Healthcare

American or European Style

The Choice is Yours

November 21, 2009

Healthcare reform is everywhere—papers, news magazines, online, on TV, at dinner tables and water coolers. Public option, triggers, opt-out, co-ops, single payer, rationing, government take over and death panels planning to kill grandmas across the country. Congress doing what it does best: bickering, blaming, stonewalling, grandstanding, making deals, pandering to special interest groups, thinking about re-election. And in the meantime, millions of American families lose their homes, their dignity, even their lives, due to this curious institution called the American healthcare system, a costly, for-profit, inefficient system that stands alone in the industrialized world. Twice as expensive as other industrialized nations, with health outcomes closely matching those of third world countries, and one of six Americans left without access to healthcare, the current system continues to distinguish America as the only wealthy, industrialized nation that fails to live up to the United Nations standard of healthcare as a basic human right.

The goals identified by the administration are universal, affordable coverage, and control of the unsustainable rise in cost without increasing the deficit. In the emotional heat of the August recess, as the debate became increasingly contentious, the language changed from healthcare reform to health insurance reform, and “bending the cost curve�—a euphemism for bringing down cost in relation to income stagnation—became the new standard. The current cost to the nation, 16 percent of GDP, is estimated by the White House Budget office to reach 20 percent by 2016.

It is helpful to consider why the American healthcare system has become so dysfunctional. Tying insurance to employment leaves the self-employed, small businesses, and unemployed out. The system is way too complicated, loaded up with thousands of different private insurance plans that do nothing to improve care, but instead create and maintain a huge, expensive bureaucracy. Dealing with this insurance maze adds high administrative costs to both hospitals and independent health care providers. The Physicians for a National Health Program reports an average medical office expense of more than $68,000 annually, simply dealing with insurance companies.

Canadians spend half as much of their GDP, with much better health outcomes for their immensely popular, publicly funded, privately delivered Medicare. They pay a few dollars more in taxes, but minimal out of pocket expenses, and enjoy lifelong peace of mind. Canadians still celebrate Prime Minister Tommy Douglas, who 50 years ago implemented their national healthcare, as the greatest Canadian ever.

Even after 30 years in the U.S., I find it mind-boggling that America continues to accept this deplorable neglect of its citizens. In Canada, Britain, Germany, France, Australia, Sweden, Japan, New Zealand—in effect all modern, industrialized nations—old, young, rich, poor, healthy, sick, employed, unemployed, immigrant or natural born citizen enjoy excellent health care coverage from birth to death. Now, some will refer to this as “socialized medicine�—a terminology left over from cold war days and meant to conjure up images of sick people huddled in Soviet hospital corridors waiting to be seen while Soviet bureaucrats wade through stacks of documents. But consider that the first national health plan was implemented by the conservative German Iron Chancellor, Otto von Bismarck, in 1881, in a move to make socialism less attractive to the working class and stem a beginning wave of social unrest.

Many people, including President Obama, agree that the simplest way to both contain cost and cover all is with a single payer system, yet that option was never seriously considered during the current debate. For nearly a hundred years, Americans have resisted implementation of a national healthcare program.

In contrast, Europeans have a much different attitude toward government, and generally participate in the electoral process in much higher numbers than Americans—35 to 45 percent higher. Government is seen as a public servant, responsible for managing national resources to the benefit of all, and individual citizens express a great deal of ownership in their often imperfect government. While there certainly is conflict and dissatisfaction, the collective consciousness of most European nations is one of societal benefit through effective government.

The Commonwealth Fund reports that universal healthcare systems across the globe function with much less bureaucratic waste—at half the cost—with better outcomes. As health insurance premiums eclipse mortgage payments, and co-pays and deductibles double and triple, paying a few more tax dollars for a publicly funded system would seem like a welcome trade-off. But many Americans simply cannot relate to the European acceptance of higher taxes in exchange for affordable healthcare. They continue to view taxes as a government intrusion and see themselves, maybe somewhat wishfully, as masters of their own life and labor.

What we are left with, then, is more than a thousand pages of complicated legalese that will take years to possibly implement, will not cover all, is unlikely to decrease cost, and has little hope of changing the way we do healthcare in the U.S.

Vibeke Mendonca-Lee is Danish and lived in Denmark for the first 25 years of her life. She lived in Germany for 11 years and has family currently living in Italy and Denmark. She is a clinical social worker in San Antonio, Texas and has been an active grassroots organizer and member of San Antonio HealthCare-Now Coalition for more than three years. Vibeke currently works as a therapist for a non-profit organization that provides housing and support for people with mental illness.