What the U.S. Healthcare Debate Means For Global Health

On the surface, U.S. talk of "high-risk pools," "Cadillac plans," and "insurance exchanges" have little to do with the health of those in Rwanda, Guatemala or Ghana, where governments struggle to build any semblance of a health system. But dig deeper, and you'll be sure to find important connections between these wonkish debates in D.C. and the health of those in developing countries.

After the Health Reform Summit yesterday, I decided to do some digging myself. Here are three things U.S. healthcare reform means for the developing world:

1). Reform can change the brain drain. For years, trained health workers in developing countries have been leaving in droves to find better work opportunities in wealthier nations. The shortage of newly trained doctors in the U.S. -- where the number of spots at medical schools has stayed stagnant for decades -- has contributed to that trend. If U.S. reform can train thousands of new health workers to prepare for the anticipated explosion in millions of newly insured patients, the brain drain trend in many countries might be stemmed, and even reversed. (A New York Times piece recently captured some promising signs on this front.) Conversely, if U.S. reform goes nowhere, we can expect to see even more health workers leaving developing countries to fill the U.S. shortage.

2). It's easier to design (and reform) a health system early on. Once a country chooses a path, as the U.S. did decades ago, it's hard to turn back. Developing countries should take notice here. This is especially significant, because as Atul Gawande profiles in the New Yorker, national health systems don't tend to pop out all nice and shiny out of a government's womb. If the debates over reform in the U.S. are any indication, it's clear that developing countries should avoid the fate of having a proliferation of different actors -- global multilateral agencies, thousands of private NGOs and corporations -- take over their health systems and laying a messy, if not shaky, foundation. That's why the approach of Partners in Health -- to prioritize the public sector's role in providing health care -- is the way to go from the very beginning, because reform later is a painstakingly difficult task. Just ask President Obama.

3). In the U.S., making health care a right has global implications. Can the U.S. finally move toward treating health care as a fundamental human right and expand coverage to 30 million uninsured? If so, it'll be a real symbolic victory (even if not as great as one hoped for a year ago), given how much America's "soft power" matters in global debates. On a substantive level, the U.S. provides more donor support for developing country health systems than any other country, and technical guidance, too. Without reform, the U.S. will likely continue to emphasize the private sector's role in those settings, often by railing against government inefficiency and continuing to fund western NGOs. On the other hand, if reform is successful and the government takes on a more meaningful role in the U.S. health care system, it's possible the U.S. policies may start to influence developing nations in ways that strengthen, rather than weaken, indigenous health care systems.

Lest we think these debates don't matter outside the U.S., indeed they do. The world is watching.

Photo Credit: The White House