Posted on December 18, 2006

Would Europe's health-care-for-all model work here?


Cover everyone and use Medicare as a model

The Press-Enterprise
December 17, 2006

The perspective of Don McCanne, senior health policy fellow, and Nicholas Skala, research associate, Physicians for a National Health Program

Compared to other advanced nations, the United States spends far more on health care but achieves only mediocre results. Though the World Health Organization has ranked us first in spending, we are ranked 37th in performance—well behind Canada and all Western European nations. What do these countries know that we don’t?

Universal coverage is public policy in the rest of the industrialized world, but it is not in the United States. We leave nearly 47 million without any insurance at all. Even the insured are finding that increasingly inadequate private insurance policies are leaving them exposed to insurmountable costs.

Although unheard-of in other nations, illness and medical bills contribute to half of personal bankruptcies here, and 75 percent of those with medical debt had coverage when they got sick.

How do other nations insure everyone, protect their personal assets from medical debt and do it at a much lower cost than that of the United States? Although no two nations have identical programs, none has adopted the disorganized, wasteful, fragmented insurance payment system that we have in America.

In nations such as the United Kingdom, the government owns the health care delivery system, and it is the direct provider of care. Other nations use a social insurance model in which care is paid for either
directly through the government or via tightly organized and regulated nonprofit companies, while doctors and hospitals remain independent.

These social insurance programs cover everyone, protect against financial losses, more effectively pool risks and fund the entire system much more equitably than we do in the United States.

This egalitarian social insurance model of other nations contrasts sharply with the market model of private plans that we have here. Private insurance companies erect massive bureaucracies for the purpose of fighting claims, issuing denials and screening out the sick from coverage.

Their principal product is an excess of administrative services with its resulting headaches. Doctors, hospitals and businesses must react by employing armies of administrators to deal with this massive private bureaucracy.

Health-care administration consumes a mind-boggling 31 percent of our health spending. Some $350 billion of this waste could be recovered and is enough to extend good coverage to all Americans. Americans are already paying for national health insurance — we just aren’t getting it. Two-thirds of our health-care system already is funded through the tax system.

Although it works well for our armed forces and veterans, Americans may have difficulty accepting a government-operated medicine system similar to the U.K.’s. But we are already comfortable with the concept of social insurance: Our Medicare and Social Security programs are familiar examples.

The public’s response to recent threats of privatization has shown just how protective we are of these programs, even though they are government programs. A national health-insurance system for the United States — in essence “Medicare for All” — would likewise be successful and popular.

Medicare is not perfect. It requires continual oversight and maintenance. But with appropriate revisions, it can serve as an American model of comprehensive coverage for everyone.

While making funding more equitable, the system can assure care will remain affordable. Even though the Europeans provided us with the health-policy science, we can take pride in the fact that Medicare is our own, made-in-America idea.

The opposing view, “Beware massive costs, rationing, loss of freedom,” was written by Grace-Marie Turner of the Galen Institute and Robert E. Moffit of The Heritage Foundation. Their op-ed was not posted on The Press-Enterprise website, but an unedited version is available from Galen:

The opposing view that was posted on The Press-Enterprise website, “Government-run systems restrict care,” was written by Merrill Matthews of the Council for Affordable Health Insurance:


By Don McCanne, MD

Would Europe’s health-care-for-all model work here? Since no two European nations have the same model, the question really is whether an insurance program that covers everyone would work in the United States. Since we already spend far more per capita on health care than the European nations, there is absolutely no doubt that a properly designed universal insurance program would work as a “health-care-for-all” model (or Medicare for All).

Grace-Marie Turner, Robert Moffit, and, separately, Merrill Matthews didn’t answer that question, but, in their usual reframing of the debate, they changed the topic to rationing. So their question is whether the level of rationing that would take place in the United States would be so severe that we should not attempt to cover everyone with effective insurance. In their response they ignored two crucial points.

Those European nations that have been attentive to capacity and have practiced queue management do not have significant problems with excessive queues. At our level of spending, there would be no need to ration reasonable, beneficial health services, though we should reduce funding for non-beneficial or detrimental services. But that is not rationing; that is value purchasing - a feature of well functioning health systems.

The other point is that they remain silent on the nation with the worst rationing of all - the United States. We ration care for tens of millions of Americans based strictly on their ability to pay. A national health insurance program would eliminate that inhumane basis for rationing.

In our debate over health care reform we don’t need more anecdotes about C-T scans for dogs, or ideological discussions about freedom to pay for your own health care. We need serious discussions about policies that will work. Unless the opponents come up with something better than national health insurance, they should get out of our way and let us heal our very, very sick system.