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The broad and

that citizens of many countries put social soli-

tems around employment, while others have

darity and equality ahead of quality and choice

completely divorced work from insurance.

growing trend in

when it comes to health policy.329 American

Some require consumers to share a significant

countries with

portion of health care costs through either

attitudes are quite different. As pollster Bill

national health

high deductibles or high copayments. Others

McInturff notes, "Never, in my years of work,

subsidize virtually first-dollar coverage. Some

have I found someone who said, `I will reduce

care systems is to

allow unfettered choice of physicians. Others

the quality of the health care I get, so that all

move away from

Americans can get something.'"330

allow a choice of primary care physicians but

require referrals for specialists. Still others

Even so, some important lessons can be

centralized

restrict even the choice of primary care doctors.

drawn from the experiences of other countries:

government

In fact, about the only system one cannot

· Universal

control and

find is the type of system described by Michael

health insurance does not

Moore, Physicians for a National Health

mean universal access to health care. In

introduce more

Program, and other national health care advo-

practice, many countries promise uni-

market-oriented

cates--a system that provides unlimited care

versal coverage but ration care or have

features.

with no premiums, deductibles, or copay-

extremely long waiting lists for treat-

ments, from the physician of one's choice. For

ment. Nor does a national health care

example, in SiCKO, Moore lambastes American

system necessarily mean universal cov-

insurers for denying coverage for rare and

erage. Some countries with ostensibly

experimental treatments.327 And, during the

universal systems actually fall far short

of universal coverage, and most leave at

New Hampshire primary, John Edwards ran

least a small remnant (1­2 percent of

television advertisements highlighting the

the population) uncovered. Although

tragic death of a teenage girl whose liver trans-

plant was rejected by her father's insurer.328

this is certainly wider coverage than the

United States provides, it shows the dif-

These stories play effectively on the emotions

ficulty of achieving either truly univer-

and drive a desire for change. Yet one searches

sal coverage or universal access to care.

in vain for a national health care system any-

· Rising health care spending is not a

where that regularly pays for experimental and

untested procedures.

uniquely American phenomenon. Other

Likewise, advocates for national health care

countries spend considerably less than

tap into the anger many patients (and doctors)

the United States on health care, both as

feel for the gatekeepers and prior approval

a percentage of GDP and per capita,

required under American managed care. But

often because they begin with a lower

many if not most foreign systems require simi-

base of expenditures. Nonetheless, their

lar gatekeepers. Moreover, copayments and

costs are still rising, leading to budget

other forms of cost sharing are commonplace.

deficits, tax increases, and/or benefit

It is also important to realize that no coun-

cuts. In 2004, the last year for which data

try's system would translate directly to the

is available, the average annual increase

United States. Americans are unlikely to accept

for per capita health spending in the

the rationing or restrictions on care and tech-

countries discussed in this study was

nology that many countries use to control

5.55 percent, only slightly lower than the

United States' 6.21 percent.331 As the Wall

costs. Nor are U.S. physicians likely to accept a

cut in income to the levels seen in countries like

Street Journal notes, "Europeans . . . face

France or Germany. The politics, economics,

steeper medical bills in the future in their

cash-strapped governments."332 In short,

and national cultures of other countries often

vary significantly from those of the United

there is no free lunch.

· Those countries that have single-payer

States. Their citizens are far more likely to have

faith in government actions and to be suspi-

systems or systems heavily weighted

cious of free markets. And polling suggests

toward government control are the most

34