Hostname: page-component-cd9895bd7-p9bg8 Total loading time: 0 Render date: 2024-12-26T04:11:30.767Z Has data issue: false hasContentIssue false

Why Can’t We Do What They Do? National Health Reform Abroad

Published online by Cambridge University Press:  01 January 2021

Extract

Even Americans who have only a vague knowledge of health policy know that the U.S. is different. We do not have “socialized medicine,” like our European or Canadian neighbors. We believe that health care is not rationed here, and that, unlike citizens of other nations, we do not have to wait in long queues when we need medical care. We believe that U.S. health care is the best in the world.

At the same time, the U.S. spends more on health care - both per capita and as percentage of gross domestic product (GDP) - than other nations do. One in six non-elderly Americans has no health insurance, and voluminous studies show that lack of health insurance has a dramatic effect on both access to care and on health status. Furthermore, on many of the most important indicators of population health, such as infant mortality and life expectancy, the U.S. scores worse than do other nations.

Type
Symposium
Copyright
Copyright © American Society of Law, Medicine and Ethics 2004

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Institute of Medicine, Care Without Coverage: Too Little, Too Late (Washington, D.C.: National Academy Press, 2002).Google Scholar
See Jost, T.S., “Private or Public Approaches to Insuring the Uninsured: Lessons from International Experience with Private Insurance,” New York University Law Review 76 (2001): 419492.Google Scholar
Jost, T.S., Disentitlement? The Threats Facing Our Public Health Care Systems and A Rights-Based Response (New York: Oxford University Press, 2003): at 14.Google Scholar
Id., at 235.Google Scholar
Id., at 204.Google Scholar
Ritter, G.A., Social Welfare in Germany and Britain: Origins and Development (New York: Berg, 1986): 3348.Google Scholar
Tariffcheck 24, “Soll ich in der gesetzlichen Krankenversicherung bleiben oder mich privat versichern?” <http://www.tarifcheck24.de/Tarifcheck24-1414/infos.html> (last visited June 9, 2004).+(last+visited+June+9,+2004).>Google Scholar
European Observatory on Health Care Systems, Health Care Systems in Transition: Germany (London: European Observatory, 2000): 4950.Google Scholar
Id., at 26.Google Scholar
Under legislation adopted in the mid-1990s, most of the insurance funds were opened up so that anyone could join any plan. This allows the plans to compete on the basis of premiums, and has in general meant that many Germans have moved to the former-white collar or business-related funds, which had better risk-profiles and thus lower premiums. See Jost, supra note 3, at 240.Google Scholar
European Observatory, supra note 8, at 41–44.Google Scholar
Id., at 40–42.Google Scholar
Id., at 24.5.Google Scholar
Id., at 25.Google Scholar
See Jost, , supra note 3, at 244–45 (describing this process in greater detail).Google Scholar
The codes are weighted on a regional basis to provide higher compensation for primary care services and to diminish somewhat the overcompensation that might otherwise result for procedure-oriented specialists. There are also limits on how many points a doctor may bill per patient, and reviews to detect overutilitzation. Payments are also adjusted in other respects too complicated to go into here. For a fuller exploration of physician compensation, see European Observatory, supra note 8, at 102–06.Google Scholar
See Sozialgesetzbuch, V., s71.Google Scholar
See Jost, , supra note 2, at 247.Google Scholar
See World Health Organization, The World Health Report 2000: Health Systems: Improving Performance (Geneva: World Health Organization, 2000): 1213.Google Scholar
Allsop, J., Health Policy and the NHS: Towards 2000, 2nd ed. (London: Longman, 1995): 1723.Google Scholar
Jost, , supra note 3, at 207.Google Scholar
European Observatory on Health Care Systems, Health Care Systems in Transition, United Kingdom (London: European Observatory, 1999): 4142, 56.Google Scholar
Id., at 53–54.Google Scholar
Jost, , supra note 3, at 219.Google Scholar
World Health Organization, supra note 21, at 12–13.Google Scholar
See Jost, , supra note 3, at 451–52, 460–61.Google Scholar
Only in some Canadian provinces is the purchase of private insurance for publicly provided services illegal. Jost, , supra note 3, at 491.Google Scholar
See Mossialos, E. and Le Grand, J., eds., “Cost Containment in the EU: An Overview,” Health Care and Cost Containment in the European Union Aldershot, England: Ashgate Publishing Ltd., 2001): 1, 510.Google Scholar
Jost, , supra note 3, at 451–52, 460–61.Google Scholar
Only 1 percent or fewer are uninsured. See Mossialos, and Grand, Le, supra note 31, at 5.Google Scholar
Australian Private Health Insurance Administration Council, Surcharges and Incentives, at <http://www.phiac.gov.au/insurenotsure/surchargesincentives/index.htm> (last visited June 2, 2004).+(last+visited+June+2,+2004).>Google Scholar
Australian Private Health Insurance Administration Council, Industry Statistics, at <http://www.phiac.gov.au/statistics/membershipcoverage/hosquar.htm> (last visited June 2, 2004).+(last+visited+June+2,+2004).>Google Scholar
See e.g., Fattore, G., “Cost Containment and Reforms in the Italian National Health Service,” in Mossialos, and Grand, Le, eds., supra note 31, at 513, 517–18.CrossRefGoogle Scholar
See Department of Health, GP and Pharmacy Services — Introduction, at <http://www.oasis.gov.ie/health/gp_services/GP_services_introduction.html> (last visited June 2, 2004); Charges for Hospital Services, at <http://www.oasis.gov.ie/health/hospitals/hospital_charges.html> (last visited June 2, 2004).+(last+visited+June+2,+2004);+Charges+for+Hospital+Services,+at++(last+visited+June+2,+2004).>Google Scholar
European Observatory, supra note 25, at 42–43Google Scholar
Id., at 41.Google Scholar
See Health Canada, Canada Health Act: Overview, at <http://www.hc-sc.gc.ca/medicare/chaover.htm> (last visited June 9, 2004). See Grogan, C.M., “Who Gets What? Levels of Care in Canada, Britain, Germany and the United States,” in Morone, J.A. and Belkin, G. S., eds., The Politics of Health Care Reform (Durham: Duke University Press, 1994): 443462 (discussing benefits and coverage in various countries).Google Scholar
Australian Private Health Insurance Administration Council, General Information, at <http://www.phiac.gov.au/insurenotsure/general1.htm> (last visited June 2, 2004).+(last+visited+June+2,+2004).>Google Scholar
Mossialos, and Le Grand, , supra note 31, at 32–36.Google Scholar
See Saltman, R.B., Busse, R. and Mossialos, E., Regulating Entrepreneurial Behaviour in European Health Care Systems (Buckingham: Open University Press, 2002): 201202, 215–216.Google Scholar
Mossialos, and Grand, Le, supra note 31, at 13–16.Google Scholar
Anderson, G.F., et. al., “It’s the Prices Stupid: What the United States is so Different from Other Countries,” Health Affairs 22, no. 3 (2003): 89.CrossRefGoogle Scholar
Gerdtham, U.G. and Jonsson, B., “International Comparisons of Health Expenditure: Theory, Data, and Econometric Analysis,” in Culyer, A. J. and Newhouse, J.P., Handbook of Health Economics 1A (Amsterdam: Elsevier, 2000): 1353.Google Scholar
OECD, Life Expectancy at Birth (male, 2001), at <http://www.oecd.org/dataoecd/13/41/31963112.xls> (last visited June 9, 2004).+(last+visited+June+9,+2004).>Google Scholar
See OECD, infant mortality data, (2001), at <http://www.oecd.org/dataoecd/13/40/31963124.xls> (last visited June 9, 2004)+(last+visited+June+9,+2004)>Google Scholar
Anderson, , supra note 46, at 97.Google Scholar
Id., at 101.Google Scholar
Jost, , supra note 3, at 222–224.Google Scholar
Moreover, even those of us who are fully insured must sometimes wait for services. I was told recently that I would have to wait six to seven months to see a gastroenterologist with my health plan.Google Scholar
Cullis, J., “Waiting Lists and Health Policy,” in Frankel, S. and West, R., eds., Rationing and Rationality in the National Health Service (London: MacMillan, 1993): 15, 2327.Google Scholar
Waiting lists also seem to be less of a problem in social insurance countries. See Siciliani, L. and Hurst, J., Explaining Waiting Time Variations for Elective Surgery Across OECD Countries (Paris: OECD, 2003).Google Scholar
Frankel, S., “The Origins of Waiting Lists,” in Frankel, S. and West, R., supra note 56, at 6.Google Scholar
Jost, , supra note 3, at 224–25.Google Scholar
Anderson, , supra note 46, at 98.Google Scholar
Strategic Policy and Research Intergovernmental Affairs, Health Care Systems: An International Comparisons, at <http://www.pnrec.org/2001papers/DaigneaultLajoie.pdf> (last visited June 2, 2004).+(last+visited+June+2,+2004).>Google Scholar
Woolhandler, S., Campbell, T., and Himmelstein, D.U., “Costs of Health Care Administration in the United States and Canada,” New Eng. J. Med. 349 (2003): 768775.CrossRefGoogle Scholar
Anderson, , supra note 46, at 99.Google Scholar
Hussey, Peter S., et. al., “How Does the Quality of Care Compare in Five Countries,” Health Affairs 23, no 3 (2003): 8999.CrossRefGoogle Scholar
Blendon, R. J. et. al., “Common Concerns Amid Diverse Systems: Health Care Experiences in Five Countries,” Health Affairs 22, no. 3 (2003): 106121.CrossRefGoogle Scholar
Blendon, R.J., et. al., “Inequities in Health Care: A Five-Country Survey,” Health Affairs 21, no. 3 (2002): 182191.CrossRefGoogle Scholar
Jost, , supra note 3, at 216–217.Google Scholar
Id., at 243–248.iv. 29 U.S.C. § 1132, (1999 & Supp. 2004).Google Scholar
29 U.S.C. 1132, (1999 & Supp. 2004).Google Scholar
Jost, , supra note 3, at 34–46.Google Scholar
See Id., at 208–214; Klein, R., Day, P., and Redmayne, S., Managing Scarcity: Priority Setting and Rationing in the National Health Service (Buckingham: Open University Press, 1996): 3940.Google Scholar
Newdick, C., “Judicial Supervision of Health Resource Allocation: The U.K. Experience,” in Jost, T.S., ed., Readings in Comparative Health Law and Bioethics (Durham: Carolina Academic Press, 2001): 6071.Google Scholar
Jost, , supra note 3, at 248–252.CrossRefGoogle Scholar
See summarizing this literature, Gordon, C., Dead on Arrival: The Politics of Health Care in Twentieth-Century America (Princeton: Princeton University Press, 2003): 28; Blake, C. H. and Adolino, J. R., “The Enactment of National Health Insurance: A Boolean Analysis of Twenty Advanced Industrial Countries,” Journal of Health Politics, Policy and Law 26 (2001): 679–708, 681–687.Google Scholar
See Mayer, L. C., Burnett, J. H., and Ogden, S., Comparative Politics: Nations and Theories in a Changing World, 2nd. ed. (Upper Saddle River, N.J.: Prentice Hall, 1996): 4649.Google Scholar
Id., at 51.Google Scholar
Id., at 54–55.Google Scholar
European Observatory, supra note 8, at 110–116.Google Scholar
Jost, , supra note 3, at 226–27.Google Scholar
See Steinmo, S. and Watts, J., “It’s the Institutions Stupid! Why Comprehensive National Health Insurance Always Fails in America,” Journal of Health Politics, Policy and Law 20 (1995): 329; Tuohy, C. H., Accidental Logics: The Dynamics of Change in the Health Care Arena in the United States, Britain, and Canada (New York: Oxford University Press, 1999): 108112 (also gives qualified support for this explanation).CrossRefGoogle Scholar
Steinmo, and Watts, , supra note 84, at 360, 362.Google Scholar
Id., at 363.Google Scholar
See discussing the concept of veto points, Immergut, E., Health Politics: Interest and Institutions in Western Europe (New York, Cambridge University Press, 1992): 226231.Google Scholar
Blake, and Adolino, , supra note 78, at 684; Banting, K.G. and Corbitt, S., “Health Policy and Federalism: An Introduction,” in Banting, K.G. & Corbitt, S., eds., Health Policy and Federalism: A Comparative Study on Multi-Level Governance (Montreal: Institute of Intergovernmental Relations School of Policy Studies, Queens University, 2001): 138 at 4–6.Google Scholar
Jost, , supra note 3, at 73–76.Google Scholar
Id., at 76.Google Scholar
Blendon, R. J., Benson, J. M., and DesRoches, C. M., “American’s View of the Uninsured: An Era for Hybrid Proposals” Health Affairs Web Exclusive, at <http://content.healthaffairs.org/cgi/reprint/hlthaff.w3.405v1.pdf> (last visited June 4, 2003).CrossRef+(last+visited+June+4,+2003).>Google Scholar
Hacker, J. S. and Skocpol, T., “The New Politics of Health Policy,” in Lee, P. R., Estes, C. L., and Rodgriguez, F. M., eds., The Nation’s Health (Boston: Jones and Bartlett Publishers, 2001): 200.Google Scholar
Jost, , supra note 3, at 177.Google Scholar
Gordon, , supra note 78, at 172–209Google Scholar
Maarse, H. and Paulus, A., “Has Solidarity Survived? A Comparative Analysis of the Effect of Social Health Insurance Reform in Four European Countries,” Journal of Health Politics, Policy and Law 28 (2003): 585614, 588–590.CrossRefGoogle Scholar
Id., at 608–611.Google Scholar
Blendon, , Benson, , and DesRoches, , supra note 91.Google Scholar
Id. It should be noted, however, that the public tends to be more supportive of collective responsibility for health care and less interested in market approaches than current policy elites. See Schlesinger, M., “On Values and Democratic Policy Making: The Deceptively Fragile Consensus around Market-Oriented Medical Care,” Journal of Health Politics, Policy and Law 27 (2002): 889925.CrossRefGoogle Scholar
Laham, N., A Lost Cause: Bill Clinton’s Campaign for National Health Insurance (Westport: Praeger 1996): at 211–213; Skocpol, T., Boomerang: Clinton’s Health Security Effort and the Turn Against Government in U.S. Politics (New York: W.W. Norton and Company, 1996): 163–64.Google Scholar
Glied, S., Chronic Condition: Why Health Reform Fails (Cambridge, Harvard University Press, 1997): 93101.Google Scholar
Blake, and Adolino, , supra note 78, at 683.Google Scholar
See Minah, K., Blendon, R. J., and Benson, J. M., “How Interested Are Americans in New Medical Technologies? A Multicountry Comparison,” Health Affairs 20, no. 5 (2001): 194201.Google Scholar
Navarro, V., The Politics of Health Policy: The US Reforms , 1980–1994 (Oxford: Blackwell, 1994): 170191.Google Scholar
Gordon, , supra note 78, at 298.Google Scholar
Navarro, , supra note 103, at 190; Blake, and Adolino, , supra note 78, at 686.Google Scholar
Gordon, , supra note 78, at 279–280.Google Scholar
Gordon, , supra note 78, at 281–284.Google Scholar
Starr, P., The Social Transformation of American Medicine (New York: Basic Books 1982): 249251; Gordon, , supra note 78, at 275–276.Google Scholar
Hacker, & Skocpol, , supra note 92, at 189; Skocpol, , supra note 99, at 153–157.Google Scholar
See Lieberman, T., Slanting the Story: The Forces That Shape the News (New York: New Press, 2000).Google Scholar
Gordon, , supra note 78, at 297.Google Scholar
See e.g. Evans, R. G., “Going for the Gold: The Redistributive Agenda Behind Market-Based Health Care Reform,” Journal of Health Polities, Policy and Law 22 (1997): 427465; Evans, R. G., “Tension, Compression, and Shear: Directions, Stresses, and Outcomes of Health Care Cost Control,” Journal of Health Politics, Policy and Law 15 (1990): 101–128, 102–104.CrossRefGoogle Scholar
Laham, N., supra note 99, at 206.Google Scholar
See Steinmo, and Watts, , supra note 84, at 364.Google Scholar
See e.g. Tuohy, , supra note 84, at 40 (U.K.); Tuohy, , supra note 84, at 53 (Canada).Google Scholar
See Harris, R., A Sacred Trust (Baltimore: Penguin, 1969).Google Scholar
Gordon, , supra note 78, at 255: Laham, , supra note 99, at 208–210.Google Scholar
Laham, , supra note 99, at 208–10; Hacker, and Skocpol, , supra note 92, at 186, 189.Google Scholar
Gordon, , supra note 78, at 211, 257; Skocpol, , supra note 99, at 134–39.Google Scholar
Jost, , supra note 3, at 72, 205–06.Google Scholar
This also happened in the United States when the Medicare program was created in 1965, and private insurers were brought in as carriers and intermediaries to operate the program. Health insurance coverage of the elderly was thin enough at that time, however, to make this strategy possible.Google Scholar
Skocpol, , supra note 99, at 138–39; Tuohy, , supra note 84, at 155Google Scholar
See Letter from Holtz-Eakin, Douglas, Congressional Budget Office, to Representative Jim Nussle, Chairman, House Budget Committee (Feb. 2, 2004), at <http://www.cbo.gov/showdoc.cfm?index=4995&sequence=0> (last visited June 2, 2004).+(last+visited+June+2,+2004).>Google Scholar
Indeed, an attempt to use Boolean Analysis to test the power of these hypotheses found that all of them seemed to contribute to the explanation, though it found the veto points hypothesis most powerful. It also found, however, that the United States is the only country where all of the obstacles to change discussed above coexist, and also the country in which all but one of these factors was most unfavorable to reform. Blake, and Adolino, , supra note 78, at 699–670.Google Scholar
Tuohy, , supra note 84, at 6, 123–124.CrossRefGoogle Scholar
Id., at 6–7, 123.Google Scholar
Ritter, , supra note 6.Google Scholar
Tuohy, , supra note 84, at 38–41.Google Scholar
See European Observatory, Health Care Systems in Transition: Spain (London: European Observatory, 2000): 1214; European Observatory, Health Care Systems in Transition: Portugal (London: European Observatory, 2000): 1999.Google Scholar
Björkman, J. W. and Okma, K. G. H., “Restructuring Health Care Systems in the Netherlands: The Institutional Heritage of Dutch Health Policy Reforms,” in Altenstetter, C. and Björkman, J. W., eds., Health Policy Reform, National Variations and Globalization (New York: St. Martin’s Press, Inc., 1997): at 79, 81.Google Scholar
Mamor, T., The Politics of Medicare, 2nd. Ed. (New York: Aldien De Gruyter, 2000).Google Scholar
Hacker, and Skocpol, , supra note 92, at 199.Google Scholar
Hacker, and Skocpol, , supra note 92, at 193; Skocpol, , supra note 99, at 173–178. The recent adoption of a prescription drug benefit for Medicare would seen to contradict this, but so much of the benefit of that legislation goes to special interest groups, most notably drug companies and managed care organizations, that it is perhaps better viewed as special interest legislation than as a social program expansion.Google Scholar