Editor's note: "Global Lessons: The GPS Road Map for Saving Health Care" re-airs on CNN TV on Sunday at 8 p.m., 11 p.m. and 2 a.m. ET; on CNN International on Saturday at 9 p.m. ET and Sunday at 6 a.m. ET. We'll take you around the world to show you how other nations manage their health care and what lessons the U.S. can learn.
As the U.S. Supreme Court released its rulings on the constitutionality of Obamacare, check out a round-up of ideas for how to save health care from a previous "Global Lessons" report and Fareed Zakaria's takes from the past few months in the lead-up to this court decision.
From Fareed Zakaria:
America's health care system is broken. Our healthy life expectancy, the standard measurement, ranks only 29th in the world – behind Slovenia. Our infant mortality rate ranks 30th – more than twice that of Sweden and Japan. And for this sub-par care, we pay more than any other nation in the world. Almost one out of every five dollars spent in America is spent on health care.
The centerpiece of the case against Obamacare is the requirement that everyone buy some kind of health insurance or face stiff penalties – the so-called individual mandate. It is a way of moving toward universal coverage without a government-run or single-payer system. It might surprise Americans to learn that another advanced industrial country, one with a totally private health care system, made precisely the same choice nearly 20 years ago: Switzerland. The lessons from Switzerland and other countries can’t resolve the constitutional issues, but they suggest the inevitability of some version of Obamacare.
Switzerland is not your typical European welfare-state society. It is extremely business-friendly and has always gone its own way, shunning the euro and charting its own course on health care. The country ranks higher than the U.S. on the Heritage Foundation’s Index of Economic Freedom.
Twenty years ago, Switzerland had a system very similar to America’s – private insurers, private providers – with very similar problems. People didn’t buy insurance but ended up in emergency rooms, insurers screened out people with pre-existing conditions, and costs were rising fast. The country came to the conclusion that to make health care work, everyone had to buy insurance. So the Swiss passed an individual mandate and reformed their system along lines very similar to Obamacare. The reform law passed by referendum, narrowly.
The result two decades later: quality of care remains very high, everyone has access, and costs have moderated. Switzerland spends 11% of its GDP on health care, compared with 17% in the U.S. Its 8 million people have health care that is not tied to their employers, they can choose among many plans, and they can switch plans every year. Overall satisfaction with the system is high.
From Fareed Zakaria:
Under Britain's National Health Service (NHS), the patient doesn't pay a thing. ... Compare that to the U.S., where an estimated 137,000 people died over seven years because they were uninsured. Of course, the Brits do pay for their health care in another way – with taxes. their sales tax is a whopping 20% and income taxes are as high as 50%.
All of that money feeds a health care behemoth. The NHS is Europe's largest employer, with well over 1 million people on the payroll. So you'd think it would be inefficient.
T.R. Reid, a former overseas bureau chief with The Washington Post toured the world's health care systems for his recent book, The Healing of America. Reid says:
"That seems sensible, right? The private sector can do things more efficiently? It doesn't work in health care. The least efficient payers in the world are the American private insurance companies. They have administrative costs of 20 to 30%. That's a 30% tax on every dollar you spend on health care. Britain is totally socialized medicine [and its] administrative costs [are] 5%. Canada is private doctors and public payers – 6% administrative costs. So it turns out, for some reason in health care, governments are doing this more efficiently than our private sector."
New Jersey’s Camden Coalition of Healthcare Providers founder and family medicine practitioner, Jeffrey Brenner, used medical billing records to find that just 1% of patients accounted for 30% of health care costs in Camden. And that's not all he discovered in the city's three hospitals. He says: "We learned that someone went 113 times in one year. Someone went 324 times in five years. In similar workup in Trenton, they found someone who went 450 times in one year." These were people with complicated medical histories and chronic illnesses. One patient alone racked up $3.5 million in medical bills over a five year period. As Brenner says, :"They're the difficult patients to treat, and no one is being paid and incentivized to pay attention to them."
What's more, Camden's problem is America's problem. Just 5% of Americans accounted for half of our nation's health care costs in 2009. This is perhaps the crucial statistic to understand about America's health care problem.
MORE FROM GPS
In opposing Obamacare, we were serious the whole time
Over the past few months, hundreds of readers have weighed in on the debate.
Reader "U.S.M.D." had this to say: "I think two issues predominate in why America spends so much of its GDP (18% or so) on healthcare, but has terrible outcomes compared to other developed contries. One, we have poor national healthcare coverage to lower socioeconomic groups, and two primary care physicians face poor patient compliance with lifestyle changes and treatment compliance. In short, even after extensive counseling, many Americans would rather be obese or would rather smoke cigarettes now, and face the consequences later. We all need to step up to the plate on this one by improving our personal health, in order to significantly lower healthcare costs and increase the average health of our country."
Ted left this comment: "The USCare ship is sinking and there are not enought life-boats (physicians, facilites, etc). So some are saying – let's get everyone on boats. If the boats overturn, we go down together. The others are saying, let's limit the numbers to a safe limit. They are being accused of being previliged. What would the captain of a real ship decide?"
A Canadian reader weighed in with her perspective: "I am Canadian... . I could also add that the admin costs are kept lower because paperwork is much less. Necessary surgeries are paid for ie heart surgery. My mother had a heart attack about 2.5 years ago, and the surgery and recovery did not cost us or cause her to lose her home or her savings. However things like elective surgery ie cosmetic etc are paid for by those who wish it. Our system isn't perfect, however we don't fear dying and or losing our homes to pay healthcare bills. This was resolved about 70+ years ago, and in the UK this was done right after WWII and they still had food rationing. I find it unbelievable that this is something the US is still arguing about."
What do you think? Is there another model in the world the U.S. should use? What has been your experience of other countries' health care systems?