Government’s Involvement in Health Care Around the World

The world is a very small place, if you’re going by the health care debate in this country.  You have the U.S., you have Canada, you have the U.K., and you have “All Others,” where they may or may not have medical care.  It’s preposterous, of course, and usually only done to make a specific point about “the evils of government involvement in health care.”  The plain truth is we’re never going to swap out our health care system for that of another country’s wholesale.  But if we really want to argue whether government intervention is necessary to reform our broken system, we need to look at the world around us.

Jonathan Cohn has a lengthy and highly-recommended article in today’s Boston Globe talking about, among other things, how poorly France and the Netherlands fit the stereotypes and talking points about what happens when government gets involved in health care.  The two countries are on opposite ends of the spectrum.  The Netherlands provides universal health care largely through private insurance companies;  France has universal basic medical care through a single-payer, with 98% of the population also opting to buy supplemental coverage through a private company.  (Yes, that means France has nearly covered its entire population twice over, and still spends less than we do as a percentage of GDP).  But both feature strong government involvement in terms of much heavier regulation of private insurers than anything we’re proposing today.  Yet they make terrible talking points for those who want to warn against the ills of government involvement.  Health care in those countries is more affordable, better quality, and doesn’t lead to the “inevitable” rationing that so many fear here at home:

In both the Netherlands and France, most people have long-standing relationships with their primary care doctors. And when they need to see these doctors, they do so without delay or hassle. In a 2008 survey of adults with chronic disease conducted by the Commonwealth Fund - a foundation which financed my own research abroad - 60 percent of Dutch patients and 42 percent of French patients could get same-day appointments. The figure in the US was just 26 percent.

The contrast with after-hours care is even more striking. If you live in either Amsterdam or Paris, and get sick after your family physician has gone home, a phone call will typically get you an immediate medical consultation - or even, if necessary, a house call. And if you need the sort of attention available only at a formal medical facility, you can get that, too - without the long waits typical in US emergency rooms.

This is particularly true in the Netherlands, thanks to a nationwide network of urgent care centers the government and medical societies have put in place. Not only do these centers provide easily accessible care for people who use them; they leave hospital emergency rooms free to concentrate on the truly serious cases. Tellingly, a Dutch physician I met complained to me that waiting times in her emergency room had been getting “too long” lately. “Too long,” she went on to tell me, meant two or three hours. When I told her about documented cases of people waiting a day, or even days, for treatment in some American emergency rooms, she thought I was joking. (In a 2007 Commonwealth Fund survey, just 9 percent of Dutch patients reported waiting more than two hours for care in an ER, compared to 31 percent of Americans.)

No one has created a perfect health care system.  There are problems with every one and strengths with every one – even ours.  But there’s one simple fact that we can’t escape:  whether it’s the Netherlands or Switzerland, whose reliance on private insurance makes it the favorite model of conservative economists as well as the model for Gov. Mitt Romney’s legislation, or the single-payer exemplars of Taiwan, Scandinavia and our neighbor to the north, no one has been able to control costs, expand access to all citizens and dramatically improve care without greater government involvement.  Not a single one.

I’m all for American exceptionalism, but this is ridiculous.

For more on health care around the world, check out these earlier posts:

• "Everybody Knows" Is Not a Credible Source on Canadian Health Care
• 5 Questions About French Health Care
• Swiping Ideas from the Swiss
• Turning Japanese? We Could Do a Lot Worse
• In Defense of English-Speaking Health Care

(Photo credit:  woodleywonderworks on Flickr.)