Fareed Zakaria, Time:
When listening to the debate about American health care, I find that many of the most fervent critics of government involvement argue almost entirely from abstract theoretical propositions about free markets. One can and should reason from principles. But one must also reason from reality, from facts on the ground. And the fact is that about 20 foreign countries provide health care for their citizens in some way or other. All of them--including free-market havens like Switzerland and Taiwan--have found that they need to use an insurance or government-sponsored model. All of them provide universal health care at much, much lower costs than we do and with better results.
---Health Insurance Is for Everyone," by Fareed Zakaria, Time (3.26.2012)
Mr. Zakaria, in his focused, pragmatic approach, offers more examples and data points to the body of evidence that more overwhelmingly than ever supports universal health insurance as the only defensible, accountable direction a country can take to create a new system or reform a dysfunctional one like ours. In this case, he focuses on two other free-market economies, Switzerland and Taiwan, one that has worked within a market model with notable success, and one that, like many other countries, has achieved even more success under a single-payer government insurance program. So, let's read some of what Mr. Zakaria has to share with us about the two approaches:
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.
[...] When Taiwan--another country with a strong free-market economy--decided to create a new health care system in the mid-1990s, it studied every existing model. It too chose a model of universal access and universal insurance but decided against having several private insurers, as Switzerland and the U.S. do. Instead it created a single insurer, basically a version of Medicare. The result: universal access and high-quality care at stunningly low costs. Taiwan spends only 7% of its GDP on health care [vs. 11% in Switzerland and 17% in the US].
Unsurprisingly, the data and experience of these two countries also support the importance of universal health insurance and universal participation. And while it indicates we should expect Obamacare to offer Americans better health care at lower cost, it also indicates that a government single-payer approach to national health insurance will provide the best health care to all at the lowest cost. This is consistent with what I and others have written about the uniques dynamics of delivering "public goods" equitably to all people. But given the political climate in the US, it is clear that the Obamacare model is a necessary stepping stone to the more efficient govermment-payer model.
But the question always remains, Has enough of a sense of national humility found it's way into our national identity, enough to temper our reflexive and brittle national hubris? Is it now possible we could be open-minded enough to learn something from Switzerland and Taiwan--and England, France, Canada, Japan and other countries, too? And especially with so many US financial and political interests marketing misinformation to protect their status quo? Progress will likely continue to be made, but only in slowly evolving stages, it seems. It is the American way.
Link:
But the question always remains, Has enough of a sense of national humility found it's way into our national identity, enough to temper our reflexive and brittle national hubris? Is it now possible we could be open-minded enough to learn something from Switzerland and Taiwan--and England, France, Canada, Japan and other countries, too? And especially with so many US financial and political interests marketing misinformation to protect their status quo? Progress will likely continue to be made, but only in slowly evolving stages, it seems. It is the American way.
Link:
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