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Health Plans May Be 'Universal', But They're Not Global

By Jesse Stanchak, CQ Staff

September 11, 2008 -- The United States would be better off designing its own health care plan from the ground up rather than emulating the health systems of its neighbors, panelists at a forum hosted by U.S. Chamber of Commerce said Thursday.

Representatives hailing from France, Japan, Taiwan, and Switzerland—countries with universal health care systems that also are grappling with rising costs and aging populations—spoke highly of their respective country's plan, but were reluctant to suggest that the United States try to copy their methods. While there's clearly much domestic policy makers can learn from foreign health plans, the United States may need to come up with a uniquely American solution to the nation's health woes, they said.

"I spent a lot of time looking at other countries' health care systems," said Cato Institute Senior Fellow Michael Tanner. "And what I haven't found is ... that one perfect system where everyone has care and there is no waiting and you get to pick your doctor and everyone's happy. Regardless of country, everyone hates their health care system." Tanner said he favored a market-based approach to health care, arguing that some countries with universal coverage plans, such as France, are looking to control costs by adding free-market components to their systems.

Jacques Drucker, a representative of the French Embassy, discussed the virtues and pitfalls of France's national health plan, which is really three different plans that citizens pay into based on the kind of employment they hold, he said. Drucker, who comes from a country where the national health plan pays for more than three-quarters of all health care expenditures, acknowledged that France is running a $4 billion health care deficit, forcing it to pursue cost saving adjustments such as limiting prescription drug coverage. But he denied the notion that the French endure rationed care or harbor resentment toward their national plan.

"The French have 60 million opinions on everything. Except maybe this: we love our health plan," he said. According to Drucker, France's plan has a more than two-thirds approval rating. The future of the plan lies in electronic health records and other efficiency increasing measures, he said.

Just across the border in Switzerland, however, universal health care takes on a very market-based twist. Swiss embassy representative Henri Getaz explained that in Switzerland, the government does not control health care directly, but rather requires everyone to buy health insurance and then pay their own co-pays and user fees, similar to care in United States. Unlike other countries with universal plans, the Swiss government only accounts for 17 percent of the nation's direct health care spending, he said.

In addition, the Swiss government plays a much larger role in regulating insurance plans than the U.S. government does for domestic plans. Swiss plans are not allowed to make a profit, Getaz said. Instead, the government redistributes risky cases among insurance providers, so that no one company has worry about getting stuck with too many unhealthy clients.

"We Swiss are quite risk adverse," Getaz said.

Tsung Mei-Cheng of Princeton University's International Center represented Taiwan, a country whose single payer system has already incorporated health IT measures and other changes mentioned by France's Drucker. Mei-Cheng argued that in a system where the government will always be responsible for paying for a person's care, there's a far stronger incentive to invest in things such as preventative care, electronic records, and best practices research.

"With a cradle-to-the-grave system, there's an incentive to keep people healthy that doesn't exist in a private plan that might only have to care for you for a few years," she said. Rather than only going to the doctor when they're very ill, most Taiwanese see some sort of health care professional an average of about 15 times a year, she said. When pressed as to how that could be possible without ensuring very long wait times to see a doctor, Mei-Cheng acknowledged that most visits are only between three and 10 minutes long.

Mei-Cheng said her country's system also is underfunded. While it is not running huge deficits like France's plan, the Taiwanese are unwilling to pay higher premiums, which limits the sorts of programs the government can implement. The biggest problem with Taiwan's system is that it is susceptible to political whims, which can severally limit the program's adaptability, she said.

The Japanese system, as explained by Japanese embassy representative Tadayuki Mizutani, is similar to Taiwan's, but faces much greater financial pressures, Mizutani said. Japan faces a declining population whose average age is fast advancing. There are fewer and fewer young people working to pay for the care of older citizens, even as costs rise at a rate faster than that of the average income. Mizutani says that by 2055 there will be 1.2 people between the ages of 20–64 for every person over 65, down from 3 younger people per senior in 2005, he said.

With increased costs come long waiting lines, Mizutani said.

"Japanese hospital waiting rooms are just like spas for the elderly. They're always in there" waiting to see a [doctor]," he said. "The joke is if you look for an older person in a hospital waiting room and they're not there, then they must really be sick!"

The example of Japan and Taiwan, two countries whose similar health care systems produce very different results, drives home a recurring theme of panel's discussion: fixing American health care isn't as simple as importing another nation's solution.

"It's hard just to understand your own health system," Getaz said. "It's even harder to understand why it works for you. And it's important . . . that you don't tell other countries 'just do what we do.' All systems must be different," he said.

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