T.R. Reid wrote a brilliant book in 2010 – The Healing of America – A global quest for better, cheaper and fairer health care. He examined industrial democracies around the world and explained their different yet effective health care systems. By a variety of means, they achieve nearly universal coverage and good outcomes. If you don’t have time right now to read a book – albeit an entertaining one –as the health care debate is being discussed in the Supreme Court, here’s a short cut. Fareed Zakaria has written a two page article in the March 26th issue of Time that summarizes many of the issues. The requirement that everyone buy health insurance – called the individual mandate – is at the center of the constitutional controversy. Government subsidies would be given to help those without sufficient funds to buy insurance.
Reid and Zakaria both point out that Switzerland, a business-friendly democracy, had a system like ours 20 years ago, with private insurance and incomplete coverage. People without insurance went to emergency rooms, insurers rejected people with pre-existing conditions, and costs were mounting. The country decided that to make health care work, everyone had to buy insurance. They reformed their system in a way similar to Obama’s proposals. Now, 20 years later, everyone is insured, the quality of care is high, and costs have moderated. I can attest to this, as I visit my sister in Switzerland every year, and have seen her in the hospital there. The care is excellent. Taiwan is another with a free-market economy that decided to create a universal health-care system in the mid 1990’s. It studied all existing models and decided against private insurers, and for a single payer system that is effective and very low cost. ”. The Swiss and Taiwanese found that it is imperative for everyone to be covered by health insurance to keep costs down and provide a system where everyone has basic care.
Reid writes that the Swiss have an ethic of ‘solidarity’ that helps maintain their unity despite having 4 official languages. Solidarity means community and equal treatment. Everyone should have equal access to vote, have a jury trial, an old age pension, a good school system and a good health care system. Some people have much more money than others in their capitalist system of government, but everyone has their basic needs for health care met.
Zakaria writes that we have “the most expensive, least efficient system of any rich country on the planet.” Chronically ill patients , 5% of the population, account for 50% of our health care costs. Their care drives up insurance premiums if they are insured, and federal, state and local health care costs if they lack insurance. Universal coverage would bring healthy people into the system and thereby result in lower average premiums. A downside to Obama’s plan is that it maintains the connection between employment and health care that is inefficient and a burden on American business. It is hard for companies to be competitive globally when they are paying large amounts for their employees and former employees. German, Canadian, Japanese and British companies pay next to nothing in health care costs, in comparison.
I hope our country can edge away from rugged individualism into more solidarity, with passage of universal health care. Stay tuned throughout the week as it is debated at the Supreme Court. E pluribus unum.
Sadja Greenwood, MD, MPH - back issues on the blog