America has the worst health-care system of eleven rich nations.
The Commonwealth Fund, a century-old foundation dedicated to improving health care, places the United States behind Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland and the United Kingdom in its latest report. The Netherlands and Norway share first place.
America is the world’s top innovator of new medications and treatments. The best medical schools are in the United States. The country spends relatively more on preventative care than most. But this doesn’t outweigh its poor scores on the Commonwealth Fund’s other criteria: access to care, administrative efficiency, equity and outcomes.
In practical terms, this means especially low-income Americans don’t get the health care they need, either because it’s too expensive, too complex or both. Preventable deaths, including infant and maternal mortality, are higher in the United States than in other wealthy countries. Life expectancy is lower.
Nearly all political parties in the Netherlands call for more government in health care.
The far-left Socialists and Greens would replace private health insurers with public health funds. Labor would keep the insurance companies but take away their power to negotiate prices with health providers. The Christian Democrats and far-right Freedom Party want to end competition between hospitals. Even the center-right VVD believes liberalization has gone too far.
I’m a member of the VVD, but on this point I disagree. (So I’m glad there are few concrete proposals to reverse liberalizations in the VVD’s manifesto.) The Dutch health-care system is one of the best in the world. In a column for Trouw, I challenge the parties that want to uproot it to point to a better example. If there isn’t one, let’s keep the system we have. Read more “Dutch Should Keep Health Care System They Have”
One can tell two very different stories about the American economy.
In one, growth is robust, unemployment is at its lowest in half a century and the stock market is booming. This is the story President Donald Trump likes to tell.
In the other, two in five Americans would struggle (PDF) to come up with $400 in an emergency. One in three households are classified as “financially fragile“. Annie Lowrey writes in The Atlantic that American families are being “bled dry by landlords, hospital administrators, university bursars and child-care centers.” This is the story Bernie Sanders and the Democrats tell: for millions of Americans on seemingly decent middle incomes, life has become too hard.
Sanders’ solution is to bring “democratic socialism” to America. He cites European countries like Denmark and Sweden as inspiration. They’re not bad places to imitate — but they have actually moved away from socialism and toward a mix of free markets and the welfare state. It is why they rank among the freest and most competitive (PDF) economies in the world.
When it was revealed last week that the British government had not ruled out giving American pharmaceutical companies more generous patent rights under a post-Brexit trade agreement with the United States, the opposition Labour Party was up in arms, accusing the ruling Conservatives of putting the National Health Service (NHS) “up for sale”.
The Conservatives rushed to deny it.
“The NHS is not on the table,” said Health Secretary Matt Hancock. “We are absolutely resolved that there will be no sale of the NHS, no privatization,” said Prime Minister Boris Johnson.
The episode was emblematic of the British health care debate: Labour mischaracterizes any proposed change as a step toward privatization while the Conservatives, rather than make the case for choice and competition, try to convince voters they care about the NHS even more. Read more “Britain’s Health Care Debate Is Broken”
It’s worth asking how expensive nationalizing health insurance in the United States would be. I’ve told you before that cost estimates range from 13 to 21 percent of GDP, a difference of $1.7 trillion, or two-and-a-half times the Pentagon budget.
Senator Elizabeth Warren puts her plan at the low end of spectrum, about $2 trillion per year (which would still mean a 50-percent increase in federal spending). Even journalists broadly sympathetic to Medicare-for-all doubt that’s realistic.
I doubt it’s going to convince anyone. Medicare-for-all’s proponents are unlikely to change their minds even if they find out the cost isn’t manageable. Americans who oppose nationalizing health insurance are unlikely to come around even if it is.
Replacing private health insurance with a single-payer, government-run system is hugely unpopular in the United States, but that hasn’t convinced two of the Democrats’ three top-polling presidential candidates — Bernie Sanders and Elizabeth Warren — to back away from it.
In the most recent televised debate, Warren, who is polling neck and neck with former vice president Joe Biden, couldn’t say how much “Medicare-for-all” would cost or who would pay for it. She has since promised to release a detailed plan.
Sanders, to his credit, admitted it would require tax increases. But by how much, and for whom, he didn’t say.
He can’t. Nationalizing health insurance for 327 million Americans is such a huge and complex undertaking that nobody knows how much it would cost.