The ACP Advocate Blog
by Bob Doherty
Wednesday, April 8, 2009
Should we be doing it like the French?
Ezra Klein, an editor at The American Prospect, writes in the Los Angeles Times that "When it comes to health care, the U.S., Britain and Canada are hurting" noting that in Canada and Britain "the two countries most often cited in discussions of what nationalized healthcare might mean, some patients report having to wait months for some elective treatments." But he also observes that "we've got waiting lines too - along with 50 million uninsured and a system that costs more than twice as much per person as that of any other country. We've just managed to hide our lines through clever statistical gimmickry."
He also notes that Germany, France, Japan and Sweden are examples of countries that have achieved universal coverage without long waits, and "all of them have more of a mix of public and private options" than the U.K. or Canada. The American College of Physicians reached a similar conclusion in a 2008 position paper that my colleague Jack Ginsburg and I co-wrote for ACP's Health and Public Policy Committee. It was approved by our Board of Regents in October, 2007 and the edited version appeared in Annals.
We looked at a dozen different health care systems around the world, and found that they all outperformed the U.S. on most measures of access, quality, and cost of care. We also found that the best performing systems could be found in countries like France and Germany that combined publicly-funded and guaranteed coverage with private coverage options. (Canada actually scored second to worst, with the U.S. taking last place, on most of the elements of a high performing health care system as defined by the Commonwealth Fund, one of our principal sources).
Now, to be clear, we didn't find any one country had it all together. There were some advantages associated with single payer systems. And countries with mixed systems of public and private options tend to be less egalitarian. We found, though, that either a pluralistic model with guaranteed coverage, or a single payer model, would out-perform the U.S. on most metrics and therefore had elements that should be considered by the U.S. as it tackles health care reform. We also recognized that any solution for this country would be uniquely American.
President Obama and top congressional leaders also seem to be looking more to France than Britain or Canada. They are putting together legislation that would combine subsidized private insurance, a public plan option, and guaranteed coverage. They aren't advocating a single payer model, despite the exaggerated fears in some conservative circles that this is exactly what they are hoping to achieve, and to the great disappointment of those on the left who argue, with great passion, that single payer is the "only" answer to the U.S. health care crisis.
Today's questions: Do you believe that it is possible to achieve universal coverage in the U.S. without long waits for appointments? And what do you think of doing it the French way - a mix of public and private options - instead of Canada's single payer model?
About the Author
Bob Doherty is Senior Vice President, American College of Physicians Government Affairs and Public Policy; Author of the ACP Advocate Blog
Email Bob Doherty: TheACPAdvocateblog@acponline.org.Follow @BobDohertyACP
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