Will Health Reform Turn Us Into Europe?


By guest blogger Robert Field:

Is American health care about to become like Europe’s?  Critics charge that health reform is modeled on the European approach.  They see in Europe a government-run system with limits on the free market.  Obamacare could be bringing us the same thing.

Comparing American health care under reform with the system in Europe leaves one big question unanswered.  What, exactly, is European health care?  We have to figure that out before deciding if we are headed there.

The problem is that there is no such thing as European health care.  Every country has its own system, and they vary widely in most regards, including the role of government.  The one common denominator is that everyone is guaranteed coverage.  Uninsurance is virtually unknown.  But each country has its own distinct way of achieving that goal.

As one end of the spectrum is England in which the government provides all aspects of health care, from the delivery of services to its financing.  The government owns the hospitals, employs the physicians, provides prescription drugs, decides what services will and will not be covered, and pays for it out of tax revenues.  This is true socialized medicine.  However, it does not entirely preempt the private market.  Those unhappy with the system can still see private providers outside of it at their own expense.

England is the only country in which all aspects of health care are socialized.  In the rest of Europe, there is a more of a mix of public and private elements.  In France, for example, there are non-governmental nonprofit funds that provide coverage either through employment or directly for people who are old, poor or self-employed.  Hospitals and physician practices can be either public or private.  The system is financed through individual, employer and government contributions.

Italy’s system relies on public insurance, although private coverage is also available.  The system is administered separately by each province, so your health care can vary greatly depending on where you live.  Hospitals and physician practices are both public and private.

At the other end of the spectrum is Switzerland.  Coverage is provided through private insurance companies.  The government requires that everyone obtain coverage, structures the market to guarantee that everyone can get it, and provides subsidies to help people afford it.  The Netherlands recently adopted a system that is similar.

Germany’s system includes a large number of nonprofit insurance funds, but private coverage is purchased by about 10 percent of the population as an alternative.  Funding is provided by employers and by the government.   There are both public and private hospitals, and most physicians are in private practice.

So, is American health care about to become like Europe’s?  The answer is yes and no.  Obamacare bears several similarities to the Swiss and Dutch systems but far fewer to the systems in other European countries.  Under Obama’s plan, as in Switzerland and the Netherlands, all sectors of health care, including insurance, rely on private elements, but the government plays an active role in regulating them to guarantee that everyone has access.  The rest of Europe provides for a smaller private role.

Looking ahead, therefore, Americans who compare our health care system to those abroad will indeed see familiar elements in a couple of European countries.  However, most of the other European systems will continue to seem quite foreign.   Nevertheless, there will be one element from all of Europe that Americans will be able to recognize.  Everyone who wants health care coverage can get it.

Find earlier items by Robert Field here, including this examination of the health reform in Massachusetts and this analysis of the legal challenges to the Affordable Care Act (Obamacare).

To check out more Check Up items go to www.philly.com/checkup.