What’s unique to the United States that’s rare in the rest of the developed world?
According to respected economist Uwe Reinhardt, Americans want to have their cake and eat it too. This is why universal coverage is such a contentious issue.
Dr. Reinhardt explains the principle of social solidarity, which means that “health care should be financed by individuals on the basis of their ability to pay, but should be available to all who need it on roughly equal terms.”
There is little of that evident in the United States: “Many Americans oppose such a mandate as an infringement of their personal rights, all the while believing that they have a perfect right to highly expensive, critically needed health care, even when they cannot pay for it.”
Indeed, “this immature, asocial mentality is rare in the rest of the world,” and it is this attitude that will continue to be a major impediment on the road towards universal coverage.
Related posts:
- The fatal flaw of universal coverage
- A doctor in Cuba becomes a nurse in the United States
- "The real danger of replicating Canada’s system in the United States"
- Countries with worse health care systems than the United States
- Can universal health coverage be sustained long-term?
- Universal coverage without primary care
- Primary care incomes and universal health coverage
{ 5 comments }
Very interesting point. It’s hard to make people live with the consequences of their bad choices with regards to their health and health insurance too.
If someone doesn’t get auto insurance in our culture, it’s not too harsh to force him/her to not drive or take away a vehicle. It’s harder to make people deal with the consequences of their bad choices when the consequence is death.
Auto insurance and health insurance are poor comparisons. Auto insurance is really an indemnity insurance against casualty losses, not against maintenance expense for wear and tear. Health “insurance” is both, and we expect it to be there to pay for catastrophes and for day-to-day “maintenance.” Costs sharing is the only way to brake a natural tendency to overuse services short of rationing. It is self-rationing of a sort.
Uwe Reinhart is right about Americans and their distorted sense of entitlement; that people are entitled to have the very best (whether they get that or not is another issue) even when they can’t pay for it. That is really an infantile conceit. It is not only not shared by the other advanced societies that have comprehensive public insurances–schemes that have rationing and do place real limits on what citizens can have and which do tax their citizens heavily to pay for–but also by other, poorer societies that don’t have comprehensive insurance and don’t tax their populations for medical insurance.
The idea that one should have the best care with no restrictions but not be held responsible for paying for it is an utterly childish notion. Unfortunately, it is an uncommonly American notion, too.
While you have a point, I think a bigger obstacle to universal coverage in the US is the insurance industry and its lobbyists. One of the biggest differences in healthcare between the US and the rest of the world is that health insurers are allowed to profit from basic medical coverage in this country while in most other countries this is illegal. Where is the incentive to lower premiums or cover more people if you have a bottom line (and stockholders) to worry about? T.R. Reid has reported on this well with his Frontline report entitled, “Sick Around the World.” Unfortunately, his follow-up report, “Sick Around America” was hijacked by the Frontline producers and insurance lobbyists.
John’s right. We Americans want to have our cake and eat it too. To some extent, this belief has been encouraged by various institutions, in the forms of newer is better and free=more. MRIs are better than CT scans, Vioxx is better than ibuprofen, Treximet is better than Imitrex plus Aleve.
Fully employer-paid first dollar coverage and the Medicare National Bank have set unrealistic expectations with respect to treatment and care. For example, it is unrealistic to maintain “corpses on ventilators” in ICU and expect Medicare, Medicaid, or private insurance to pay for it. It’s all about heroic measures and maintaining heartbeat/brain stem function rather than allowing life’s natural course. (Disclaimer: My advance directives are palliative care only.)
Rationing already exists – preauthorizations, retroactive recission, retroactive underwriting. Let’s expose and publicize the insurance industry’s dirty laundry.
Why wouldn’t universal health care not involve a sliding fee scale, based on ability to pay? Why maintain the fiction of “list orice” when all but the uninsured pay negotiated rates? Why don’t we kick those government officials, current and former, who decry “socialist” universal health care, out of their cushy health care plans and let them find out how fun and easy it is to get private coverage? Some of those folks would have to join their state’s high risk pool. Wouldn’t that be an interesting educational experience for these people to see what it’s like for the rest of us? (Too bad they have money and could afford to pay cash for everything.)
Uwe’s fatal flaw, repeated endlessly –
Is the USA like Europe?
Is Japan like China?
Dumb. Really dumb. Like comparing the NFL with the NHL.
I refuse to play this dopey game, “the USA should be like [insert name].”
Like Japan? So — we get rid of .. non-American Indians? Non-whites?
Just dumb.
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