies still exist. In Germany there are at least two-hundred, in Japan over 2,000, but they must accept all applicants and pay all claims. They are allowed to sell for-profit policies to satisfy the cravings and vanities of the very rich for such things as cosmetic surgery and luxury hospital suites, but not for the basic services at fixed prices stipulated on a universal basis in the unified system. Otherwise they compete for customers by offering special services outside the standard plan- like relaxing vacations at health spas, house calls and the like.

All the health care systems of the developing world have problems delivering effective and affordable health care. In the democracies of the developed world, however, universal health care coverage creates a sense of common purpose and solidarity- the expectation of both mutual sacrifice and gain- and a political will to overcome difficulties with long-term strategies- which hardly exists at all in the United States.

By the most careful and rigorous estimates of the esteemed Institute of Medicine, more than 22,000 Americans die each year for the lack of accessible and affordable heath care. At least 700,000 go bankrupt paying their medical bills out of pocket, many losing their homes entirely. This never happens in the other developed nations of the world because they have universal health care systems.

1 comment:

  1. "The Healing of America; A Global Quest For Better, Cheaper, and Fairer Health Care" by T.R. Reid (longtime correspondent for the Washington Post, former chief of its Tokyo and London bureaus); The Penguin Press, 2009.

    Bismark himself was responsible for establishing universal health care in Germany- The Sickness Insurance Law of 1883. HE had many pragmatic reasons to do so. " He introduced social rights to avoid granting wider political rights:" is the way one historian put it, hoping to undermine political support for the Socialists and other left-wing parties of his time. But it also seems that Bismarck was driven by a charitable impulse, perhaps a product of his Lutheran upbringing. When the chancellor first proposed his welfare state to the Reichstag in 1881, he described it as a means for the more fortunate Germans to care for the least of their brethren: "a program of applied Chriantianity".

    Aneurin Nye Bevan, an obstreperous but cunning Welsh coal-miner, was primarily responsible for seeing that the recommendation put out by William Beveridge's Committee on Social and Allied Services were enacted into law, in 1948. A very interesting story here. He once called Winston Churchill's supposedly inspiring radio speeches as "turgid, wordy, dull, prosaic and almost invariably empty". For his part, Churchill dismissed Bevan as a "squalid nuisance".

    Taiwan instituted universal health care in 1994, with the great help of Professor William Hsiao, a health care economist at the Haevard School of Public Health. This was at the same time that the Clinton health Care Initiative went down in flames. Hsiao's famous textbook "Getting Health Reform Right" is required reading among health care officials anywhere on earth who are trying to fix health care in an era of rising costs.

    France is considered by WHO to have the best health care system in the world. Of all the developed nations of the world, the U.S. has the worst though, of course, about nine out of ten Americans think we have the best, at least when responding to some vaguely constructed public opinion poll.

    Naturally, one gets tired of making an argument that few people are even willing to listen to, let alone act upon.