OP-ED

Why Health Care Reform Is So Difficult in the United States

Humphrey_Taylor_HIWhy is it so hard to change the American health care system? And so much easier to change other countries’ systems?

I pondered this question recently while attending the Commonwealth Fund’s International Symposium on Health in Washington where our latest survey comparing primary care in eleven countries was discussed. I heard presentations describing changes that have been, or are being, implemented in England, France, Germany, Norway, Sweden, Switzerland, the Netherlands, Canada, Australia and New Zealand. In some cases, these are fundamental reforms in how medical care is delivered and how providers are reimbursed. Many of these countries can demonstrate real improvements in the quality of care and efficiency in their systems.

Evidence of how much more difficult it to improve this country’s system is provided by the OECD data from nineteen countries on the number of “deaths amenable to medical care,” that is deaths that could have been prevented by appropriate medical care. It is bad enough that the United States has dropped to last place – with the highest proportion of preventable deaths – of all nineteen countries measured. The data also show that all the other eighteen countries had lowered the number of preventable deaths over five years by much more than this country’s modest 4% improvement.

I would suggest that all of the following are reasons why it is easier, in some countries much easier, to reform their systems than it is to change ours:

  1. Their systems are so much simpler. Ours is much more complicated with our “thousand points of payment,” Medicare, Medicaid, Kaiser, the VA, the Mayo Clinic, HMOs, PPOs, and millions of employers and their different health plans.
  2. They already have universal coverage, so they can focus on improving quality, efficiency and cost containment without a huge ideological debate about the roles of government and the private sector.
  3. They have parliamentary systems, where their governments can usually win the votes of a majority of legislators and only a simple majority is needed. It is much, much harder for an American president to win enough votes in both houses of Congress, including a filibuster-proof sixty votes in the Senate, for controversial new legislation.
  4. Lobbies, representing special interests, are much more influential in this county.
  5. The power of money; elected officials in most other countries do not have to raise larger sums of money for their campaigns, and are therefore much less beholden to industries or professional groups.
  6. They only need a bare majority of votes in their legislatures. None of them have anything like the US Senate’s ability to filibuster.

Another factor that may also make a different is the influence of partisan news networks, especially Fox News, and of talk radio, that spread emotional and often misleading arguments, fuel populist feelings and dumb down the debate.

I should note here that the ease with which parliamentary systems can enact major reforms is not always a good thing. After World War II, Britain’s Labour government nationalized its substantial steel industry. It was then privatized (i.e. denationalized) by the next Conservative government, nationalized again in the 1960s and then denationalized in the 1970s – by which time it had been almost wiped out.

However, when we look at the difficulties our presidents since Theodore Roosevelt have had when trying to pass major health care reforms, one wonders if the uniquely American barriers to change and reform are really desirable.

Livongo’s Post Ad Banner 728*90

Categories: OP-ED

Tagged as: ,

37
Leave a Reply

37 Comment threads
0 Thread replies
0 Followers
 
Most reacted comment
Hottest comment thread
26 Comment authors
401 kHealth care workerHealth InsuranceGary Lampmansomaie Recent comment authors
newest oldest most voted
401 k
Guest

401 k
The workers have the freedom to decide how much moolah will be deducted from their checks and deposited into price savings account.

Health care worker
Guest
Health care worker

I totally agree that our system is exteremly complex. We have a lot of middle-mens to increase overhead, who suck up individual’s money and then lobby, using that money, against rightful decisions like health care reform. The $$ spend on trying to prevent healthcare reform could have helped millions of needy people. We are so bogged down by legislation that we do not even think of cost or quality of care. It is almost time to pass health care reform..something will be better than nothing.

Health Insurance
Guest

all ethical decision making is structured around values. In order for universal health care to be embraced by all citizens in the United States, they will first have to agree to the collective value of equity and fairness and embrace the goal of meeting their collective responsibility to each other while maintaining individual rights and freedoms. That may prove to be the most difficult obstacle of all.

Gary Lampman
Guest
Gary Lampman

Oh, No special treament for the Rush Linbaugh who has put a Free advertising plug in for the Industry. Tort Reform is not the issue as only 1 to 5 %percent of lawsuites proceed with any rewards. These are the most serious Cases of Medical Error that end in a lifetime of infirmity, Disability and Death. Tort Cases are the ONLY means of accountability! Otherwise, the patient would bare the insurmountable costs of Medical Error. The problem is,neither the doctors or the institutions want to be Held accountable for anything that may happens. If it be Medical Error or Hospital… Read more »

somaie
Guest
somaie

Often we forget the little guy, the SMB, in our discussions of the comings and goings of the Internet marketing industry. Sure there are times like this when a report surfaces talking about their issues and concerns but, for the most part, we like to talk about big brands and how they do the Internet marketing thing well or not so well.
http://www.onlineuniversalwork.com

Stephen
Guest

Sure, those reasons contribute to the difficulty of passing healthcare reform in America. Let me add to that list, getting a bit more broad: 1) Health benefits are paid with pre-tax dollars. This disrupts the labor markets and puts certain groups at a disadvantage. It also encourages Cadillac plans. Regardless of what people say, fact is that Cadillac plans encourage excessive health demand and consumption that do not contribute at all to health outcomes. I can go on and on regarding this topic, but details are beyond the scope of my argument in this particular instance. 2) Roughly two-third of… Read more »

calcium
Guest

Hello
This is a good post and I came to know so many new things about American health care system.You have given good reasons about it and I think every one would agree with it.Thank you very much for such informative post.

Doc Wally
Guest
Doc Wally

There are those who have argued, with erudition, that pervasive dislike of African Americans by Caucasians is a powerful impediment to health care reform in this country.

Margalit Gur-Arie
Guest
Margalit Gur-Arie

MD as HELL, I do agree with you that legislative measures that force people to purchase a particular product from a private entity is most likely unconstitutional and I sincerely hope that somebody brings this to the Supreme Court. BTW, this is not the first mandated government interaction by virtue of birth and citizenship, the draft is, but there are no constitutional issues there. The obvious solution, if we indeed want to provide universal care, is some form of taxation and I know we are in disagreement whether we should do that or not. Yes, the founders had a vision… Read more »

exhaustedMD
Guest
exhaustedMD

I read this piece and a good portion of the comments, and can only offer this, as a psychiatrist who has been thoroughly wiped out by all the intrusions into my specific specialty these past 15 years: when you triangulate a 2 person relationship, ie doctor-patient, by third parties like insurers and other administrative organizations, the relationship is doomed. I once wrote a letter to the editor of my local newspaper back in 1996 after a story about the behaviors of managed care and noted in it: “take the F-O-R out of profit in health care and better care might… Read more »

Che
Guest
Che

“They already have universal coverage”. -What do you do when life gives you lemons? “Another factor that may also make a different is the influence of partisan news networks, especially Fox News, and of talk radio, that spread emotional and often misleading arguments, fuel populist feelings and dumb down the debate”. – I knew it! There is no freedom of speech in said countries. So sad. Apparently there is only what the government wants you to believe. What about the oh soo [NON]partisan? “news” networks like MSNBC,NYT,CNN et al? Just because they hold liberal views doesn’t inherently make them innocent… Read more »

Nate
Guest
Nate

LsnNLrn, great point, the federal government already took over all student loans, is it that hard to imagine they only provide loans if you study a field they approve? Maybe they start rationing degrees and only allow so many of each? Sorry we don’t have any loans left for history why don’t you try medicine instead. They also have taken over the small business buisness loan market, if you dare try to open or run a business sans the education they think you should have they will just prevent you from borrowing money. This is what happens when you trust… Read more »

Jack E Lohman
Guest

Nice try folks. There is but one reason: a corrupt congress, owned lock stock and barrel by the insurance industry. But worse, by other industries as well. Only public funding of campaigns will return congress to the people, and for $5 per taxpayer per year it’d be one terrific bargain.

DeborahB
Guest
DeborahB

I hope that none of the writers who are so sure that we don’t need healthcare reform ever get sick, or old – and uninsurable. Not all of us can get insurance from employers and not all of us are well enough to work. And for those of us in those categories, private insurance is often unaffordable even if available. Our healthcare system is an embarrassment. And it is a right. I equate it to knowing the police will come if you are assaulted, or that the fire department will come if your house is on fire. You should be… Read more »

LsnNLrn
Guest
LsnNLrn

Healthcare is not a right, it is a service. By nature, our healthcare is dependent upon someone else to render the service of their expertise. Healthcare as a “right” to all citizens would suggest that there is, and always will be, healthcare personnel to provide us our “right” to care. An absence of healthcare professionals would mean that our “right” to healthcare would be restricted. Is the next legislative bill going to force citizens to start a career in a health related field so that we can have our “right” to healthcare? Something cannot be a right if it is… Read more »