2016 race forces U.S. health care into focus
Hopefuls’ remarks on systems abroad highlight contrasts
WASHINGTON — Declaring the U.S. health system the “envy of the world,” as President George W. Bush did during his 2004 re-election campaign, was once an easy applause line for politicians.
But this year, two leading presidential contenders, Republican Donald Trump and Democratic hopeful Sen. Bernie Sanders of Vermont, have invoked America’s foreign competitors when discussing their health care plans.
There is a lot abroad that might interest Americans.
Canada, Great Britain, France and other developed countries not only spend substantially less on health care, their citizens often report better access to medical care and far fewer financial worries.
They also enjoy better health.
While Americans three decades ago lived as long as Britons and longer than the Germans, Irish or Portu- guese, they now live on average two years less than residents of those countries.
The presidential campaign has thrust a renewed spotlight on the U.S. health care system, with Republicans, including Trump, promising to repeal the Affordable Care Act and Sanders pledging to replace it with a government-funded system that would provide “Medicare for all.” Former Secretary of State Hillary Clinton, the Democratic front-runner, is the only candidate who seeks to build on the existing law, commonly called Obamacare.
The law, which President Barack Obama signed in 2010, is closing some gaps between the U.S. and its global counterparts, in part by guaranteeing Americans coverage for the first time.
The law has also helped some 20 million people get coverage, according to government data.
And while health care costs are still rising, the increases have been slower than they were before the law was enacted.
But resistance to the law has blocked millions of poor Americans from getting health insurance in states that have chosen not to expand their Medicaid safety nets through the law.
And though the law imposes many new protections — including banning insurers from denying coverage to sick people — it largely preserves America’s complex and expensive system with its multiple forms of insurance and largely unregulated prices.
“The particular way we have chosen to do this has left us with a whole range of ills ... including a system that is much, much more expensive,” said Dr. Don Berwick, a former Harvard physician and patient safety advocate who ran the Medicare and Medicaid programs in Obama’s first term. “We are literally laughed at by other countries.”
The average price of the cancer drug Gleevec, for example, was $6,214 in the U.S. in 2013, according to a survey by the International Federation of Health Plans. That was nearly double the price in Switzerland and more than six times the price in New Zealand.
Berwick, who has worked extensively with international health care systems, ran unsuccessfully for governor of Massachu- setts on a platform advocating a single government-funded health plan as the best way to control costs. Sanders is now doing the same.
Trump, though he has disavowed such a “singlepayer” plan for the U.S., noted that such a system “works in Canada” and “works incredibly well in Scotland.”
Those comparisons have drawn fire from many conservatives, who argue the American system still outperforms its competitors.
For some medical conditions — such as breast cancer and heart failure — U.S. patients do have better sur- vival rates than patients in other industrialized countries, according to data from the Organization for Economic Cooperation and Development.
And Americans generally wait less to see a medical specialist, though they have more difficulty seeing a primary care physician.
More broadly, Americans die more frequently from illnesses that can be averted or controlled with timely medical care, including childhood measles, diabetes and colon cancer, research suggests.
And in nearly all industrialized countries — whether the government directly provides insurance as is done in Great Britain or heavily regulates private insurers as is done in the Netherlands — patients enjoy more financial protections. And the added protections mean lower bills.
Just 1 percent of British patients said they had serious problems paying medical bills, according to a 2013 report by the Commonwealth Fund, a New York foundation that studies health systems domestically and around the world..
In the U.S., by contrast, 23 percent of patients reported similar financial hardship.