As Americans warm to a national health insurance system, other countries can offer a roadmap
On a recent trip to France, our tour guide was asked to speak about her country’s health care arrangements. Americans hear virtually nothing about France whenever the topic of other countries' health systems comes up. She explained that the high taxes people pay fund not only health care but also college where tuition fees are nominal – around 200 Euros a year.
She then went on to tell us how she once questioned why she had to pay taxes to fund other peoples’ health care. Then her daughter got sick and required expensive medications for two years. “There was no way we could have paid for that,” the guide told the group, adding that she finally understood what her country’s health system was all about. It was about a broad pooling of the risk that makes it possible to cover everyone at a cost far less than we pay in the U.S. She said she would never again complain about her country’s national health system, which is funded by a mix of payroll taxes, general revenues, employer contributions and taxes on alcohol, tobacco and drugs.
I hoped her point was not lost on the other travelers, many of them predisposed to dislike other health care systems and to believe as the guide once did that they shouldn’t have to pay for the care of others. The guide had zoomed in on a common American complaint that I’ve discussed before: Why should a 59-year-old pay for the maternity care needed by a 25-year-old? The answer, of course, is that the risk pooling among the sick and the well, the old and the young, the rich and the poor makes it possible for everyone to get care without all the bureaucratic nonsense, lack of care for too many, and stratospheric costs that characterize the American system.
For me, perhaps, the larger point from the discussion on the tour bus was the realization that we don’t talk much, if at all, about other health systems unless it’s Canada. Most of that commentary disparages the Canadian system and sometimes the British system. But change may be afoot. The public, editorial boards, and even doctors seem to warming to the idea of national health insurance, which would bring the broad risk pools that the French, British, and Canadians realized long ago were necessary.
This week, the New England Journal of Medicine noted a remarkable shift in the public’s attitudes about government involvement in health care. A study by Harvard pollster Robert Blendon found that the percentage of Americans who said it was the responsibility of the federal government to make sure all citizens have health care coverage had increased from 42 percent in 2013 to 60 percent today. The number believing the government has no responsibility dropped from 56 percent to 39 percent over the same period. “When confronted with millions losing coverage, the public became more supportive of the principle that the federal government should ensure coverage for these people,” Blendon told me. “This substantial change likely impacted the outcome of the Senate debate and is likely to be an important factor in the immediate future.”
So why aren’t we talking more about other countries like France or Germany or Japan that have universal systems, generally excellent health stats, cover everyone, and cost less? Why wouldn’t we want to compare ourselves to the gold standard as we do in other endeavors? “Why, because we don’t want to,” says Jeff Lerner, president of ECRI, a health research organization that assesses clinical procedures and drug therapies. “We don’t like the answer,” he said, noting there are many reports showing France and other countries do better than we do.
Since the Clinton administration, politicians and policy makers have repeatedly told us we should not be looking to other countries for inspiration, and they’ve pointed to our “uniquely American” health care system. But that “uniquely American” arrangement with its lack of cost containment, declining health statistics, reliance on private, profit-making insurance companies, and the exclusion of millions from coverage and care faces an uncertain path to sustainability over the long haul.
The time has come to be realistic about American health care. There are thousands of Americans who support a national health care system, but advocates of this kind of system have yet to make a convincing case for what it should look like. Writing for The Nation, Joshua Holland noted that “achieving universal coverage – good coverage not just ‘access’ to emergency room care – is a winnable fight if we sweat the details in a serious way.”
To do that, we need to take a serious look at how our peer countries like France, Germany, and yes, the United Kingdom do it and pluck the best ideas from them. Our guide, for example, told of the generous maternity benefits available to pregnant women and new mothers in France to help babies get a healthy start. The Commonwealth Fund reported earlier this summer that the U.K. excels at patient safety; the Australians at patient engagement. The Netherlands does a much better job at primary care than the U.S., where basic care is still not widely available.
Even that favorite punching bag of American politicians - the much-maligned British National Health Service – has much to recommend. In the Commonwealth survey, the U.K. ranked number one out of 11 countries based on such health dimensions as access to care, equity, the processes of getting care, and administrative efficiency.
The U.S. ranked dead last.
Veteran health care journalist Trudy Lieberman is a contributing editor at the Center for Health Journalism Digital and a regular contributor to the Remaking Health Care blog.