In his article, Comparing Health Systems in Four Countries: Lessons for the United States (1), author Laurence D. Brown uses examples of Canada, France, Germany and Great Britain to detail what he believes to be detriments to implementing a universal healthcare system in the United States. During this analysis, he isolates 10 main themes about healthcare system, one being the “costs” of healthcare. In this section, Brown describes attempts by the four European countries to curtail rising healthcare costs through cost containment measures, and ensuing problems such as “waiting lists” that these measures create. However, he concludes that despite these problems, the four European countries control healthcare costs relatively well.
He then goes on to describe problems with implementing such solutions in the US. One of the greatest obstacles, Brown states, is that universal healthcare will create an overall increase in spending in the short term, a cost that will level out in the long-term. This immediate increase in costs, he believes, creates a significant disincentive to the adoption of a universal healthcare system in the US.
But, is this really the case? A recent article in the New York Times, “Massachusetts tries to reign in its health care costs” offers an interesting counterpoint (2). The article describes the state’s attempt to control healthcare costs by encouraging “global payments” to providers rather than fee-for-service systems. This theoretically lowers costs by decreasing excessive care supposedly encouraged by the current fee-for-service system. The program will begin by imposing a global payment system for state employees and those with state-subsidized health insurance, but includes “coercive legislation” that would encourage private insurers and providers to follow suit. Governor Deval Patrick references the “success” of the state’s previous mandatory coverage program and says, “we have shown the nation how to extend care to everybody… and we’ll be the place to crack the code on costs”. Although those in favor know that the plan will increase overall spending in the short-term, due to the eventual “leveling out” of costs, there is continued support. As State Representation Steven Walsh, chairman of the Joint Committee on Health Care Financing says, advocates of the plan know that it may take up to 15 years to “squeeze all the inequities out of the system”.
Therefore, although some may argue that Massachusetts is an anomaly compared to most of the US, this article seems to indicate that not all Americans are as resistant to change as Brown says they are. Of course, I am not saying that the Massachusetts reforms are without flaws. And, of course, not all states in America will adopt the Massachusetts plan or a universal health care system. However, the current debate in Massachusetts provides some hope that there is a place for new ideas about healthcare reform in the United States.
(1) Brown LD. Comparing Health Systems in Four Countries: Lessons for the United States. Public Health Matters 2003; 93 (1): 52-56.
(2) Goodnough A and Sack K. “Massachusetts Tries to Rein in its Health Costs”. New York Times 17 October 2011: A1. Print.