Tuesday, March 2, 2010

A Health Care Success Story (??)

Whenever we talk of ‘socialized’ medicine systems, opponents of those systems refer to Canada and the UK’s system to illustrate the shortcomings of a governmental health care program. However, Canada and the UK’s system are but two examples. Proponents of government health care inevitably point to the ‘successes’ of various socialized systems as their basis for having a socialized system that works. In the interest of fairness, let’s take a look at the gold standard of government-run health plans as determined by the World Health Organization. In 2000, the WHO recognized France’s system as the number one health care system in the world.

The truth is that France has had continual challenges in balancing their health care budget and has made incremental changes for the last three decades, including SIX tax increases specifically for health care while reducing benefits and increasing out-of-pocket costs. In 1990, general revenue taxes supplied 7% of French health-care expenditures. By 2003, the general revenue figure had ballooned to 40%, with no end in sight. The French national insurance system has been running constant deficits since 1985. Since the WHO report, some of the changes implemented to help contain costs have been steadily increasing fees, reducing reimbursements to both health care providers and patients and facility closures. Ironically, France is borrowing ‘Western’ health care ideas to contain costs. In 2004, France had a number of far-reaching reforms, including coordination of care through one ‘primary’ physician who must be consulted first before going to a specialist. Failure to do so results in reducing the reimbursement to the patient by almost 57% ! France currently spends the most of any European country as a percentage of its GDP (11%) compared to the U.S.’s 17% and it continues to grow. Without drastic action to contain costs, France’s system could face bankruptcy as evidenced by France’s Prime Minister Francois Fillon, who stated “The truth is that I am the head of a state that is in a state of bankruptcy due to its financing plan.”

While cost continues to be the biggest challenge affecting every country’s health care, perhaps the most telling is the general health of the underlying population. Opponents of free market health care routinely state that the U.S. spends the most on health care but has poorer outcomes, living on average two years less than our French counterparts. Is this a result of our health care system or Americans’ choices ? The answer may surprise you. Seventy-four percent of health care spending in the U.S. is directly related to preventable conditions such as heart disease, diabetes and cancer. Obesity is the main cause of the first two, smoking and other lifestyle choices account for a large part of the third. Why does U.S. health care cost so much more than France’s with lesser outcomes ? Consider that the U.S. leads the world in obesity with over 30% of its population considered clinically obese. It is generally accepted that two thirds of Americans are either overweight or obese. Compare that to less than 10% of France’s citizens being clinically obese. So, is it that difficult to understand that treating 90 million sick Americans costs more than treating 7 million French citizens ? Another factor is America’s lawsuit-happy culture. While malpractice claims themselves account for a negligible percentage of health care spending, the fear of malpractice leads to wasteful and redundant practices that are estimated to be as much as $60 billion a year (or 3% of overall medical spending). Malpractice cases in France are brought before their regions' government-appointed review board that determines how much compensation (if any) should be paid out of a national compensation fund

Simply because something works in another country is no basis for implementing the same program in America. Demographics and cultural differences account for the majority of America’s health care problems. It’s not the failure of the U.S. style of health care that is responsible for our system’s high cost and lower outcomes. It may not be popular, but the real blame lies with the American people’s lifestyle choices. While American’s certainly have the ‘freedom’ to choose their own lifestyle, they should understand that with freedom comes responsibility for the choices they make. It is not the fault of corporate America or American’s health care providers for American’s health care woes. It’s always easier to point the finger of blame outward than it is to look in the mirror.

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