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