Across the world, universal healthcare is in poor health

October 29, 2013

Most Europeans don’t understand the U.S. healthcare debate. They don’t understand it because the opposition to it, and its breadth and depth, runs so counter to the experience of almost every European born since World War Two. It’s an experience so deep, so vigorously underpinned by government action and social teaching, that it has become a moral credo. They think healthcare is and should be a public provision. Most Americans don’t seem to.

The Europeans, who think of their unions as stubborn defenders of public provisions, don’t understand why a bunch of U.S. union leaders have come out against some of Obamacare’s central elements, arguing in a letter that it will “shatter not only our hard-earned health benefits, but destroy the foundation of the 40 hour work week that is the backbone of the American middle class.” (They worry that the thresholds for employers to provide health insurance will mean employers shift full-time employees to part-time work.)

The Europeans also don’t understand the visceral opposition of the right to the proposed system. Harvard economist and Obama advisor David Cutler looked at Mitt Romney’s 2012 campaign and said, “Never before in history has a candidate run for president with the idea that too many people have insurance coverage.” Yet Romney got a respectable vote. To oppose universal healthcare in Europe would be to guarantee instant political oblivion.

West European states have cradle-to-grave medical care for all of their citizens — and the residents of all the West European states go to their graves, on average, later than Americans, even if only by a year or two. This isn’t a direct measure of the quality of the medical care, and there’s a sizable debate about the connection between life expectancy and quality of healthcare. But Europeans believe in it, because they see it as a crutch in their sicker old age and believe that the U.S. system is heartless to the poor. In every West European country socialized medicine has become a matter of sentimental attachment as well as practical assistance. (Remember London’s tribute to the National Health Service during the Olympics?)

Now, though, that belief in socialized medicine is under strain, for the health services of the rich European states are in various kinds of “crisis.” I put the word in quotation marks because healthcare is ritually said by journalists to be in crisis: it’s the word that cries wolf. But this time there is a wolf.

In Italy, the UK, Spain and France, cuts of varying depths are now being introduced. In France, where the health system is usually seen as the best, the budget is exceded by billions of euros every year: the head of the association of French pharmacies says the system cannot survive more than six years without deep reform. In the UK, the new director of the Care Quality Commission that oversees standards, said after his appointment earlier this year that “the system is on the brink of collapse.”

The more socialized the U.S. system becomes, the more it will find itself facing the same dilemmas as the Europeans’. These dilemmas are all symptoms of the way we live now.

In nearly every country, people live longer than they once did. And in most countries, women give birth to fewer kids. In 2000, around 16 percent of Germany and the UK’s population was over 65 in 2000, while the U.S. had only 12.7 percent. But in the U.S., the proportion of over-65’s will increase to near 20 percent of the population in 2050, and over 80’s to around 8 percent. The UK will have over 20 percent of 65-plus citizens by 2050. Germany will have around 30 percent of 65-and-up by 2050; it will have around 15 percent of its population in their 80s.

So there will be fewer economically active taxpayers in North America and Europe while there’s a greater need for taxes to pay for socialized medical care.

Most of these older people will be healthier than previous aging generations and they may get relief from illnesses that others didn’t. Many fewer will smoke, because anti-smoking campaigns have meant that the diseases associated with smoking are down: the proportion of smoking Europeans is under 25 percent.

But they’re also likely to be fatter and some will be obese: within Europe the UK and Germany tend to lead in the obesity stakes, but France and even Italy, with its Mediterranean diet, are coming up fast. More will be prone to terrible degenerative diseases, of which Alzheimer’s is the most common — and most costly, at around $100 billion a year in the U.S.

Obamacare puts the U.S. closer to the Europeans in its generous universality, and closer to the Europeans’ budget problems. Behind the mendacious claim that the Affordable Care Act would create state-appointed “Death Panels” lurks the germ of an insight. Once medicine is paid by tax revenue, health becomes one of the government’s central concerns. It has little choice but to intervene directly to try to stop people’s bad habits that land them in the hospital. Governments have pressed harder and harder on smokers, and it’s working, if slowly. But if, for example, the obesity trends continue, the specter of Fat Panels may swim into view.

Making, and keeping, citizens of all income levels healthy is the biggest welfare challenge for the early 2000s. Socialized medicine always had a moral hazard tucked inside it: the healthy citizens subsidize the smokers, the drinkers, the food bingers, and the drug takers who occupy the emergency rooms every night.

Warnings of collapse now come often, with too much authority behind them to be dismissed. The creation of a system of medical services that is available free for everyone is a fine thing for a country to do for its citizens: but it needs citizens who won’t overload it by letting their appetites off the leash — for then everyone suffers.

PHOTO: Janet Perez (R) oversees specialists (top) as they help callers and potential customers find health insurance at a customer contact and call center for HealthSource RI, Rhode Island’s health insurance exchange program for the Affordable Care Act or “ObamaCare,” in Providence, Rhode Island October 25, 2013.  REUTERS/Brian Snyder


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an even better reason for our version to be crammed down our throats.

Posted by Chazz | Report as abusive

What absolute drivel. Did Mr. Lloyd even do any research on this, or is he just being intentionally misleading?

First of all, contrary to the conventional wisdom, people who smoke and are obese end up spending LESS on health care over the long run compared to individuals with healthy lifestyles.

You can find a multitude of sources by googling “lifetime healthcare costs of healthy individuals compared to obese”. Here are some sources that I found through a simple google search that Mr. Lloyd did not bother to do: 8/02/080204212858.htm  :doi/10.1371/journal.pmed.0050029

Here is a quote from the conclusion of the PLOS Medicine published study:

“Although effective obesity prevention leads to a decrease in costs of obesity-related diseases, this decrease is offset by cost increases due to diseases unrelated to obesity in life-years gained. Obesity prevention may be an important and cost-effective way of improving public health, but it is not a cure for increasing health expenditures.”

So, in a socialized system it is actually the unhealthy who are subsidizing the healthy! I suppose now Mr. Lloyd would argue that the government would now have a perverse interest in encouraging drinking soda and eating fast food… of course it would be an extremely silly argument, but what does that matter right?

P.S. DEATH PANELS!!!11!!!1!1111

Posted by S04kr4t3s | Report as abusive

It is because the economic system is obsolete. It is based on a pyramid not on modern tax based system. In the future The west will have to become more intune to advanced technology and robotics. Plus it will have to limit any immigration of those who have no money or outstanding skills.

Posted by vxx | Report as abusive

Good article. Balanced, not biased. That’s not often seen in journalism anymore.

Posted by tmc | Report as abusive

The facts presented here, independent of opinion or speculation, validate several positions I put forth whenever appropriate.

1. The Bozos who habitually run down the United States for not having adopted socialized medicine long ago never admit that their countries are financially strained to the breaking point by systems that can not offer the cutting edge medicine available in the U.S. or the most modern medical technology.

Their people wait longer to see a doctor, longer for meaningful treatment for serious illnesses such as cancer…to the pint that more die awaiting treatment or as a result of treatment too long delayed. Neither situation can change, for that would increase costs.

2. The U.S. has long been shooting itself in the foot by GIVING medical care without co-pays to our indigent that hard working Americans can not access via Medicaid via ANY insurance they can afford. In fact, many are loosing the insurance they had before Obamacare because their employers are changing or eliminating such “optional” coverage. Healthy workers must earn the wages from which the taxes come to support our “system”.

2. Today leaders of BOTH major parties, who KNOW America is broke, stand together in rolling the welcome wagon out for up to 20 million illegal alien wetbacks from Mexico and south. There are “professional” in their communities who assist those interested how to get fraudulent Green Cards, Social Security Cards, Drivers Licenses, vehicle inspection stickers and auto insurance documentation.

There is NO incentive to limit unnecessary Medicaid visits to doctors for these people and their children, who overrun Emergency rooms and clinics nationwide. They also bring into this country diseases that have been eradicated here for decades.

The result is that working Americans can’t get in to see their doctor when they get sick. If they’re lucky, they can get a prescription called in for relief. That’s neither progress nor is logical priorities.

Posted by OneOfTheSheep | Report as abusive

Unless you plan to shoot yourself when get serious sickness or are rich, you will need universal health care or at lest regulations that say you do not pay more than the healthy. If your employer has pay more for your insurance expect lose your job to be less stable. If are unemployable due to high premiums or the direct effect of an illness, how are you going pay for health care.

Also unless you much about medical care and know what sickness you will get, how are you going judge a plan.

Posted by Samrch | Report as abusive

The plain fact is medicine and health care are for the sick. Without a universal plan, the sick cannot pay because they either cannot work or have too high a premium for an employer to pay.

Posted by Samrch | Report as abusive

Besides self interest, you will find large portion of Jews and Christians who feel and learned that if you have more than enough food to be healthy, you are not allowed to let other starve. Such is various religious writings. By extension since sick need medicine as much as food, if you are not in danger of starving you cannot let the sick die of lack of health care. Of cause that does not mean every crackpot treatment should be bankrolled.

Therefore, expect some support by religious left for universal health care. A few stories of sob stories in the press will mobilize them. As a result many cities and states have some sort of medical for for the poor even before Medicaid. Without Obama-care expect a heaver bill for them to be paid for by the tax payer.

The religious or moral left says the taxpayer will be their brother’s keeper. The religious right and the anarchists say that is stealing from them.

Posted by Samrch | Report as abusive

When you boil it all down, for a single payer system to be sustainable the state must control health costs by micromanaging and/or social engineering your lifestyle choices and balancing out the rest with rationed care. If your idea of citizenship is lobbying politicians for certain medical treatments or exemptions from random nanny-state laws and regulations, so be it. But, there’s about 50% of the country that’s going to fight it all the way to the hilt because that’s positively un-American.

Posted by RJWagner | Report as abusive

Many of the young working people in the Scandinavian countries, acknowledge that the safety nets offered to today’s elderly are not financially sustainable and will not be available at the same levels going forward. And, they are not happy about it. They will reach the point where rationing services is the only alternative, as aging populations consume services disproportionate to their numbers. This is the same issue our young people are decrying relative to social security and medicare, and now ACA.

Should the U.S. reduce its defense commitments on the European continent and elsewhere (e.g.Japan, Korea) as proposed, those countries will have to either move resources into the national defense sector or do without. Transferring additional resources to national defense will mean fewer resources for social programs (healthcare, education, retirement, etc.) Those will be difficult choices, but they still will have to be made.

At that point the conversation will move towards “do older people have an obligation to die?”

Posted by COindependent | Report as abusive