On the Envy of Other Nations’ Health Systems (And of Obamacare)

Young man, there is America-  which at this day serves as little more than to amuse you with stories of savage men and uncouth manners; yet shall, before you taste of death, show itself equal of the whole of that commerce which now attracts the envy of the world.

Edmund Burke (1729-1797),  Irish statesman and member of English House of Commons

We believe that envy has an appropriate place in health policy, if in this case means health systems struggling to address specific weaknesses by identifying strengths in other systems that they could emulate… More bottom-up flexibility in England and more to-down regional strategies  for the United States would represent progress.

Nick Seddon and Thomas Lee, “ A Strategy for Reform,” New England Journal of Medicine,  June 13, 2013, Reform London and Partners Healthcare System and Harvard Medical School
 

Creating a high-performing health system entails challenges athat are being addressed by other countries.   Incorporation of international evidence-based policy initiatives migh enhance U.S. cost containment efforts.   Germany's bundled payments and Japan's payment adjustments are two of the many options that are tranferable and relevant to the U.S. context.

Gerald Anderson, Amber Willink, and Robin Osborn,  "Reevaluating 'Made in America- Two Cost Containment Ideas from Abroad, " New Englad Journal of Medicine,  June 13, 2013, Commomnwealth Fund and Bloomberg School of Public Health

The Swedish system performs superbly, and my Swedish colleagues cited evidence of that fact with obvious pride. The United States spends more than $8,000 per person on heatlh care , well more than twice what Sweden spends.  Yet health outcomes are far better in Sweden in virtually every dimension.

Robert Frank, economics professor at Cornell, “What Sweden Can Tell Us about Obamacare,” New York Times, June 16, 2013

What will happen, if in the end, Obamacare really works? Of course, you can expect scare stories and Fox News alerts abut higher premiums.  These anecdotes will focus on young health people with no coverage who will have to join the rest of the country in the insurance pool, or pay a fine.  Some employers will also choose to pay the government rather than insure their own workers.  It’s a fascinating moment, akin to the dawn of Social Security and Medicare.

Timothy Egan, “Million-Anecdote Baby, “ New York Times,  July 13, 2013

There you have it – a voice from the past, saying the rest of the world would eventually envy America’s economic might and voices from American  progessives, expressing envy over other nations’ health systems for their lower costs and universality.    How to account these points of view?  Could it be America’s entrepreneurial  freedom-loving culture , relatively low level of regulations, and distrust of big government?  Could it be our  relatively low top income tax rates,  39.6%, versus an average of  over 50% in Europe, which has an addition VAT tax of 19% to 25%.  Or could it be that progessives  are right? That comprehensive benefits for all, which will come at higher costs for the young and American businesses, may be the future?

Tweet:  The world envies U.S. prowess and might: The American left envies other nations’ health systems with their lower costs and universal access.