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Taking The Pulse of “healThcare for all” around The World
“The test of our progress is not whether we add more to the abundance of those who have much, it is whether we provide enough for those who have little.”
— Franklin Delano Roosevelt
There are more than 200 recognized countries in the world and close to 60 of them pro- vide health care for every one of their citizens. Regardless of income or ailment, they offer equal access for all. The United States is not one of them. So what does universal healthcare look like and where and how in the world is it working?
In the US, talk of universal healthcare is cringe-worthy to many as the subject immedi- ately evokes images of socialism and other forms of government and economics distasteful in the mouths of pure free market capitalists. But, around the world, there are examples of countries with health care systems that do a better job of providing for everyone and many of them do it for a fraction of US costs, too. Most of them are not countries Americans would otherwise see as socialist.
In comparative global health statistics, the US does not fare well. In 2010, the US was still spending 17.1% of its Gross Domestic Product (GDP) on healthcare, the most of any industrialized nation. By 2016, it was up to 17.8%. However, average life expectancy in the US at 78.8 years ranks lowest among 12 comparable countries with similar GDP and income averages according to the Kaiser Family Foundation, a non-profit organization focusing on health issues [].
Infant mortality in the US, another measurement used to determine the overall health of a nation, ranks at 169 worldwide (the higher the number, the better the ranking), right between Serbia and Boznia and Herzegovina according to the World Factbook published by the CIA [].
In 2016, London-based think tank The Legatum Institute, released its 10th annual global Prosperity Index report. It’s a vast survey that rates the most prosperous countries in the world, with access to healthcare being an important factor in determining a nation’s rank. The US did not make the top 20. In fact, the report states that “21 percent of Americans are dissatisfied with their standard of living. This is more than twice the percentage in Ger- many.” Germany ranked number 10 in the institute’s report.
By some estimates, including a 2009 Harvard study, as much as 60% of personal bank- ruptcies filed in the US are due to medical bills. This number has recently begun to decline, possibly due to both changes in bankruptcy laws and the Affordable Care Act, the sweep- ing health insurance reform implemented in the US in 2013.
Even though the systems in other industrialized democratic nations may not be perfect, there are a number of them that are doing at least something better than what we are do- ing in the US.
In his book The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care and the 2009 PBS documentary Sick Around The World, journalist T.R. Reid looked at healthcare systems in other countries including Great Britain, Japan, Germany, Taiwan and Switzerland which all provide some form of universal health coverage. All of these countries are politically viewed as industrialized democracies similar to the US. But, unlike America, a common thread he found among these countries was healthcare is considered a basic human right in each of them.
“The other countries, just like we do, they guarantee the right to vote,” Mr. Reid said in a 2009 US News & World Report interview. “They guarantee everybody a public education if you want it. They give you legal protection if you are charged with a crime. We do all those things too, but the other countries have also decided that everybody has a right to health- care when they get sick. The United States has never made that decision.”
In the United Kingdom (UK), the National Health Service (NHS) was created in 1948. This is the model that many Americans find most troubling. Hospitals are owned by the government and doctors are salaried government employees. Funding for the single payer NHS comes from taxes. There are no fees for care including office visits, hospital stays and most prescription drugs. Because access to medical care is free, Great Britain has become a world leader in preventative medicine.
The NHS is certainly not without problems. Rising costs, staff shortages, care ration- ing and long wait times have plagued the system. Private insurance is available, usually through an employer, though wealthier individuals sometimes purchase it, to obtain sup- plemental healthcare outside the national system. Private insurance can grant quicker ac- cess to elective surgeries and specialty physicians. Only about 11% of UK citizens carry this coverage. In Britain, most private care is delivered by NHS doctors moonlighting with a private practice.
In 2015, healthcare expenditures were 9.8% of the UK’s GDP, just over half of what’s spent in the US. Life expectancy in the UK is more than three years longer than in the US at 82.2. And the UK ranks 190 on the infant mortality scale, significantly better than the US. The UK is 20th on the Legatum Prosperity index. There are no bankruptcies in the UK due to medical expenses.
Germany and Japan have health care systems that are not all that different from ours. Insurers compete for business but there are big caveats in those countries: insurance com- panies can’t make a profit from basic care policies and they must cover everyone.
Germany has a universal multi-payer healthcare system that began in the 1880’s. In Germany, the wealthy can opt out of competing, non-profit private insurance — so-called “sickness funds” — but 90% of the population stays in the system. Private insurers can’t profit from basic policies and companies that do share their revenue with ones that have shortfalls at the end of the year. The health insurance funds are paid through wage taxes to which both the employer and employee contribute equally. Doctors and hospitals negoti- ate annually with insurance companies for fixed- rate payments for services. About half of all hospitals are public while another third are private non-profits. Patients may pay small co-pays for doctor visits and services but there is also a cap on cost-sharing. Private insur- ance policies are available for services not covered by the statutory policies like private hospital rooms, special dental care and even naturopathic and homeopathic medicines.
Germany spends around 11.3% of its GDP on healthcare. The average life expectancy for a German national is 81.2 years, still over 2 years better than their American counterparts. Germany ranks 205 for infant mortality and is number 10 on the Legatum Properity Index. Bankruptcies from medical expenses do not occur.
Japan also uses a system of compulsory insurance that includes government help for the poor. Everyone must join a public health insurance plan either through an employer or a municipal government. Monthly premiums are determined by income level and the
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