Friday, April 18, 2008

The Health(care) of Nations

I recently watched a excellent Frontline documentary entitled Sick Around the World outlining the healthcare systems of five capitalist democracies. While each of these systems has its own problems, all these systems are very much preferable to what the United States has.
These five countries represent the 3 health-care models.
It is surprising that Britain, in amy respects the most free-market among these countries (some aspects of the British economy are less regulated than the US), was the only one that had "socialized medicine". The National Health Service (NHS) was largely passed over by the free-market reforms of the Thatcher government, though there are now modest attempts to make the parts of the NHS more free-market. The special was good at point to both the advantages and the flaws of this system.
The others are not socialized medicine, but rather socialized insurance. Germany, Japan and Switzerland are all to some degree set up along the "Bismarckian" system, in which insurance plans are forced to cover everyone.
Of all of the systems, Taiwan's seemed the best. There is good reason for this: when Taiwan's became a "developed" country, it had no good health-care system. The government looked at what other countries had done and emulated what worked. They came up with a single-payer system. A review of the documentary in the New Republic explains.
Virtually alone among health care commentators in the U.S.--a category that includes me--Paul Krugman has been touting Taiwan for a while. The film makes it easy to see why. Today, the people of Taiwan have guaranteed access to health care--and, according to the film, it's very good health care. There are no chronic waiting lists, like you find in Britain, and the care is very advanced. Among other things, Taiwan is among the world leaders in establishing electronic medical records--an innovation that should significantly improve care by keeping doctors and nurses better informed about patient histories and, no less important, avoiding potentially dangerous drug interactions.

This sounds like the best solution, I think. Taiwan was able to lower health-care spending, while expanding to cover everyone. I'm not sure if it's possible to institute this in America (though the matter was hotly debated in the Edwards camp and Al Gore now favors a single-payer system).
As the special made clear, none of these systems is foreign to us. The Veteran's Health Administration is like the NHS, Medicare is like the Taiwan system and the health system for employed Americans resembles Germany.
I think Switzerland might be the most instructive. The Swiss successfully reformed a health-care system much like America's around the time the Clintons failed to do so here. Both the Democrats have plans that would move America in this direction, while McCain's plan does nothing of the kind.
Paul Krugman argues that of the two plans, Hillary's is more effective because it mandates coverage, whereas Obama's does not. I agree, but I would point out that the bill passed by congress will probably be unrecognizable. The 1993 healthcare bill ended up looking like the plan of Clinton's rival Paul Tsongas. Still, I think that Clinton may be more effective on this particular issue and probably will make it a higher priority.
(Posted by Ewan)

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