What Obama Can Learn From European Health Care (Part II)

The first overriding difference between U.S. and European healthcare systems is one of philosophy. The various European healthcare systems put people and their health before profits — la santé d'abord, "health comes first," as the French are fond of saying.

It is the difference between health care run mostly as a non-profit venture with the goal of keeping people healthy and productive — or running it as a for-profit commercial enterprise.

It's no coincidence that, as the United States tries to grapple with soaring healthcare costs and lack of universal coverage, UnitedHealth Group CEO William McGuire received a staggering $124.8 million in compensation in 2005. He is just one of many grossly overcompensated kingpins of the U.S. healthcare industry.

U.S. healthcare corporations will spout platitudes about wanting to provide good service for their customers, but there's no escaping the bottom line that the CEOs of giant health corporations ultimately are accountable to one small group — their stockholders.

If nothing else, the U.S. healthcare system provides a valuable fable illustrating that corporate profits and affordable, quality universal health care are not a viable mix.

The second major difference between U.S. and European health care is in the specific institutions and practices that flow from this philosophy of "health comes first." Contrary to stereotype, not every country in Europe employs government-run, "socialized medicine."

Unlike single-payer Britain or Sweden, other nations like France, Germany, Switzerland and Belgium have figured out a third way, a hybrid with private insurance companies, short waiting lists for treatment and individual choice of doctors (most of whom are in private practice).

This third-way hybrid is based on the principle of "shared responsibility" between workers, employers and the government, all contributing their fair share to guarantee universal coverage.

Participation for individuals is mandatory, not optional, just as it is mandatory to have a driver's license to drive a car.

These healthcare plans are similar to what Massachusetts recently enacted — but with two essential differences.

First, in France and Germany, the private insurance companies are non-profits. Doctors, nurses and healthcare professionals are paid well, but you don't have corporate healthcare CEOs making hundreds of millions of dollars. Generally speaking, the profit motive has been wrung out of the system.

The second key difference is in the area of cost controls. In France and Germany, fees for services are negotiated between representatives of the healthcare professions, the government, patient consumer representatives and the private non-profit insurance companies.

Like in the U.S. system for Medicare, together they establish a national agreement for treatment procedures, fee structures and rate ceilings that prevent healthcare costs from spiraling out of control. And this is good for businesses because it doesn't expose them to the soaring healthcare costs that have plagued U.S. businesses and created bitter labor strife between business owners and their employees.

So if the United States’ privatized system is at a dead end, which would be better to adopt in the United States, either the single-payer type of Britain, Sweden and Canada — or the shared responsibility system of France, Belgium, Germany and Japan?

Either would be vastly better for most Americans than what the country currently has.

But in talking to different people in Europe in many countries, including doctors, nurses and consumers, I came to the tentative conclusion that the shared responsibility systems seem to offer a few advantages over single payer, including shorter waiting periods for surgery and other procedures.

Generally speaking, their healthcare systems had a better reputation among the people who used them, I found. In fact, it is not uncommon for those who live in single-payer countries like Britain to travel to the shared responsibility countries like France or Belgium.

That way, they avail themselves of certain healthcare services and surgeries because the lines are shorter and the care just as good if not better (individuals from EU member nations have reciprocity to use each other's medical services).

This trend seems noteworthy and worth further investigation. Instead of relying on the assumption that universal health care is synonymous with single payer, U.S. proponents of quality, affordable health care should examine the shared responsibility systems of France, Belgium, Germany and elsewhere.

President Barack Obama, to his credit, is doing what he can in difficult times to extend healthcare coverage to some of the 47 million Americans currently lacking it. Recently he signed legislation, previously vetoed by President Bush, to expand the State Children’s Health Insurance Program (SCHIP), which will provide subsidized health care to up to four million mostly low-income children.

And his fiscal stimulus package included $25 billion for subsidizing 65% of healthcare premium costs for laid-off workers for up to nine months. Yet for many of the unemployed, even that subsidy will not be sufficient to allow them to afford healthcare coverage, an increasing concern as the ranks of the unemployed rise. And none of these measures do anything to bring down the cost of health care, which slowly is crippling the U.S. economy.

Americans love to be number one and win the gold, whether in Olympic skiing, the World Series, Super Bowl or the Tour de France. But I am still waiting for the day when Americans decide they want to be number one in health care. Wouldn't it be grand to beat the French for a change at something that really matters?

Editor’s Note: Read Part I here.