The U.S. has been absorbed by the Supreme Court case this week on the future of health care. But Americans are not alone.
Several European nations, where universal health care has been the norm for decades, have been waging their own intense debates as they also deal with aging populations and rising costs.
Britain passed a new health care measure earlier this month, after more than a year of rancorous debate. Can the European experience cast some light on the American debate over health care?
“There are some common problems,” says British analyst Chris Ham, “but we’re coming to this debate from very different starting points. In the States, it’s about how to extend coverage to more people, whereas [in Britain], it’s about how to get more bang for the buck out of our current system.”
Ham is the chief executive of The King’s Fund, an independent health policy think tank in London.
The British Debate
Britain’s debate is still going on, with critics charging that the Conservative-led government is trying to privatize the more than 60-year-old system in an effort to cut the nation’s budget deficit.
The government says the reforms will trim a bloated health care bureaucracy and give doctors more control over health care management.
Just before the measure finally passed this month, Richard Horton, the editor of the prestigious British medical journal The Lancet, said, “People will die thanks to the government’s decision to focus on competition, rather than quality.”
Britain’s health care system is funded through general taxes, and it provides free health services to residents of the United Kingdom.
As in most countries, the issue is cost. The National Health Service currently costs the U.K. more than $158 billion a year.
Ham says his group agrees that reforms are needed, but believes the process should have been “more evolutionary, not so radical.”
He fears that implementing the new regulations will destabilize the system and distract health care administrators from the real goal of improving health care.
Still, Ham says, most Britons generally like their system, especially as compared with the United States.
“We often cite the fact that you have about 50 million Americans who have no insurance or are under-insured. The biggest cause of bankruptcy [in the U.S.] is health care costs, and we find that very shocking,” Ham says.
France Experienced Bitter Fight
France consistently rates among the best health care systems in the world, and yet it, too, underwent a bitter fight when it adopted revisions in 2009.
The French system is financed by income and payroll taxes, and health insurance is compulsory.
The national insurance plan covers about 70 percent of healthcare costs, and most people use private insurance, obtained through their jobs, to pay the rest.
Residents of France can choose any doctor or specialist they wish.
As in Britain, the French changes were driven by rising costs.
“All health systems face the same challenges,” say Victor Rodwin, an expert on the French system and a professor of health policy at the Wagner School of Public Service at New York University. “You have new technologies, aging populations and more chronic disease. More and more treatments are possible. You have rising demands from consumers and patients to try everything. The question is — when you have universal coverage, is that sustainable?”
Despite the passions that were ignited when the French reforms were first passed, he points out that health issues haven’t been a factor in France’s current presidential campaign.
He says most people in France perceive their coverage as better than both the British and American systems.
“They don’t like the British system because they believe it involves waiting in queues for health care,” Rodwin says. “And when they look at the U.S., they don’t like the idea of 16 percent of the population not being covered. They think that’s socially irresponsible.”
In Germany, Chancellor Angela Merkel’s center-right coalition faced a slump in popularity during the fight that ended with the passage of health care changes in November 2010.
Germany Has Had Multiple Changes
“Health care is an area where no country seems to think they have it right,” says Arthur Daemmrich, a professor at the Harvard Business School. He points out that Germany has had a series of major health care revisions in the past decade.
Daemmrich says some reforms in various countries may be converging toward shared solutions. “More and more countries are putting rules on pharmaceutical pricing,” he says.
“The second area of convergence is to set up formal bodies like [Britain's] National Institute for Health and Clinical Excellence, or NICE, to set policies for reimbursement,” Daemmrich adds.
“In Britain, for example, a new bio-tech drug that extends a person’s life on average one or two months, but costs $25,000, would not be reimbursed,” he says, adding that Germany put a similar measure in place.
Mark McClellan, a former commissioner at the U.S. Food & Drug Administration, says, “The British system and ours are moving in the direction of being focused on the results patients get, and not just on the costs.”
We’re starting from very different points, but moving toward systems that will give physicians more flexibility, but also make them more accountable for costs,” says McClellan, who now heads the Engelberg Center for Health Care Reform at the Brookings Institution.