Could Americans benefit by adopting the healthcare financing system of another industrialized nation?
To answer that simple question, all you have to do is factor in advancing medical technology, cultural expectations of patients about who gets access to what care and how quickly, the diverse and changing medical needs of a nation of 300 million, the budgets and laws of the 50 states and the federal government, and the perplexing economics of healthcare -- one of the largest and most complex industries of the 21st century.
In other words, it would be much easier to just keep doing what we’re doing. Still, with our healthcare system putting millions of Americans into financial danger, we have no choice but to consider alternatives.
In the Company of Industrialized Nations, We Are Alone
When it comes to medical care, Americans have a dubious distinction: “Every other industrialized country has national healthcare,” says Jerry Gordon, secretary of Single-Payer Action Network Ohio, an advocacy group for healthcare consumers.
The chief consequence is that about 15 percent of Americans are uninsured, falling through the cracks of a system fragmented among employer-sponsored health insurance plans, individual policies for those who can afford them and government coverage, chiefly Medicare and Medicaid.
But Americans can be proud of many of their healthcare establishment’s achievements. For example, the breast cancer survival rate in the US is higher than that of nearly all other industrialized countries.
On the other hand, US life expectancy is lower. While Americans born in 2003 can expect to live 77.5 years on average, Britons are likely to reach 78.5, the French 79.4, Canadians 79.9 and Japanese 81.8, according to data from the Organisation for Economic Co-operation and Development (OECD).
Healthcare Spending Differences Among Nations Are Stark
These differences in health outcomes are critically important, but the much greater quantitative disparity between the US and other industrialized nations is healthcare spending. In 2004, Britain spent $2,508 per person on healthcare, versus France’s $3,159 and Canada’s $3,165, according to the OECD data. The costs of healthcare per American? A staggering $6,102.
The cost differences may stem in part from structural differences in healthcare financing. When a nation chooses a single-payer system, it can realize great savings, for example, by simplifying administration and eliminating private insurers’ high marketing costs.
But our higher costs aren’t just from the increased administrative overhead associated with countless providers and insurers operating in 50 states, each with its own healthcare laws and regulations. For example, in Canada, which has a single-payer system, lower physician pay helps keep down the total cost of healthcare.
Culture Has Shaped the Evolution of Our Healthcare System
Americans differ from people in other countries in terms of what they’re willing to accept when it comes to healthcare.
“France would have revolted at what Americans rolled over to” by acceding to the restrictions imposed by HMOs and other managed-care systems, says Paul Dutton, associate professor of history at Northern Arizona University and author of Differential Diagnoses: A Comparative History of Health Care Problems and Solutions in the United States and France.
On the other hand, affluent Americans are accustomed to getting what they want, when they want it, whether they’re purchasing consumer goods or medical services. Many observers say that a truly egalitarian, national healthcare system would be perceived by Americans as socialist and would never fly.
Would Expanding the Role of Market Forces Help or Hurt?
Even if the US does eventually adopt a system of universal healthcare, it will probably follow the lead of the many industrialized countries that allow individuals to pay extra for medical services not covered. Of course, many elderly Americans already buy supplementary insurance to fill the gaps left by Medicare.
But this approach can exacerbate the root problem -- rising healthcare costs. In the Netherlands and Switzerland, for example -- two countries that have recently tweaked their systems to allow greater patient choice or to reduce waiting times for in-demand procedures -- costs are rising rapidly.
“The evidence suggests that competition and free markets make prices go up,” says Pauline Rosenau, a professor of management, policy and community health at the University of Texas School of Public Health in Houston.
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