Nine takeaways for the US from other health care systems

Dylan Scott at Vox traveled to Taiwan, Australia and the Netherlands to gain a better understanding of their health care systems and how they differ from ours. Here are his nine takeaways.

1. The US is the only developed country that is not committed to universal health care.

Unlike Taiwan, Australia, the Netherlands and the UK, policymakers in the US have not reached consensus that the federal government should guarantee everyone in the country access to health care, much less that health care should be affordable to all.

2. There’s no perfect universal health care system.

Every other developed country covers everyone, and their residents pay far less for their care than we do in the US. Still, some countries do not have enough health care providers and costs are rising.

Australia recently adopted a two-tiered system, offering everyone public health insurance and those who can afford it, private insurance. The government is investing a lot of money in the private system. As a result, there is less needed funding for the public system. Also, there are longer wait times for people in the public system.

Meanwhile, the Dutch system now relies on private insurers which has driven up health care spending. Administrative costs are higher, deductibles are now almost $500, and health care is less affordable for people.

3. Governments spend a lot to guarantee their citizens health care. 

In other countries, governments negotiate health care prices, set rules for what is covered and when and how much people can be charged for copays. Private insurers are really claims processors, without the liberty to decide how care is covered, unlike in the US, where they must each negotiate their own rates and have tremendous freedom to restrict access to care and set copay amounts.

4. To ensure health care affordability, governments impose cost controls.

Some countries rely on global budgets–they set aside a fixed amount to pay for health care each year. The Australian government sets prices for doctors’ services. And, Australia has a system for evaluating whether a prescription drug offers value.

Moreover, governments tend to rely on national electronic health records databases to see what’s working and not. Governments determine what care is covered, at what price, and how much patients will pay for their care. Insurers operate more like claims processors. They cannot set their own rules.

5. Many countries are struggling to deliver and cover long-term care.

Long-term care costs for older adults and people with disabilities are growing. And, it’s not clear whether and how countries will deliver the care people need or help to cover the costs of long-term care.

The US government today spends far less on long-term care than every western European country except Portugal.

6. Private insurance is sometimes part of the health care system, but with lots of controls and challenges.

Scott sees private insurance as a political compromise in other countries, not a policy solution.

The insurance industry has a lot of financial and political power to sway policy in their favor. In Australia, private insurance gives people with means more health care choices, but it has hurt everyone else to some degree.

7. Physicians will never be completely happy with a universal health care system.

Curiously, in every country almost twice as many doctors or more are satisfied or very satisfied with their health care system than are dissatisfied or very dissatisfied. Only Germany has less doctor satisfaction (63 percent) than the US (65 percent) and more dissatisfaction (36 percent v. 34 percent). Norway had the highest doctor satisfaction (91 percent), with Australia close behind (88 percent).

8. Health insurance coverage is not the same as guaranteeing people the health care they need.

Health care delivery system reforms need to be part of the picture if you want everyone to have access to care. Coverage is not enough. For example, some underserved regions might need hospitals or specialists. Or, as in the Netherlands, doctors might be required to provide care during the evening and weekends and make home visits. To share the load, doctors formed cooperatives.

9. What works in the US might be different from what works in other countries.

The US effectively has more than 50 health care systems. It has one for people with Medicare, one for people with Medicaid, one for Vets, and one in each state. And, the US has substantial racial disparities in our health care system.

Health care in the US varies depending upon which system you are in, your race and your ability to pay. And, it is profoundly inequitable. So long as policymakers are beholden to the corporate health insurers, it’s not likely much will change.

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