Letters to the Editor, submitted to The New York Times, January 19, 2010
My exposure to European universal health care systems began in 1971 when I became Director of Research and Development, in the UK, for an American pharmaceutical company. In that position I had frequent contact with European physicians associated with teaching hospitals. Also, as an American resident in the UK for many years, I always received prompt, modern care from the UK National Health Service. Excellent as I think that organization is, its performance isn’t directly relevant to the current US health care reform debate because no such truly “socialized” single payer system is being considered for this country.
However, I believe that the insurance-based universal health care systems operating in western continental European countries, do provide us with highly relevant models from which we cdan benefit. Hoping to be able to contribute constructively to the ongoing debate, I undertook several months ago to learn more about the systems in Germany, The Netherlands, Switzerland and France. I have come away with the following conclusions.
- Any initially-created US system will inevitably be changed over time. Based upon the European history of continuing refinement, amendment and occasional drastic overhaul, it would be a mistake to make the controversial “Public Option”), an “all or nothing” issue now. The essential goal should be to establish a workable and affordable system which embodies the principle of universal coverage. Once this is in place, any serious shortcomings in the initially created system will become evident and subject to correction.
- Most of those now opposing establishment of a universal health care system will become its supporters because once it is in operation it will gain overwhelming public support. This has repeatedly happened in Europe and it happened after the establishment of Medicare. .
- The “Public Option” need not be an insurance company run by government bureaucrats. The French government-created “Assurance Maladie” is divided into five autonomous, but regulated, insurance funds. Their supervisory boards are made up of representatives of health care providers, labor unions, employers and private insurance companies.
- Contrary to the assertions of zealous advocates of the Public Option, non-profit insurance companies can provide effective premium-cost competition for for-profit insurers. Also, premium costs can be controlled by regulation.
- A risk equalization mechanism is a crucial component of the Dutch and Swiss systems. In the Netherlands all insurers who have provided participants with the government-mandated basic health insurance package receive payments from a special government-supervised fund. The amounts of these payments are determined by an analysis of the demographics of the policy-holding populations served by each insurer. The more high-risk policy holders a company has insured, the higher the risk-equalization payments it receives. These payments have overcome the traditional aversion of insurers to covering high risk individuals.
- Administrative costs can be minimized by mandating a basic health insurance coverage that is identical for everyone and under which the same approved reimbursement amounts apply to all patients and providers.
- In these European countries, for- profit insurance companies compete vigorously in the selling of popular supplementary “top up” policies. Having this opportunity, they accept strict regulation of the costs of the mandated basic health insurance policies.
- Improvement in the availability and effectiveness of preventive care and primary diagnosis and treatment have been basic thrusts of the European systems. In France a network of thousands of neighborhood clinics has been created. Primarily in poor areas, these provide pre- and post partum examinations and care for mothers and regular exams and needed care for infants and children. The care provided by these clinics may well be a primary reason that infant mortality in France is 11th best in the world while that in the US is 33d. In The Netherlands, neighborhood clinics actively help people adopt healthy, disease- preventing lifestyles (e.g. to stop smoking). They provide convenient access to the services of a GP, treat minor illnesses and accidents and are open evenings. Their services reduce the need for more expensive E.R.and specialist visits, and hospitalizations.
- The U.N.’s 2006 “league table” of life expectancies at birth for years 2005-2010 says to me that the lifetime health care provided the populations of the four European countries is superior to that now provided in the USA. The figures are: Switzerland 81.7 years, 4th in world; France 80.7, 10th; Netherlands 79.8, 17th; Germany 79.4, 23d; USA 78.2, 38th. (Japan ranks 1st in the world with 82.6 years life expectancy at birth)..
- Costs for a medical education are generally government-paid in the four European countries; doctors in these countries do not start their careers heavily in debt. We need to subsidize the cost of medical school for students who commit to go into primary care practice.
- Costs of malpractice insurance and lawsuits are not serious issues in these countries. We need tort reform.
- Lloyd H. Conover, Ph.D. St. Petersburg, FL