Published in the Richmond Times-Dispatch, May 24, 2009
During his recent trip to Europe, President Obama told a French audience that America would never have European-style health care. "We are going to work hard to make sure that we have a health care system that won't be identical to what you have in Europe," he said.
This is encouraging news.
Although many U.S. reformers praise the health systems of Britain, France, Switzerland, and other European nations, these systems are fraught with problems. They are burdened by cost overruns, and yet they still deny patients the latest care and the choices we take for granted.
In France, for example, the government now dictates which doctors and specialists a patient can see. And strict reimbursement schedules can penalize doctors for performing costly procedures, even when those procedures are clinically determined to be best for the patient. Consequently, many doctors are refusing to treat patients with certain illnesses.
Government efforts have done little to control costs. In 1996, the French government established health spending targets. That was the only year it met them. In every year since, the French health system has run a deficit.
THINGS AREN'T much better in neighboring Switzerland.
In response to soaring medical costs, Swiss officials started forcing hospitals and specialty units to close. Between 1998 and 2000, the number of hospital beds dropped by six percent nationally. Not surprisingly, patients have experienced diminished access to care and are routinely shuffled from one facility to another.
Alphonse Crespo, a Swiss surgeon and think tank researcher, traces his nation's shift from a focus on choice and quality care to emphasizing cost reduction to 1994, when his country adopted a compulsory insurance system.
The Swiss have since put severe restrictions on private health options. In 2002, the Swiss government placed a limit on private medical offices. Doctors are now prohibited from setting up new practices unless another doctor's office in the area closes. Although unpopular, this rule may be extended through 2011.
The British health care system is quite open about its willingness to sacrifice quality of care for cost savings.
In 1999, British lawmakers created the National Institute for Health and Clinical Excellence to analyze whether various medical devices and pharmaceuticals are effective enough to justify their price. NICE issues regular "comparative-effectiveness" studies, and the National Health Service (NHS), Britain's public insurance system, uses them to decide which treatments are worth covering.
Because of these studies, the British health system routinely delays and denies access to new, life-saving medicines, forcing doctors to use older, less-effective treatments. Right now, British patients have access to only about 10 percent of the drugs that have been released in the U.S. market over the past two years.
Indeed, Britain recently made the headlines when NICE decided not to recommend payment by the NHS for several promising kidney cancer treatments. Agency officials determined they were too expensive, considering they extended patients' lives by "only" six months. Facing public pressure, British officials relented and approved one of the drugs. But three others still languish in approval purgatory.
NOT SURPRISINGLY, the quality of care in Britain has suffered severely. According to Lancet Oncology, the prestigious medical journal, less than 70 percent of British women diagnosed with breast cancer are alive at least five years after a cancer diagnosis, compared with nearly 84 percent for American women. For British men with prostate cancer, the five-year survival rate is just 51 percent. In America, the survival rate is 92 percent.
Despite this, President Obama and many in Congress have praised comparative-effectiveness research. They directed more than $1 billion toward such research in the recent stimulus package, and use of the research is a major component of Obama's recent budget proposal to reduce health spending.
Maintaining high-quality health care while keeping costs low is no easy task. But the lessons from Europe are clear: When the government tries to reduce costs, health care quality and access suffer.
Obama's recent promise to create a uniquely American health reform solution was heartening. But if the president fails to deliver on his promise — and he instead imports elements from these European health systems — we could very well lose the opportunity to show the world that we can reform our health sector while protecting the quality of care and innovation Americans value so highly.
Grace-Marie Turner is president of the Galen Institute, a non-profit research organization focusing on patient-centered solutions to health reform.