Universal Health Care

Most industrialized nations have long supported the idea that access to healthcare is a fundamental right, and have built centrally planned systems to accomplish that goal. The result has been universal coverage that delivers excellent quality outcomes at lower costs than the United States.

In some countries, such as England and Canada, the government controls both financing and certain aspects of healthcare delivery, while in others, including Australia, Sweden and Germany, the system is publically funded, but with the majority of the medical care privately delivered.

In sharp contrast, the United States provides healthcare coverage through a variety of channels – some public (Medicare and state-based Medicaid programs), some commercial
Citizens in all three countries report satisfaction levels with their national health systems of between 85% and 90%. Support for their health care system, respect for their physicians and confidence in the quality of care provided is extremely high in each. And these outstanding outcomes are achieved at a cost relative to their GDP, which is dramatically less than in the U.S.

The Patient Experience

On the plus side, universal coverage relieves stress on families and facilitates the work of physicians and hospitals. When patients go to a doctor in the community or are admitted to a public hospital, their bills are paid by the government, with minimal out-of-pocket expense to themselves. The stress of worrying about how they will pay for the care they receive is eliminated and the risk of personal bankruptcy virtually nonexistent.

The drawback, however, is delays in access, particularly for routine procedures. Urgent, more acute problems are generally attended to in relatively short order. But expected waits for routine procedures in public hospitals vary from four to six months, depending on the particular intervention – far longer than what commercially insured Americans experience
They require leadership. That leadership can come from above. Governments can legislate new laws and regulations, insurance companies can adjust guidelines and fees, and hospital administrators can send e-mails and implement new policies. But most of these efforts fail to have the positive impact the people who designed them expected.

This is why physician leadership is so crucial, and going forward will determine whether our health care system achieves its potential. Physicians will resist changes imposed by health plan executives and hospital administrators, and nearly all pay-for-performance incentives fail to achieve their desired results. Physicians will change their practices, and implement improvements to benefit patients, but only when the efforts are led by colleagues they know, respect and trust.

This is our culture in the United States. As Malcolm Gladwell described in his book, "The Tipping Point," the colonists followed Paul Revere because they knew and trusted him, not because of his title or position, The United States will never be Australian, England, Canada or Sweden. As long as our culture prevents us from embracing the approaches others use, we will have to accept the limitations that result.

But nothing should stop our country from achieving outcomes just as good as