Even as American political culture helps to explain the health care debate in America, culture is far from the only reason America lacks universal coverage. Another factor that has limited debate about national health insurance is the role of interest groups in influencing the political process.
Should any attempt at comprehensive national health insurance ever be made, lobbyists would certainly mobilize to prevent its implementation.
As policy experts have pointed out in studies of the U. The political system is prone to inertia and any attempt at comprehensive reform must pass through the obstacle course of congressional committees, budget estimates, conference committees, amendments and a potential veto while opponents of reform publicly bash the bill. Ultimately, the United States remains one of the only advanced industrialized nations without a comprehensive national health insurance system and with little prospect for one developing under the next president because of the many ways America is exceptional.
People have often asked which system was my favorite and which one would work best in the US. Alas, that is not so simple a question to answer.
But there were certainly plenty of lessons we can take to heart as our country engages in its own discussion of the future of health care. The first necessary condition for universal health care is a collective commitment to achieving it. Every one of the countries we covered — Taiwan, Australia, the Netherlands, and the United Kingdom — has made such a commitment.
In fact, every other country in the developed world has decided that health care is something everybody should have access to and that the government should play a significant role in guaranteeing it. Except for the United States.
Overall, including independents, 57 percent of Americans say the government has this obligation. In other countries, there might be disagreement about how to achieve universal health care, but both ends of the political spectrum start from the same premise: Everybody should be covered.
Even in the Netherlands, which overhauled its health insurance in under a center-right government, there was no question about universal coverage. I came across this quote from Princeton economist Uwe Reinhardt while I was starting to report this project, and it stuck with me throughout.
From his most recent book Priced Out , which was published after he died in Canada and virtually all European and Asian developed nations have reached, decades ago, a political consensus to treat health care as a social good. By contrast, we in the United States have never reached a politically dominant consensus on the issue. When I told people in Taiwan or the Netherlands that millions of Americans were uninsured and people could be charged thousands of dollars for medical care, it was unfathomable to them.
Their countries had agreed that such things should never be allowed to happen. I saw all kinds of health systems in action: true single-payer in Taiwan, a mix of public and private insurance in Australia, private coverage for everybody in the Netherlands.
Each of them surpassed the United States in two critical ways: Everybody had insurance, and costs to patients were much lower. Specialty care in the rural parts of the country is lacking. On the whole, the medical field seems to be ambivalent about the national health insurance. But raising taxes to more adequately fund the system or bumping up cost sharing to encourage more discretion in health care use is almost as big of a political challenge there as it would be here.
Nobody wants to pay more for health care next year than they did the year before. Australia has layered a private health care system on top of its universal public insurance program, and that gives both doctors and patients more choice about medical care. But once you have different tiers in your health care system, disparities are going to emerge.
And because the Australian government is spending billions of dollars supporting a struggling private insurance industry for middle-class and wealthier patients, it has fewer resources to devote to disadvantaged populations, like indigenous Australians or patients living in rural areas who have less access to medical care. Public patients in public facilities face longer wait times.
The Netherlands, meanwhile, has handed over the responsibility for providing coverage to private health insurers, and that has come with costs too. The Dutch have had to impose strict regulations on health insurance, including harsh penalties for people who fail to sign up for insurance on their own.
Doctors in the Netherlands are more likely than those in more socialized systems to say their patients struggle to afford medical care. They are also more likely to say the administrative work they have to do is a drain on their time.
Health care spending in the Netherlands has also been rising at a faster clip since the move to the mandatory private insurance system.
Edward Booty , CEO, reach The views expressed in this article are those of the author alone and not the World Economic Forum.
High rates of COVID infection are setting Africa back but young innovators across the continent are deploying a social entrepreneurship skillset to fight the pandemic from the grassroots. I accept. In some of the world's rural communities, there may be just one doctor for 70, people.
Edward Booty CEO, reach Take action on UpLink. Forum in focus. New statement champions the role the private sector can play in achieving universal health coverage. Read more about this project. Explore context. Explore the latest strategic trends, research and analysis. Systemic challenges and the COVID pandemic threaten progress towards achieving universal health coverage; To regain momentum, a diverse range of issues must be addressed from implementing telehealth to improve access in remote areas to overcoming corruption; Government spending and private sector support must also increase.
Have you read? We just need to focus on outcomes. The growing financing gap for UHC. Public expenditure on healthcare as percent of total healthcare expenditure. They are wrong: The US ranks 28th, below almost all other rich countries, when it comes to the quality of its healthcare assessed by UN parameters pdf, p. When did the country diverge from other industrialized nations and, rather than offering universal health coverage, built up a system that relied on private insurance?
Labor unions also worried that it would weaken their own bargaining power, says Palmer, as they were otherwise responsible for getting their members social services. In president Franklin D. Roosevelt imposed an effective freeze on labor wages, and companies started offering health and pension benefits as a way to retain workers instead. This was the beginning of employer-sponsored healthcare, though there was no government mandate to offer it except in Hawaii.
Unions began negotiating the benefits as part of what they could obtain for workers. Another turning point, Palmer says, was an exceptionally successful campaign by Clem Whitaker and Leone Baxter, the founders of Campaigns, Inc.
According to Lepore, after successfully halting the reform in California, Campaigns, Inc. In the s, right-wing politicians, medical professionals, and representatives of the medical industry opposed attempts to broaden national health coverage on the grounds that it was a Soviet-inspired concept—an objection that gained force after the Russian revolution. That sentiment, Brown believes, is still alive. Despite knowing well that a single-payer healthcare system is the only sustainable long-term solution for creating broader coverage without skyrocketing prices, he says, even advocates of single-payer like Nobel Prize-winning economist Paul Krugman consider it paywall politically unfeasible.
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