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Should Americans fear universal health care?

The U.S. could improve in the areas of cost, access, equity and efficiency without sacrificing quality

Dr. Allison Roxey takes a nose-swab sample from a resident as a team of University of Washington medical providers conducts testing for the new coronavirus at Queen Anne Healthcare, a skilled nursing and rehabilitation facility in Seattle on April 17, 2020.
Ted S. Warren, Associated Press

Most Americans agree that our health care system is sick. Majorities believe our system has major problems, are dissatisfied with access and affordability, and think it is the responsibility of the federal government to make sure all Americans have health care coverage.

Despite these concerns and support for universal coverage, many Americans are fearful of “socialized medicine” generally, are unsure that universal coverage should be achieved without a role for private health insurance companies, worry that implementing universal health care will increase their taxes and/or be even more expensive than our current system, and do not wish to adopt a system that limits choice or increases wait times.

Are these fears warranted by the available data?

A good place to start concerns wait times, given that surveys show that Americans are perhaps most fearful about the impact that government-coordinated universal health care would have on their ability to receive timely medical care. Would you have to wait longer to see your doctor in a government-coordinated system? It depends on how the system is structured.

In some of the best health care systems around the world, timeliness of medical care is actually better than in the U.S. A recent report from the Commonwealth Fund, an independent research organization in New York, for instance, found that 51% of Americans were able to make a same-day or next-day appointment to see their doctor or nurse. This put the U.S. eighth among the 11 wealthy countries included in the report. While there were countries like Canada (43%) that performed worse, the vast majority performed better, including the Netherlands (77%) and New Zealand (76%).

Of the 10 measures of timeliness included in the report, the U.S. was near the bottom of the list on five measures and in the middle of the pack on two measures. On the three measures where the U.S. scored well (time to treatment after diagnosis and wait times for specialist appointments and elective/nonemergency surgeries), there were still countries with government-coordinated universal health care systems higher in the rankings on all three measures.

What about safety? When it comes to the percentage of the population experiencing medical, medication or lab mistakes in the past year, the U.S. (19%) actually fared worse than nine of the other 10 countries in the report, with far fewer mistakes in leading countries like France (8%) and Germany (7%).

On the other measures of health care system performance included in the report, the U.S. was in the middle of the pack (fifth overall) on the care process, near the bottom on administrative efficiency (10th), and last on measures of access, equity and health care outcomes.

How about choice? Contrary to what many Americans may think, people in other wealthy countries with government-coordinated universal health care systems actually have much greater choice of hospitals and doctors than Americans do. In the U.S., health insurance companies impose “narrow networks” or “preferred provider organizations” that dictate which doctors we can see. No other rich country permits such restrictions. The patient can choose any doctor, hospital or lab, and the insurance system — whether private or run by the government — has to pay. In the U.S., only the public plans — Medicare and Medicaid — give patients free choice.

No health care system is perfect, but a number of countries have found a way to deliver quality care for a fraction of the cost. The U.K. and Germany, for instance, offer health care systems on par with the U.S. in terms of quality, have longer life expectancy and have better recovery rates from disease or injury — they also manage to cover all of their citizens, while close to 30 million Americans are uninsured. Yet Germany spends only 61% of what the U.S. spends per capita, while the U.K. spends just 42%.

How do other countries offer quality health care at a fraction of the cost? One way is through limiting the cost of health services. The average bypass surgery in the U.S. costs around $78,000, for instance, compared to around $24,000 for the same surgery in the U.K. Allowing the government to negotiate and then set prices — not unlike the American Medicare system — would go a long way toward bringing the costs of American health care in line with other wealthy countries without sacrificing quality.

Another way is through administrative simplicity. It is much cheaper to run a system with one set of rules and a standard price schedule than a chaotic mess like U.S. health care, with thousands of payers each with its own distinct forms, its own rules and its own negotiated prices.

It should be noted that universal health care can be accomplished in a variety of ways, it does not have to be through a system like the U.K. if that seems like too much government and too radical a change for Americans. Germany achieves universal coverage and much lower costs with private insurers and providers but firm government regulation — an arrangement that would feel somewhat familiar to Americans.

Can we reform the American health care system in order to improve in the areas of cost, access, equity and efficiency without sacrificing quality? The real-world evidence seems to strongly suggest this is possible. Our energies might be more productively focused not on whether it is possible, but instead on fixing the dysfunctional nature of our federal government so that it can adequately address our ailing health care system.

Lawrence Eppard is a faculty member at Shippensburg University, co-host of the “Utterly Moderate Podcast,” and author of “Poorly Understood” and “Rugged Individualism.” Alison Dagnes is a faculty member at Shippensburg University, co-host of the “Utterly Moderate Podcast,” and author of “Super Mad at Everything All the Time” and “Politics on Demand.” T.R. Reid is a former journalist for The Washington Post, documentary filmmaker, and author of “The Healing of America.”