With the amount of misinformation and deliberate distortion that characterizes the American discussion of health care reform, it is no surprise that it has tended to devolve into little more than a shouting match. In the process, both extremes seem to have lost any grip they ever had on reality. This is especially true when many American commentators invoke the failings and successes of health care systems in other countries.
Perhaps the greatest and most prevalent fallacy about health care overseas is the enduring myth of the ‘European health care system’ where treatment is free. First, Europe is a continent with more than two dozen countries – and just as many health care systems. Second, single-payer, government-run systems are only one end of a continuum that runs all the way to systems that are highly market based systems, arguably more so than that of the US.
Countries with government single-payer health care include: the UK, Portugal, Spain, Italy, and the Scandinavian countries. The Republic of Ireland is single-payer but with a substantial private sector. The UK is actually somewhat unusual in that the government owns the public providers as well as paying for care, in many single payer systems doctors and hospitals are at least partially private.
France is often labeled a single-payer country but in fact it has a two-tier mixed system. The French are charged a payroll tax that funds basic coverage for everyone that is administered through quasi-private insurers, not through a government bureaucracy. Most people also buy separate supplementary coverage. Doctors and hospitals are private and patients have full choice. Belgium is similar.
Germany administers health care through private (but nonprofit) insurance companies and is paid for through premiums deducted from payroll. There is also a private insurance system in which about 10 percent of Germans participate. Recent reforms, however, are introducing more of a role for government. Austria has a similar system.
The Netherlands and Switzerland have market driven systems which use a philosophy called ‘managed competition.’ Coverage is purchased from primarily nonprofit insurance companies, via work in the Netherlands and by individuals in Switzerland.
The rampant confusion about what these systems look like seems to stem from a tendency to elide universal coverage and single-payer. It makes sense to look to other countries, especially when most any strategy Americans are considering has been tried somewhere, but if policy wonks and politicos, never mind the population, cannot do the most cursory of research, than they squander those lessons.
The ‘European healthcare system’ may be imaginary, but the consequences of believing in it aren’t.
