August 19, 2009 / 12:35 PM / 9 years ago

No such thing as a perfect health system

LONDON (Reuters) - Transatlantic mud-slinging over healthcare conceals a simple reality that no country has yet a found a perfect system for helping the sick.

St. Thomas's Hospital is seen behind a British union flag in London August 16, 2009. British political leaders set aside their differences this week to defend the nation's health service against an onslaught of criticism from Americans who oppose reform of their own healthcare system. REUTERS/Toby Melville

U.S. critics of healthcare reform point to Europe as an example of why they oppose President Barack Obama’s fight to rein in costs, constrain insurance companies and expand health cover to most of the 46 million Americans who are uninsured.

Although Obama has never proposed a system akin to Britain’s, where a single payer — in this case the government’s National Health Service (NHS) — picks up the cost, critics have been cranking out broadcast advertisements painting European systems as expensive socialized medicine which rations both care and lives.

It is true that Americans trawling Europe’s differing forms of universal care for tips on overhauling their system will pick up plenty of gripes from patients and doctors.

Yet Europeans still show overwhelming support for the principles underpinning the continent’s various programs of mandatory coverage, first pioneered by Germany’s Iron Chancellor Otto von Bismarck more than a century ago.

“There is no perfect health system,” said Anna Dixon, director of policy at Britain’s independent healthcare think-tank The King’s Fund. “Most health systems are trying to reach the same objectives, but we all do it in different ways, and part of that is to do with our history.”


Figures suggest Europeans get more bang for their healthcare buck, since overall health outcomes are better despite much lower spending than in the United States.

But while European systems boast more solidarity between the sick and the healthy, where healthy people are willing to shoulder the costs of maintaining adequate healthcare for all, they are increasingly strained by rising drug and hospital costs and aging populations. The result is a continuous process of reform which produces a patchwork of policies in countries like Germany, France and Britain as governments strive to realign healthcare to a more complex and costly era of medicine.

“All governments around the world face significant budget constraints,” said Peter Cornelius, an economist at private equity firm AlpInvest in Amsterdam.

“And from a structural point of view, governments also face higher social welfare costs, including health costs, from a graying population. When you combine the two, governments in the U.S. and Europe face huge budgetary challenges.”

Some Americans opposed to reform say Britain’s NHS system is tantamount to socialism, without noting that UK primary care doctors operate to a large degree as private businesses.

Analysts, and Obama himself, say such claims are scaremongering.

“The universal healthcare systems in developed countries around the world are not nearly as ‘socialized’ as the health insurance industry and the American Medical Association want you to think,” said T.R. Reid, an author and Washington Post writer, in a new book “The Healing of America” published next week.

According to the Organization for Economic Cooperation and Development, the U.S. ranks with Turkey and Mexico as the only OECD nations that do not get close to universal health coverage.

The data also show the costs. At 16 percent of its gross domestic product (GDP), the amount of money spent on U.S. healthcare is almost twice as much as in Britain and Spain and substantially higher than Germany or France.

European countries, meanwhile, consistently rank higher than the United States on a range of health measures, including life expectancy at birth, infant mortality and “amenable” mortality — deaths that can be averted by good healthcare.

Certainly Britons have been swift to defend their system, keen to fend off outside attacks on an NHS they moan about almost constantly themselves.

A former finance minister, Nigel Lawson, once said the NHS was “the closest thing the English have to a religion” — and the manifestation of that has seen thousands join an online “welovetheNHS” Twitter campaign.


But the rallying cries cannot drown out the hard truth that access to healthcare is restricted everywhere.

“There are not unlimited resources in any country to fund unlimited amounts of healthcare for everybody,” said The King’s Fund’s Dixon.

U.S. “rationing” is a function of each person’s ability to pay, whereas for much of Europe it is imposed largely on a treatment-by-treatment basis, with some therapies deemed simply too expensive for the public purse.

Europeans note the irony of the latest U.S. attacks, knowing that their own efforts to grapple with rising healthcare costs have forced them to pinch a few ideas from across the Atlantic.

In France — which the World Health Organization ranks as number one for healthcare performance — mounting deficits on insurance programs have forced the introduction of U.S.-style “co-pays” on care.

There are also cutbacks in services that remind some French people of NHS-style rationing.

Analysts dismiss suggestions that Obama is trying to superimpose the NHS on America, but say he is right to seek out a few tips from Europe for cheaper, broader healthcare.

The combination of a fresh administration with a recession that is making more Americans too poor to afford healthcare has created what Dixon described as “a perfect storm for reform.”

“The U.S. healthcare system is too expensive even for the America economy to fund and there are many, many people who don’t have adequate access to healthcare,” she said. “So, we’ve have got to hope that he can at least extend coverage.”

Editing by Sonya Hepinstall

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