Health Care Reform In The USA

The health care reform that has just passed in the US is mainly concerned with insurance reform. It doesn't turn the US into Canada or the UK. It does make the US a lot more like Switzerland (or, oddly enough, Massachusetts). I find this interesting since I lived in Switzerland for a couple of years. I have never lived in Massachusetts, although I have seen nearly every episode of Cheers.

In Switzerland about twenty years ago insurance companies started pulling the same shenanigans they were pulling in the US -- aggressively dumping people off their coverage, expanding denial for "pre-existing conditions", that sort of thing. The Swiss shortly got annoyed and about 15 years ago enacted reform that cleaned up insurance practices and made insurance mandatory, along with public and subsidy provisions. The measure was passed by referendum. [Switzerland is much more of a democracy than the US, which is not always a good thing.] Private healthcare in Switzerland is still going strong and by all measures I can see, including anecdotal first-hand experience for myself and my family (we had private insurance), the overall system is of good quality.

The UK, on the other hand, seems to have adopted a typical "worst of both worlds" approach, trying to get the worst of capitalism and the worst of socialism and combining them, with the best will in the world, to yield something that kind of works, kind of fails, and is in perpetual CRISIS. From personal experience and observation, if you've got decent private insurance and/or enough money to pay for private healthcare, you can get fantastic quality care in the UK. If you are poor, you'll do much better for healthcare in the UK than in the US. The group that would really be better off in the US than the UK is the subset of the middle class that don't have private insurance through work, but likely would in the US doing equivalent jobs. But, seriously, if anyone's thinking of big-time reform, the UK would not be on the shortlist of models to emulate.

France, though, is a different story. I have never lived in France but by all accounts the quality of care is very good from top to bottom. For full universal health care with public options but still allowing private hospitals and doctors in private practice (I am more than happy for good doctors to get wealthy, it's an important job and they've earned it), France would top my shortlist.

Comparing Switzerland, France, and the US*:

• %GDP spent on healthcare is substantially higher in the US than in either France or Switzerland
  
• Total spent per capita on healthcare is substantially higher in the US than in either France or Switzerland
• despite percentage of costs covered by the government being lower in the US, per capita public expenditure is higher in the US than in either France or Switzerland
• life expectancy at birth, infant mortality rates, and some other gross markers of health are better in France and in Switzerland than in the US
• both France and Switzerland have substantially higher ratios of practicing physicians/population than the US
• Switzerland has more nurses per capita than the US, but the US has more than France

It will be interesting to see how this evolves in the US over the next decade or two.


*These numbers, and lots of others, along with pointers to the more comprehensive full report, available here.