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Paul Hauck

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Paul Hauck: U.S. health care not ‘best in the world’

In response to the op-ed piece, "Single-payer health care won't work" by Rich Ulery, he offers reasonable, if somewhat out of context, criticisms of the health care financing models used by Canada and the United Kingdom.

He ends his piece by calling the American medical system "the best in the world."

That is a difficult statement to justify. It is hard to find any broad, objective measure of health care provision on which the United States outperforms every other nation. Indeed, the World Health Organization's Index lists the U.S. at 37th place while Canada and the U.K. rank 30th and 18th, respectively.

Forbes magazine reports that a study done by the Commonwealth Fund rates the U.S. last out of 10 comparable countries in quality of health care on a composite of measures of quality, access, efficiency, equity, and "healthy lives" (a measure based on such factors as infant mortality and healthy life expectancy at age 60).

Being the exceptional nation we are should not preclude us from learning from other’s successes.

These and other similar findings are all the more perplexing given that the U.S. spends more per capita on medical care than all other countries, save two. Further, our approach has, prior to the Affordable Care Act, left up to 47 million people without any access to affordable care.

I would suggest that our difficulty resides in our financing structure. According to the Bloomberg Health-Care Efficiency Index, the U.S. health-care system ranks 50th out of 55 nations in efficiency because it "tends to be more fragmented, less organized and coordinated." Our system of financing health care was never designed strategically. It is a "Rube Goldberg" contraption that includes elements of socialized medicine (Veteran's Administration, military systems, the Public Health Service), single payer (Medicare and Medicaid), employer-based funding, individual insurance, and private pay.

Late in the last century two highly industrialized, strongly capitalistic nations found themselves facing sky-rocketing health-care costs. They each went about systematically assessing health-care financing systems and completely redesigned their approach. Both nations were focused on finding an approach that would provide all of their citizens with access to good, basic medical services in as efficient a manner as possible. Both rejected the American approach.

Switzerland, fiercely capitalist in spirit, chose a market-based approach. It was based on the ideas first promoted by our Heritage Foundation in the early 1990s. This plan was based on an "individual responsibility mandate" and was the basis for the Massachusetts plan and the Affordable Care Act. It left in place the medical delivery system but changed its financing by doing away with all employer-based and government paid financing.

Their new system requires every citizen to purchase a private policy that covers government-defined "basic services." Government subsidies assist lower income individuals on a sliding scale. Insurance companies must charge the same regardless of the patient's age, must cover pre-existing conditions, and must operate as non-profit organizations, thus removing the conflict of pitting profit against quality of patient care. This has resulted in 99.5 percent of the population being covered, has put the insurance companies in the position of competing on the basis of service and efficiency, and has provided essentially unlimited physician choice.

Taiwan chose a different path. They analyzed the policies of 10 nations in depth in an attempt to amalgamate the best features of each. They opted for a single-payer system, covering all citizens, modeled after our Medicare program. It is funded by taxes paid by employers and employees, for those in jobs, flat monthly fees for those self-employed, and government subsidies for those unable to pay.

This system's efficiency has been greatly improved by use of a chip-embedded health "smart card." This contains the patient's history and eliminates unnecessary duplication of tests, over prescription of medications, and poorly coordinated treatments. The charge for a medical cost is then automatically sent to the insurer for electronic reimbursement.

There are as many ways of financing healthcare as there are nations striving to do so. What is clear is that ours is among the least efficient and most inequitable. My fear is that the cacophony of voices from ideologues on the right and left, those motivated by profit at the expense of the nation's health, and those who benefit from promoting controversy and animus over rational discourse will prevent us from making a rational appraisal of this most important issue.

Being the exceptional nation we are should not preclude us from learning from other's successes.

Paul Hauck, PhD, is a retired pediatric psychologist who lives in Penn Valley.