December 17, 2006

December 17, 2006 | Commentary on Health Care

Would Europe's health-care-for-all model work here?

Is there any reason we should follow the Europeans and have government officials run our health-care system? California lawmakers seem to think so. In fact, the California Legislature passed a bill this fall that would have created a single-payer, government-run health-care system for the state. Fortunately, it was vetoed by Gov. Schwarzenegger.

But states such as Maine and Vermont are pressing forward by imposing much more centralized political control over the financing and delivery of health-care services.

With nearly 47 million Americans uninsured, public anxiety over health care is increasing -- along with public confusion. Opinion polls show that a large majority thinks that Americans, as consumers, should pay less for health care. But many also say that Americans, as taxpayers, should spend more, as long as it doesn't increase their personal levels of taxation.

America already has a hybrid system, and the rapidly rising costs of government-run health-care programs are producing a tidal wave of red ink. To pay off Medicare's long-term unfunded liabilities -- benefits promised but not paid for -- would require a payroll tax hike from today's 2.9 percent to a projected 13.4 percent.

To inject a dose of reality into America's domestic debate, five European health-policy experts recently explained how European health-care systems work at a briefing for congressional staffers in Washington, D.C.

Britain's Stephen Pollard of the Centre for the New Europe warned Americans, "Do not listen to the perennial siren voices, which call for a single-payer system in the United States." Americans, he said, would never tolerate the rationing of care Europeans routinely experience.

Access to cancer treatment, for example, became a major crisis in Britain when patients were having to wait a year or more after being diagnosed to begin chemotherapy. The British government now is spending a fortune to reduce that waiting time to three months by 2010, but it's unlikely to meet that goal, Pollard insists.

European tax-and-spending policies, particularly to sustain European health and welfare programs, are massive. Government spending already consumes more than half of the gross domestic product in France and Sweden, and more than 45 percent in Germany and Italy.

Ultimately, households, not employers or a disembodied abstraction called the government, pay 100 percent of health-care costs, Alphonse Crespo of the Institut Constant de Rebecque in Switzerland observed. "Citizens always wind up paying for health care, either through taxes, insurance premiums or out-of-pocket costs."

An even bigger issue is personal freedom. "The real question," says Crespo, "is whether they have single-decider systems. In many European countries, there are single-decider systems in which governments and their agents control what medical services (their) citizens will or will not receive. It's a question of choice and control."

If you want to give up your personal responsibility for your health care, he says, realize that you also will be giving up your personal autonomy and your freedom.

Political leaders in many parts of Europe are being forced as a last resort to consider market options and to move away from centralization -- even though they would never dare call it an American solution.

Americans should pursue an American solution. The central role of the states in public policy -- the key benefit of federalism -- can work both ways. Creative state legislators in California and other states could reverse current trends toward centralization and inject a healthy dose of market competition and consumer choice into state arrangements that are too often governed by outdated and counterproductive laws and regulations. Personal freedom is good for your health.

Robert E. Moffit, Ph.D., is Director of the Center for Health Policy Studies at The Heritage Foundation and Maria-Grace Turner is the head of the Galen Institute.

About the Author

Robert E. Moffit, Ph.D. Senior Fellow
Center for Health Policy Studies

Related Issues: Health Care

First appeared in The Press-Enterprise