reform of US health care

Jeffrey S. Flier, dean of the Harvard Medical School, advocates a cautiously conservative reform of US health care. His main recommendation is to extend the tax subsidy for health insurance, currently limited to employers, to everyone. This measure, according to Flier, “would enable the uninsured to use tax-sheltered money to buy health insurance for themselves” and give insured employees the freedom to choose their insurance provider. I see at least three problems with such a policy. First, it does not address the very serious problem of the high cost of US medical care. Second, it provides no help for the unhealthy, who find it impossible to purchase personal insurance at affordable rates. Third, most of the benefits accrue to those with high incomes: tax shelters are of little or no value to those with little or no taxable income.

Harvard economist Greg Mankiw posts an excerpt and a link to Flier’s article, but fails to mention that the online journal that published Dean Flier’s views contains a number of articles on health care reform in its current issue. One of these, authored by Professor Marc Feldmann of the Imperial College School of Medicine in London, UK, offers an international perspective. Here is an excerpt:

American medicine has much to be proud of. …. But there are also problems on a huge scale, which means that the US’s world-leading health expenditure (16% of GNP) is delivering health care that is worse than in much of Europe in terms of clearly analyzable indicators, such as infant mortality or length of life. European countries like the UK typically spend 8%–10% of GNP on health care. ….

The lower-percentage cost of health care in Europe covers all the population, while the US’s 16% still leaves 45 million uncovered. Clearly there is an unanswerable case for major reform in order to deliver value for money, not just for the lucky ones able to avail themselves of the best hospitals, or of quality cancer care, but for all the population. The humanitarian principle — quality health care for all — that the European nations have espoused, though practised in different ways, leaves none of the population disadvantaged and uncovered. ….

[T]here are proven ways of delivering health care that is both cheaper and better for most of the population than the current style in the US. There is no need to look across the Atlantic, where cultures are different. Just look closer, north, to Canada. The Canadians are all insured, there are no health care bankruptcies, and they live longer than in the US.

Marc Feldmann, “A view from a European medical academic who spends time in the US“, Journal of Clinical Investigation,  published online 10 September 2009.

Professor Feldmann is overly optimistic. Even the Canadian single payer system — socialized health insurance with private provision of medical care — is too radical a model for many US policymakers. Switzerland’s system of universal health care could be a more attracive model. All Swiss residents by law must purchase private insurance, selected from more than 30 insurance companies, which gives them access to their choice of private medical care. The system works well, but requires tight government regulation and generous subsidies for those with low incomes.


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