Where the healthcare debate seems bizarre

July 22, 2009


global_post_logoMichael Goldfarb serves as a GlobalPost correspondent in the United Kingdom, where this article first appeared.

In America, the health care debate is about to come to a boil. President Barack Obama has put pressure on both houses of Congress to pass versions of his flagship domestic legislative program prior to their August recess.

Good luck.

Opponents are filling the airwaves with the usual litany of lies, damned lies and statistics about socialized medicine and the twin nightmare of bureaucratically rationed health care and high taxes amongst allies like Britain, France and Germany. So here is a brief overview of health care in some of Europe’s biggest economies: Britain’s National Health Service is paid for out of a social security tax. Services are free at the point of provision. No co-pay, no reimbursement. The budget last year was 90 billion pounds (about $148 billion). That makes the average cost per person about 1,500 pounds ($2,463).

The NHS is big — huge, in fact. With 1.5 million employees it is one of the largest employers in the world. Only China’s People’s Liberation Army, India’s state railways and good old Wal-Mart employ more folks. Sixty percent of the NHS budget goes toward salaries.

The French system is run on a compulsory purchase of insurance through the workplace. The insurance cost is based on how much a worker earns. Low-income workers pay nothing. The average contribution per person is about $4,000. The government sets fees for services and negotiates the price of drugs with pharmaceutical companies. (See related GlobalPost story “Why French doctors still make house calls.”)

Service is not free at the point of provision. But reimbursement for costs is swift and in the case of catastrophic illness all fees are waived. People are free to purchase supplementary insurance from private companies.

With a compulsory insurance plan, as in France, German care is universal and equitable. Germans pay approximately 14.3 percent of their earnings to buy this insurance. As in France, people are free to buy supplementary private health insurance. Each system is unique (as are all the systems around Europe) but they have two things in common that make them different from the United States: Coverage is universal and the cost of care as a percentage of GDP is significantly less.

For Europeans — even those who would label themselves conservatives — American attitudes to setting up a universal health care system with strong state participation and management seem bizarre. The peace of mind that comes from knowing that in an emergency you will be taken care of and you won’t be financially ruined has no price. Why resist it?

Beccy Ashton, policy adviser at health care think tank The King’s Fund, worked for more than half a decade in the U.S. She explains the difference this way: “In Europe healthcare is regarded as a human right. In America, people think of it as a commodity that you buy.” If you look at how the Big Three’s health systems came into being you realize changing American attitudes may be difficult.

Britain and France created their systems out of the rubble of World War II. Pushed from below, the leaders of both nations sought to bring greater social equality to their societies. Social security systems were set up with equal access to health care given pride of place.

This wasn’t done without facing down doctors and insurance companies, but politicians are never so bold as when the public will for something is clear. In 1945 in both Britain and France, there was no going back to the status quo before the war started. Germany’s system has the weight of history behind it. Its origins can be traced back to the first era of German unification when Chancellor Otto von Bismarck created the First Reich. In the 1880s he set up a system of compulsory health insurance by workers and employers and other forms of social security. He did not invent the system out of nothing. There had been a tradition among the German guilds going back to the Middle Ages of members making compulsory contributions to help their brothers in old age or if a colleague had to stop working because of injury.

Clearly, America at this moment in time has not recently experienced an epoch-shattering historical event like a World War and despite Obama’s comparative popularity, he doesn’t have the clout of an Iron Chancellor to simply decree what he wants and know that Congress will rubber stamp it.
Beccy Ashton points out, “The President must be aware of the fine line he has to walk. If he goes forward with a radical agenda, he knows you’ve lost before you’ve started.”

So people in Europe continue to watch with bemusement as American legislators grapple with reforming a system that basically needs to be junked. Professionals like Ashton answer calls from reporters and try to refute right-wing misinformation that floats around the debate. Those damned lies and statistics.

The only statistics on health care systems that really matter are life expectancy and infant mortality. Both speak to accessibility and affordability. If you want to know how the U.S., the wealthiest nation on earth, stacks up, here you go:

In life expectancy, the U.S. ranks 38th or 45th depending on whether one uses the United Nation’s statistics or those compiled by the CIA. (In both cases, life expectancy in Cuba is higher!) According to the CIA World Factbook, the U.S. has many more infant deaths than its EU counterparts or northern socialist (to right-wing ideologues) neighbor, Canada. While the U.S. has 6.26 deaths per live births, Canada had 5.04. Britain, France and Germany? 4.85, 3.33 and 3.99, respectively.

Other health links from GlobalPost:

Winter in the time of swine flu

Coming home from school with strawberry condoms

(Pictured above: Healthcare reform supporters rally outside U.S. Senator Sam Brownback’s office in Overland Park, Kansas, July 9, 2009. REUTERS/Carey Gillam)


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“The NHS is big — huge, in fact. With 1.5 million employees it is one of the largest employers in the world. Only China’s People’s Liberation Army, India’s state railways and good old Wal-Mart employ more folks. Sixty percent of the NHS budget goes toward salaries.”

And here is where your bizarre argument falls flat on it’s face. It’s not the purpose of government to be an employer. It is also not the purpose of the government to decide what level of care I receive, how much I pay for it, or how long I need to wait to receive said care.

Only those with the complete and total inability to understand the purpose of liberty and the free market would waste time making arguments for nationalized programs and, in the same breath, claim that it will not impact the free market.

It is also quite obvious that you do not keep up on current news or you would know that our liberal thieves in government are floating yet another tax on a single group of citizens to help for their “reform”.

You sir, are the one spreading damned lies.

Posted by Rick | Report as abusive

Since the countries you mention are comparable to large states with the US, how do each individual state in this country rank against countries with socialized medicine? Combining data from states with poor social services (TN, WV, MS, AL, LA & AR) with data from states with better services (CA, NY, MA & WA) tells me nothing. Also are benefits interchangable in different countries like they would be in different states? If I am on holiday (or work) in another country, I should be able to receive the same services I do in my home country. Would we have such agreements with Canada and Mexico to cover non-citizens?

Posted by Scott Hess | Report as abusive

As an American, I can provide two huge examples of why people in the US resist universal health care.

One is that somehow, the public has been convinced that the current system gives people great freedom and choice relating to their healthcare. In actuality, health insurance companies often drive coverage. A friend had his galbladder removed and his insurance company refused to pay for it because it was not percieved as a formally diagnosed condition. On a personal note, I was bitten by a cat once, and my insurance company initially refused to pay for my anitbiotic shot because it was considered an unnecessary immunization. I had to virtually throw a fit for the insurance co. to agree to reimburse me. The doctor who performed the galbladder surgery for the friend agreed to personally fight with the insurance company for reimbursement. Insurance companies call the shots. You have the freedom to obtain any treatment you want, but your insurance company may choose not to pay for it, thus having the effect of limiting your healthcare options.

The second issue is that when it comes to any question of taxes in the US, Americans are extremely selfish and would rather keep money in their pocket than give some of it up in order to serve the greater good. Our schools stink because of this attitude. Our roads are often filled with holes. A heavily traveled bridge in Minnesota actually collapsed last year. Yet, if you asked the average American if they would be willing to pay higher taxes for better schools, smoother roads or safer bridges and the answer would be “hell no”.

Damned Lies [Goldfarb],
Your statistics are correct, but incomplete. Please keep in mind our healthcare is actually better age from 30 to end of life by several measures. Why? I would like to understand that better before I sign off on a bill.

Additionally, we are a nation of obese people. 60% of health care problems are behavioral [diet and excercise], but I see nothing addressed in these bills or your discussion. Without addressing this, our costs as a % of GDP will be higher.

Furthermore, end of life health care options will change. It will be rationed. Obama is avoiding the term, but it is unavoidable. I would like to know the details. The New York Times had an article on it that left me unsettled.

I am hoping that both sides [including you!] can quit throwing mud without addressing real issues that are unique to America.

Well, I can wish in one hand and …. in the other, and see which one gets filled first, something like that.

Chicago IL

Posted by Anthony | Report as abusive

Thank you Michael Goldfarb for your excellent description of the health care system in the U.S.(i.e., needes to be “junked.”

Alan Goldfarb (no relation).

Funny you mention damned lies and statistics, then bring up infant mortality rates. Infant mortality rates are computed under different and more generous criteria in other countries- if an infant is under 500 grams, many countries do not count it as a live birth-the US does. In some countries, if an infant is alive for less than 24 hours, it is counted as a stillbirth- the US accounts for this as a mortality.

And the quality of a country’s healthcare system is only a correlate with life expectancy. America has some of the fattest, laziest people on the planet. No amount of doctoring or care can reverse the terrible lifestyle choices Americans make for themselves everyday.

The only reason why Europeans can afford treatment is because medical and drug companies were able to deploy it profitably to Americans first. Good luck seeing medical breakthroughs when America is paying drug companies a pittance for treatment.

Posted by Charles Mcguy | Report as abusive

Winge and whine all you want but my own anecdotal evidence suggests government has been involved for years, and if there was a single payor my insurance would not get ripped off when I need service out of state, my doctor officing in the hospital where I have my lab work would not operate record keeping separate from the hospital, and every time I see someone new I wouldn’t have to create my medical record from scratch. Better yet, Healthcare would no longer be a bargaineing chip in union negotiations. My wifes employer is trying to delete spousal coverage. The state often dictates how many beds can be alocated to the hospitals in the state. I was referred to a surgeon for a hip replacement 3/25/05 and couldn’t get in for a first contact until 6/20/05. Don’t even try to scare me with that rationing BS. Some people. They’ll say anything, especially if it might open the door to dissention division and defeat of our Presidents initiative. Trust me, I wont give up on single payer. Social Security might be a good vehicle, and by the way, if we cut employer contributions to half of what they are now and extend employee contributions to the full extent of income no one will even notice (enough to hurt) and we would fund that liability for ever. Run the numbers.

Posted by DanO | Report as abusive

I am a “Northern Socialist” a.k.a. Canadian, although for a Canadian I lean towards a more capitalist outlook, most Canadians would consider me a conservative monster for advocating a “two-tiered healthcare system” (universal healthcare supplemented by any form of optional healthcare). While I am generally leery of government intervention, and we must keep in mind that nothing is free, anything provided by the government is paid for by the taxpayers. We the people pay for everything, because there is no one else here (corporations are useful, but, fictional entities owned by real people).

Neither side should complain about the other side using statistics (misusing on the other hand…), in fact statistics are one of the only tools available for making a decision rationally on this subject. And in this case the facts speak for themselves. The average US citizen pays far more money to get far less quality healthcare, as compared to the average Canadian citizen. This is including the contributions from the government (taxpayer). I have taken many economics courses (getting top marks in most), and I am well aware that government intervention rarely gets better results than the market left to its own devices. But, in THIS case the evidence is overwhelming that the Canadian system provides far better quality care, for a far lower cost to society as a whole (the European systems do too from what I’ve read). While it is true that in theory the “rich” CAN pay more and get better quality care, in practice even most “rich” Americans DO pay much more and STILL get lower quality service than “poor” Canadians (many studies have shown this).

The bottom line is clear: the vast majority of Americans would be better off both financially and health wise with a universal healthcare system. Anyone who would want to pay more and get less, just to ensure that they do not pay one cent to help any of the “undeserving” poor, should probably examine their motives, moral character, and claim to rationality. “It’s not the purpose of government to be an employer”, absolutely true, but it IS the purpose of the government to try to safeguard and improve the well being of its citizens. I am all for small government and the free market, because they usually do lead to the greatest good for the greatest number, but I don’t think that we should blindly adhere to this principle even when it is plainly obvious that in THIS case the greatest good for the greatest number lies elsewhere.

Conservatives can talk about liberty if they must but the question remains: why do they want the vast majority of Americans to be worse off? This includes the vast majority of conservatives. The Canadian healthcare system is not perfect, but it is abundantly clear that the Canadian system stands head and shoulders above the American healthcare system.

Posted by Jon_Sociologist | Report as abusive

I don’t deny that US healthcare is extremely inefficient. But you’re making a mistake when comparing overall spending with Europe. The state-funded systems there also have their massive inefficiencies. But they are from another source.

What you haven’t taken account of is that government spending is “more expensive” than private spending. Additional government spending requires an increase in the tax rate which reduces GDP by altering incentives. Christy Romer estimated that a tax rise resulting in a $1 increase in revenue reduces GDP by $3.

My take is that what is firstly regulatory changes that result in competitive healthcare provision and secondly “product diversification”: there needs to be rationing of healthcare at different levels at different prices. Then you can avoid the US problem of too-costly healthcare and the European problem of everyone being treated at the same level and funded completely by tax. You can have a moderate level of subsidization, not 100%.

Posted by CSMR | Report as abusive

Ninety Five Percent (here is another statistic) of all Americans’ health care issues are directly related to lifestyle choices. We have bought the lies that the FDA and AMA have pushed. The ‘food pyramid’ is wrong. High fructose corn syrup is not ‘natural’. Carbonated beverages destroy you joints. This is about money, not health. If you want health, grow your own food…the exercise will do you good.

Posted by Jim | Report as abusive

I work for a defense contractor, and have for 23 yrs.
Anyone who thinks they want the government to have any more influence on healthcare has their head up their arse, real deep!

Posted by wa | Report as abusive

Just look at it this way:

CURRENT HEALTH SYSTEM: you pay and you pay, it all goes to the pockets of insurance companies shareholders. You might be drop out if you are too expensive.

EUROPEAN STYLE HEALTH SYSTEM: You pay and You pay, maybe a bit more, and it goes to a pool, where you can pick it up any time. It will not go to shareholders”s pockets BUT to an old lady unable to pay, or a cancer patient.

Think, where would you rather put your money??

Posted by Miguel | Report as abusive

My father has socialized medicine. No not Canadian, American. He is over 65. He loves it. Could he get health insurance at 79 years old? NO. It is not profitable. Sorry dad. Health care is only for the healthy.

We are not talking about getting you car fixed. We may be talking about your child’s sight or ability to walk.
I have had Cigna thru my employer and they denied every claim until I fought with them. The insurance co deices what care I get not my Dr.
Sorry not everyone can have access to health care.
NO Sorry not every CEO can have a Rolls etc…

(Cut and paste from Forbes.com)
H Edward Hanway
Total Compensation
$28.82 mil (#35)

5-Year Compensation Total
$78.31 mil

H Edward Hanway has been CEO of Cigna (CI) for 6 years. Mr. Hanway has been with the company for 28 years .The 54 year old executive ranks 3 within Health care equipment & services

All what they say about the healthcare system is a bunch of lies. I lived in Canada, had two children and did not have to pay anything. A small premium was deducted called OHIP to pay for the healthcare when I was working. but when I stopped working I still got healthcare but did not have to pay. Here in the US when you stopped working everything goes to the dogs. You have to sell your soul to pay for anything healthrelated. Did anybody find out whether these people in Congress get life time healthcare even if they do not serve in the congress anymore. As long as they get a free ride they do not know what a common man has to undergo. Just like they receive whopping pensions, even when they go to prison, unlike us who even after working 30 years do not have anything called pension.

Posted by rangini | Report as abusive

Rick and Charles,

Yeah, right, lads, and George W. is a good ol’ boy from Texas. That’s sarcasm, by the way: George is actually a nasty piece of work from Greenwich, CT. (I used to live a few miles down the road from the Shrubs). In other words, you people will believe anything.

Posted by Eibhear | Report as abusive

Unlike the author of this piece, I have been following the actual legislation that has been proposed. In short, the legislation would cost me personally in excess of $80,000 per year more than I currently pay for my family. That is outrageous and unfair. That is reason enough for me to oppose the plan as written.

Secondly, the rationing of health care in Britain is not a myth or a lie. It is a fact. My father’s cousin’s daughter died in her early twenties a couple of years ago because the National Health Service refused to treat her condition. Treatments for her condition in the U.S. were available, but in the U.K, they wouldn’t treat her! By the time my family found out about it, the poor girl had been bravely fighting the NHS for a couple of years. We started raising funds to give her private care, but the U.K. government wanted to tax the funds! Before we could fight our way through the bureaucracy, she had died. As far as I am concerned, “national health care” murdered that poor girl. And, that is a fact.

Posted by Joe | Report as abusive

The health care system in the United States is fine. The argument for the government sponsored plan rests on the assumption that poor people don’t get health services in this country… which is completely false. Every hospital I know of offers a plan to make services affordable for the working poor, a group to which I belong. I do not have health INSURANCE, but I do get medical care.

The people I have spoken with who are resisting Mr. Obama’s plan are doing so because, in a word, it is UNFAIR and because Mr. Obama, within the first year of his tenure, already has an enormous credibility problem.

We have had detrimental legislation hastily shoved down our throats this year… and we are choking on it.

Posted by Eljay | Report as abusive

I feel sorry for the people of America.

As the richest country in the world it rates at 72nd from 191 countries for Overall Level of Health according to the World Heath Organisation.

For context: Colombia, Chile, Costa Rica and Cuba are rated 22nd, 33rd, 36th and 39th respectively.

The Free-market system is obviously a roaring success.

That Europeans look at the US debate on healthcare reform with bemusement is interesting, but not all important or relevant. That’s like us Midwesterners opining that Europe’s abandonment of its Christian foundation is a source of bemusement. “So what?”, Europeans would say. I think most Americans would agree that the scale of the federal government and its increasingly grand claim on Americans’ lives is a cause of great concern. With specific regard for healthcare reform, the singular element of the Obama administration’s plan is a tax-subsidized insurance plan that would compete with private plans. (And let’s not forget that the proposed plan would mandate coverage of elective abortions and require private plans to do so, as well.) US States that border Canada have hospitals full of Canadians who, despite their wonderful single payer plan, come to the US for surgery. So, while we’re glad Europeans are deriving some amusement by this, we’re not impressed by Europeans’ blithe attitude toward the loss of their liberty and their lack of understanding of the great issues at stake.

Posted by Mike in Indianapolis | Report as abusive

The United States became the strongest, greatest country on Earth due primarly to capitalism!

Perhaps we are not yet ready to become just another wimpy socialist nation.