Universal Coverage: Nothing to Fear

Oct. 18, 2006 — -- Most people know that all other developed nations -- like England, Canada, Germany or Japan -- provide universal access to public health-care coverage but spend far less than we do for health care.

But most Americans worry that if the United States adopted a public system of universal health-care coverage, this wealthy nation would not be able to pay for it while still providing the kind of health care that those Americans who are now insured are used to.

The question is: If the United States did adopt a universal health-care system, would those of us who are now insured and have reasonably good access to health care be denied the health care we want or need?

Or, would health care be rationed?

The experiences of other nations could shed some light on the subject.

Every country organizes health-care financing in its own way.

A few like the United Kingdom are "single-payer" systems administered by the national government and funded from general taxes.

Others are funded by general taxes, but are, like the Canadian system, decentralized, and funded at both the national and state or local level.

Many systems, including the German, French and Japanese, are social insurance systems.

Countries also organize health-care delivery in their own way.

In some countries, health-care services are provided directly by the government, but in most countries services are provided by private hospitals and professionals.

There is one thing that all these countries have in common -- in no country does everyone get all the medical care that they want or from which they could benefit.

Resources for health care are limited and have to somehow be divided up among a country's citizens.

The United States divides up health-care resources even now, even without universal coverage. America allocates most health-care resources on the basis of whether or not people can pay for those resources.

Most people think that kind of allocation is unfair or unjust, even irrational. The healthy baby of a wealthy family may get more medical attention than the sick baby of a low-income family.

In countries with universal health care, the sick baby would be guaranteed access to medical care.

But that kind of guarantee -- that the universal system will provide health care to the sick -- isn't enough to convince most Americans that a universal system is a good idea.

What most Americans think of when they think of health care rationing in other countries are waiting lists. So, the sick may be guaranteed care over the healthy, but the sick still have to wait for care.

That is a reasonable concern -- in both Canada and the United Kingdom, waiting lists for medical care are a problem.

In many other countries, Germany, Japan and France, for example, waiting lists are not a major problem.

Indeed, in Germany, patients with health problems are more likely to get an appointment to see a doctor the same day as they need it -- and less likely to have to wait six days or more to see a doctor -- than are American patients.

Germans are much less likely to have to go to the emergency room to get care on nights or weekends than we are.

Germans are no more likely than Americans to have to wait more than four weeks to see a specialist.

In Japan, a patient can often go to a doctor without an appointment, but may have to sit for a long time in the waiting room.

Whether one has to wait for medical care or not turns more on how much a country spends on health care or how health-care delivery is organized than on whether or not health care is publicly financed.

Many Americans also worry that universal health care means losing the freedom of choice of provider -- as if you no longer could choose your doctor, but someone else told you where to get care.

But that also isn't a real problem in other countries that have universal health care.

Germans, and Japanese, and Canadians can in general freely choose their own doctor, unlike many Americans in managed-care plans.

Some other countries have "gatekeeper" systems that limit access to specialists, but many countries allow direct access to specialists as well as to primary-care physicians.

Americans like to think of themselves as a resourceful, creative people.

If other countries can make health care available to all their residents while spending less than we do, and yet do so without wait lists and without limiting the availability of useful technology, why cannot we?

Timothy Stoltzfus Jost is the Robert L. Willett professor of law at Washington and Lee University in Lexington, Va.