Healthier systems

More information from The Healing of America by Washington Post correspondent T.R. Reid:

There are private insurance companies in most of the countries Reid visited, hundreds of them in some cases, like Germany and Japan. The critical difference between insurers in most countries with national systems and insurers here—they’re non-profits. This is crucial. Instead of insurance companies posting billion dollar profits and making their stockholders happy, they’re paying claims and making their customers happy. Since all citizens must be insured by law, the pool of customers, including young, healthy 22 year-olds, guarantees a steady, reliable supply of income, large enough to keep those companies solvent, even when they’re covering those with pre-existing conditions.

In 1994, interesting stories involving health care popped up around the globe. Taiwan, for example, decided it wanted something in place for its 23 million citizens besides the market-oriented “out of pocket” system. It convened a commission, looked at health care around the world, fashioned a mix of features borrowing from Germany, Japan and Canada, and, through positive political will (as in “let’s get this done”), passed the National Health Insurance Act in July of ’94. By March of ’95, the new system was installed and functioning.

In Switzerland in ’94, a similar movement was brewing. The status quo back then was very similar to ours. Lots of for-profit insurers, most making stacks of cash by doing things like denying applicants with those pesky pre-existing conditions. So how, with lots of opposition against tinkering with their “good thing,” were the Swiss able to get over the proverbial hump? Switzerland is a country that talks openly of and greatly prizes a sense of national solidarity. With this attitude, a health-care system that was leaving more and more of its citizens uninsured had become unacceptable. But not by grand majority. In a referendum held in ’94, the Swiss, appealing mostly to that solidarity, barely passed its Federal Law on Compulsory Health Care. It didn’t install a government-run insurance program, but made use of its existing health insurers. Lo and behold, national health care did NOT turn out to be a death knell for that industry. One company president told Reid, “We opposed the reform in ’94. But in fact, our industry has thrived with it.” Go figure.

By the summer of 1994, the move to install a national health-care system here was all but dead, the Clinton bill tied up in a Senate committee until it withered away. Sixteen years later, we still are, like the mythical Sisyphus, trying to roll that boulder up the hill. It can be done, as Reid points out. But not, it would appear, without a serious gut check and some sense of national moral imperative.