What Obama Can Learn from European Health Care (Part I)

Imagine a place where doctors still do house calls. When I was visiting my friend Meredith, living in the small rural town of Lautrec about an hour's drive outside Toulouse, France, one day she was stung badly by a wasp, causing a sizable and painful swelling on her hand.

She called her doctor, and to my great surprise within 15 minutes he had shown up at her door — the famous French doctor's house call. I couldn't get over it. "House calls in the United States went out when Eisenhower was president," I told her, shaking my head.

My father-in-law had a similar experience while vacationing in Switzerland. He awoke one morning with what turned out to be a painful urinary tract blockage. The doctor paid a house call with hardly any wait at all and inserted a cleverly designed catheter that had no drainage bag.

Even though he was a foreigner, my father-in-law paid out-of-pocket only $100 for this emergency service. Back at home in Minneapolis when he had to go to the emergency room a couple of years later, he waited nearly nine hours to receive medical attention, even though he had health insurance.

A U.S. expatriate living in Belgium told me that both he and his sister in Minneapolis had a procedure called a catheter ablation of the heart to eliminate an irregular heartbeat. Even though she had full medical coverage provided by her employer, she spent $2,400 out-of-pocket for the procedure which was performed as an outpatient surgery under a mild sedative.

For the same procedure in Belgium, he paid just under $100 and received full royal treatment, including two nights in the hospital for observation and post-op recovery.

The medicine he now needs to take costs him about $4 for a three-week supply. In the United States that same medicine costs his sister $19 — nearly five times the price in Belgium.

Even the moderately poor and formerly communist countries in East and Central Europe have universal health care. In the Czech Republic, when the government wanted to introduce a co-payment of less than $2 per office visit, it nearly toppled the government because health care is viewed as a basic right and an integral part of the nation's social contract.

What is truly disturbing, given the vast outlays for health care in the United States, are the various health indicators showing the country’s poor performance.

Whether one looks at infant mortality, life expectancy, the number of physicians, hospital beds, medical errors or high out-of-pocket expenses, America underperforms to a shocking degree. Consequently, the World Health Organization (WHO) has ranked the United States 72nd of 191 countries for "level of health."

And it ranks 37th for "overall health system performance" — just behind Costa Rica and Dominica and just ahead of Slovenia and Cuba, countries with a fraction of the economic wealth of the United States.

France and Italy, which have universal health care coverage for all their residents, even recent immigrants, were ranked first and second in the WHO listing. Most other European nations, who also have universal coverage for all, also were ranked near the top.

Yet despite this difference in performance between U.S. and European systems, somehow Europe manages to spend only a fraction of what the United States spends on health care.

According to the WHO, the United States spends 16.5% of its GDP on health care, or about $6,100 per person. This compares to an average of 8.6% in European countries. France does it for far less, spending just $3,500 per person, or 10.7% of its economy.

Says Dr. Christopher Murray, director of the WHO's Global Program on Evidence for Health Policy, "Basically, you die earlier and spend more time disabled if you're an American — rather than a citizen of most other advanced countries." That's a highly unsatisfactory state of affairs for the world's lone superpower.

How do the French, Italians and other European countries do it? How do they manage to provide better health care than most Americans receive for about half the per capita cost? While there are differences from nation to nation, there also are some broad generalities to point to, as well as national specifics.

These give us a pretty good snapshot that should be instructive to the Obama Administration as it grapples with the inefficiencies that are continuing to hurt American workers, businesses — and increasingly will hurt U.S. competitiveness in the global economy.

Editor’s Note: Part II of this feature will be published on The Globalist tomorrow.