Different Paths to National Healthcare

An article I’ve referred to often is “Getting There from Here,” by Atul Gawande, a cancer surgeon in Massachusetts. The article appeared in the January 26, 2009, issue of The New Yorker. Now, don’t go hating on me and calling me a socialist. I’m just conveying information I found interesting.

Gawande discusses how universal healthcare came about in various countries. He says that in every country, the idea is initially derided as “a Bolshevik fantasy.” Sounds familiar.

On both sides are idealists. Hardcore reformers insist that the best thing to do is start from scratch–scrape away the existing system and build the “perfect” system in its place. On the other side are the free market folks, who want to end all public and employer-based insurance, and let people fend for themselves in an open market. If you can afford it–fine; if not–tough.

In the middle are the pragmatists–and in every country, they prevail over the ideologues. Their vision is to start with the existing system, and build from there. It still involves major change, but it’s less traumatic than starting from scratch.

Gawande gives three examples–France, Switzerland, and England. All had a healthcare system in place, and rather than dismantling it, they used it as the starting point. That is pretty much what we’re doing in the US.

England’s system emerged from World War 2, when private hospitals and clinics were overloaded with casualties (or destroyed). The government had to take over…and people liked the result. Their system grew from that point. Their road to national healthcare has absolutely no correlation to the US.

In France, the only organized healthcare involved collective insurance funds financed through payroll deductions by unions and major manufacturers. The French government was too busy with post-war rebuilding to spend much time on healthcare, so they just expanded the system already in place. Now they have more doctors, higher life expectancy, lower infant mortality, and lower costs than the US. The World Health Organization ranks it as the best healthcare system in the world (the US is 37th). And they didn’t even put much effort into it. Not that the French put much effort into anything they do.

In Switzerland, people relied on private insurance. When they passed a universal coverage law in 1994, they required every resident to buy private insurance, and government subsidies restricted the cost to no more than 10% of the person’s income. Some similarities to what we’re doing…or not. Hard to tell what Congress will do, as they keep tweaking the thing to death.

The point is, each country starts at a different place, and each country’s system is a bit different. The wise route is to build on what already exists, rather than start over. That seems to be the route we’re taking.

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