American exceptionalism in health care

Jon Perr explained for Daily Kos why Obamacare does not fix the dysfunctional U.S. health insurance system.

On January 1, 2014, the Affordable Care Act went fully into effect.  But for all of the furious fighting over the law these past five years, Obamacare was always an evolutionary reform grafted onto the existing American health care system.  The Medicaid public insurance program has been extended to roughly four million lower income Americans so far.  About two million more people have purchased private insurance, many of them aided by subsidies from Uncle Sam.

And while many (though not all) of the worst abuses that let insurers pad their profits by denying or dropping care for the sick have been banned, the edifice of private insurance remains largely intact.

Far from a “government takeover of health care,” Obamacare preserves all of the hallmarks—private insurance companies, private hospitals, private doctors, and the patchwork of different systems for veterans, seniors, workers, and the poor—that define the American model of health care provision.

Click on Why the U.S. should treat health care like a utility, not a market to read Perr’s full article.  Hat tip for to Bill Elwell for the link, which is the source of the charts.

What’s striking about these comparisons is that there are widely different systems of health care in the peer countries with which the United States is compared, and yet all the peer countries come out better than the United States in most respects.

Britain’s National Health Service, for example, is a government-run medical system, in which physicians work for the government, just as in the U.S. Veterans Administration health system.  Canada’s Medicare system is a government health insurance system, but physicians and hospitals are independent.  Except for the fact that it covers everyone, it is like the U.S. Medicare system, which in fact was copied from the Canadian system.  France and Germany have private insurers, but they are non-profit and have no financial incentive to keep payouts low in relation to premiums.

Yet these diverse systems all produce better results at lower cost than the U.S. system.

I don’t think that Obamacare will change this much.  It will enable many people now without health insurance to get it.  But Obamacare does not address three of the major drivers of high health insurance costs – the financial incentives of for-profit insurance companies, the monopoly prices of the drug companies and the sheer complexity of the system.

It is unfortunate that we Americans are so in love with the idea of our own exceptionalism, and with the Capitalism as Freedom meme, that we are unable to learn from the best practices of others.

Tags: Affordable Care Act, Health Care International Comparisons, International comparisons of health care costs, Medicaid, Medicare, Obamacare