I am sitting in my hospital room in a bone marrow transplant unit in a European city. I am a patient who has recently received a stem cell transplant. I am U.S. citizen, but I am a resident of a country with a single payer health system. The insurance system here covers 85 percent of the population. And participation is mandatory, although high earners can opt out by purchasing private insurance. Citizens and working residents pay a tax of about 15 percent of their earnings for their government financed health care coverage. The insurance is administered by one of several non-profit organization that differ very little in coverage benefits because of the mandatory high level of minimum coverage. Doctors and pharmacists in private practice are reimbursed by these insurance administrators.
I am not a permanent resident of this country. I live here legally on a temporary work visa. Nonetheless I am full participant in the insurance plan. The costs of stem cell transplants vary considerably, but in the United States they average about $800,000. Here they average a bit more than $250,000. In my case, that is about what the insurance plan will end up paying for my transplant. When I walk out the hospital, my bill will be a $10 per day charge. Let me emphasize that is not because I have a Platinum plan at a cost affordable only the jet-setting global elite. On the contrary, I am getting the same coverage for the same excellent treatment that anyone else living here would receive. That’s what single payer means to me and my family.
Today the doctor paid me a visit and handed me a letter that I need to submit to the insurance administrator. The letter states that when I am released, I will need to make frequent follow up visits at a time when my immune system will be weak. By doctors’ orders I may not to take public transportation. In this case, the insurance administrator is required to reimburse my taxi fare. Once again, a standard benefit of this single payer scheme.
When Paul Ryan seeks to defend the new Republican healthcare plan, which according an independent analysis of the Congressional Budget Office would render 14 million people uninsured next year alone, he tends to lean on the rhetoric of liberty. Naturally this is because he can’t plausibly claim that it is good for health outcomes. He says, “If the government says, ‘Thou shall buy our health insurance,’ the government estimate are going to say people will comply. And when you replace that with, ‘We’re going to have a free market and you buy what you want to buy,’ they’re going to say not nearly as many people are going to do that.”
It’s time to for Americans to face up to the costs of the kind of liberty that Ryan and his followers advocate. The basic principle of insurance is risk-pooling. If people participate voluntarily on the basis of their beliefs about their own risks, participation will be limited mostly to those who see themselves as vulnerable (the poor, the sick, and the elderly) and the premiums will be expensive. Mandatory participation not only broadens coverage, but it reduces premiums.
Americans already pay more for health care than their counterparts in other wealthy countries. In 2013 the Commonwealth Fund conducted a study of health and healthcare in the wealthiest countries in world, the OCED countries. It found that “In 2013, the U.S. spent far more on health care than these other countries...Despite spending more on health care, Americans had poor health outcomes, including shorter life expectancy and greater prevalence of chronic conditions.” Spending as a percent of GDP in the USA is just over 17 percent. In continental Europe it tends to be just over 11 percent. For the UK it is just under 9 percent. More spending in the US did not result in more doctors to serve the population. There are 2.6 physicians for every 1000 people in the USA, and 4.1 per 1000 in Germany. More spending in the US does not increase life expectancy. Life expectancy at birth in the USA is 78.8 years, and in Germany it’s 80.9. Nor does more spending yield a healthier population. The percentage of the population over 65 with two or more chronic conditions in the USA is 68, in Germany only 49. And the number of infant deaths per 1000 live births in the USA is 6.1; in Germany it’s nearly half that 3.3. In general, the coverage is far wider in Europe; the costs of care are less; and health outcomes are better.
The country that I live in can hardly be described as a tyranny. Freedom of religion, speech, and movement are all secure. Elections are free and far less corrupted by money than in the U.S. Better health outcomes at lower costs have not been purchased at the cost of basic liberty. Yes, people must pay into the scheme. But being secure in their healthcare coverage they are also freer to take chances in employment moves and entrepreneurial initiatives. And perhaps the biggest difference is in the attitude of solidarity. It is simply unthinkable for most people here that a person should be left to suffer ill-health or even death due to the lack of insurance. Ask not for whom the bell tolls.
When I am healthy enough to leave the hospital and go home, I will count myself as fortunate to be living here where coverage and excellent care was made available by tax payers. More than that, it is unthinkable to me that someone with my disease in the U.S. might fail to get the life-savings transplant she needs because she is either uninsured or without the insurance that would cover the procedure. That outrage will cast a long shadow on my feeling of good fortune.