Why is the United States the only most-developed nation lacking some form of government-funded universal health care system?
Why are so many Americans, even those who support or rely upon government programs like Medicare, so vehemently opposed to ‘socialized medicine?’
Why do so many Americans continue to believe theirs is the best health care system in the world, even when presented with irrefutable evidence to the contrary?
To help answer these questions, this Digital Journalist interviewed more than a dozen leading health officials from around the world and asked them to compare health care attitudes in their countries and in the United States.
“It comes down to a difference in culture and character,” said Dr. Fiona Godlee, editor-in-chief of the British Medical Journal (BMJ) and a fellow at the Royal College of Physicians in London. “In America, you’ve got this sense of individualism and Darwinian survival and opportunity to win. In the UK, we have this very strong sense that we have to provide for the weaker in our society.”
Dr. Stephen Leeder, editor-in-chief of the Medical Journal of Australia (MJA) and professor of public health and community medicine at the University of Sydney, also said people in other countries apparently value fairness and equity more than in the United States.
“In the pursuit of excellence, people lost along the way do not count for much, and if you can buy excellent health care… if you can afford it, you get it. If you can’t, you don’t. You guys simply do not believe in equity,” Leeder said of Americans.
The notion of health care as a human right, so often scoffed at in the United States, is central to most nations’ health policies and practices.
“Health care is absolutely a basic human right,” asserted Canadian Federation of Nurses Unions (CFNU) President Linda Silas.
Norwegian Health Minister Bent Høie, a Conservative, says he is “wary of the philosophical implications” of the term ‘basic human rights.’
“But personally, I completely agree with the statement that health care should be a right in all societies,” Høie insisted. “All societies should strive to ensure that their people have access to quality care.”
“The aim must be to provide health care to everybody irrespective of his or her ability to pay for it,” said World Medical Association (WMA) Secretary General Dr. Otmar Kloiber, who points to the Universal Declaration of Human Rights— which was signed by the United States– and the US Declaration of Independence as documents that “enshrine and express common values of mankind.”
In addition to being a basic human right, many of those interviewed for this article asserted that their public health care systems are an integral part of their national identities.
“It’s ingrained in us like maple syrup or hockey,” said Dr. Louis Hugo Francescutti, president of the Canadian Medical Association (CMA). “It’s part of being Canadian. It’s in our DNA.”
Swedish Health Minister Göran Hägglund, who is also leader of the center-right Christian Democrat party, said that people have a “moral obligation to look after each other,” and to that end, “Swedes consider our various welfare systems to be a part of our national identity.”
So what do international health officials make of all the horror stories disseminated by US special interests about the lack of patient choice, ‘rationed care,’ ‘death panels’ and long waiting lists, stories apparently meant to scare an American populace that ranks 51st in global life expectancy away from public health care?
“Any patient can at any time switch physicians. There are no ‘death panels,'” insisted CMA president Francescutti. “Do we have slightly longer waits than Americans? Yes we do. But when you take a look at the indicators, we’re faring better than you in just about every category, and you’re spending twice as much money.”
“What people should do at the end of the day is not exaggerate,” added Dr. Francescutti. “Nobody gets turned away here. Nobody goes bankrupt if they have a heart attack. God forbid you have a heart attack in the United States and you don’t have coverage.”
Indeed, unpaid medical bills are the number one cause of US bankruptcies, with nearly two million Americans affected in 2013.
International public opinion polls show people are very satisfied with government-funded health care systems. According to a recent comparative study of public attitudes toward health systems in 11 nations, 61 percent of Britons believe their health care system “works pretty well and only minor changes are needed.” In America, only 29 percent answered similarly, but 25 percent of Americans said the US health system is “in need of complete rebuilding.”
Fully 85 percent of Canadians surveyed by McGill University in 2007 said that eliminating the nation’s public health system would “result in a fundamental change to the nature of Canada.” In a 2004 CBC television special, Canadians voted Tommy Douglas, a provincial leader best known as the ‘Father of Medicare,’ as the “Greatest Canadian” of all time.
“We’re so lucky with what we have,” said CFNU president Silas. “We don’t want to lose it.”
“I can’t imagine life without the NHS (National Health Service),” said BMJ editor Godlee. “[In Britain], we can’t remember a time when you’d live in fear you’d get ill, or someone in your family would get ill, and you’d have to pay for that out of your pocket. That’s something we never experience.”
“In an almost religious kind of way, people remain terrifically wedded to the idea of the NHS,” added Godlee. “The people have made this absolutely clear to any politicians who dare say we don’t need the NHS. [The NHS] is a bit like God in America, it’s like our version of Christianity.”
Still, convincing an American public that largely believes in ‘market-based solutions’ for everything and the notion that government cannot effectively solve a problem as big as health care reform of the merits of even more government is a tall order indeed.
Dr. Ida Hellander, director of policy and programs at the US advocacy group Physicians for a National Health Program (PNHP) argues that insurance and pharmaceutical corporations and other special interest groups are largely responsible for Americans’ aversion to publicly-funded health care.
“Insurance and drug corporations spend about $300 million a year on lobbying Washington alone, and have more lobbyists than there are members of Congress, and can influence elections at every level,” said Hellander. “There have been very well-funded campaigns to make people believe that publicly-funded health care equals ‘socialized medicine…’ People don’t come up with these things on their own. A lot of money went into making people think these things.”
“You have to really examine who’s making the most noise against ‘socialized medicine’ in the United States,” Canada’s Silas said of public health care. “It’s almost 100 percent those who are better off in society.”
Dr. Hellander lists a long history, beginning in World War I, of powerful special interests tarring public health care as ‘un-American.’
“Later on with communism, it was drilled into people during the Cold War, and the American Medical Association (which maintains its longtime “unwavering opposition against the encroachment of government in medicine”) ran the largest political campaign in its history against the passage of Medicare, calling it ‘socialism,'” she said. That propaganda blitz featured an affable Hollywood actor named Ronald Reagan, who would, as president, sign landmark legislation requiring hospitals to treat all patients, including undocumented immigrants, in need of emergency care, regardless of their ability to pay.
While many Americans may be surprised to learn that a conservative icon like Reagan would endorse what seems suspiciously like ‘socialized medicine,’ numerous most-developed nations have successfully combined public and private health care systems.
“New Zealand has a long tradition of public funding of health care as the being the most equitable and efficient way to deliver what the population expects,” explained Jannel Carter, spokeswoman for New Zealand Health Minister Tony Ryall, a member of the center-right National Party. “Within that, there is still a place for privately-funded and provided health care and the two sectors work successfully together.”
“Australians can choose private care if they can afford it and if they wish, or if not able to pay can use Medicare, both in offices and in hospitals to cover much, if not all, of their costs,” said MJA editor Leeder.
Norwegian Health Minister Høie warned that “unchecked and unregulated markets in health care can drive up costs tremendously and won’t ensure access to care for all groups in society.” But the Conservative added that in Norway, “the private sector has an important role in limiting monopolies, ensuring healthy competition and increasing patient choice.”
“Giving people freedom of choice, allowing private sector innovation and using market-inspired reforms is fully possible within a publicly-funded health care sector,” insisted Høie. “What we try to do is find the mix that gives the optimal result: limiting costs, while ensuring quality care– for all.”
According to a 2009 Harvard Medical School study, 45,000 annual US deaths are linked to lack of health coverage. And with more than 47 million Americans, or one in six people, still lacking health insurance, the need for change that goes beyond the welcome but inadequate reforms of ‘Obamacare’ is greater than ever, according to many of the international health professionals interviewed here.
US doctors also acknowledge something must be done. According to a 2012 Commonwealth Fund survey of primary care physicians in 10 nations, only 15 percent of American doctors said their country’s system “works well.” Fully 61 percent of Norwegian physicians answered similarly.
Part of the solution, argues Dr. Francescutti, is overcoming irrational fear of government-funded health care.
“Americans are worried about socialized medicine. What do you think Social Security and Medicare are,” asked the CMA president. “I always find it so funny when Americans say, ‘we don’t want socialized medicine,’ but as soon as they turn 65, they’re asking, ‘Where’s my Medicare?'”