ly converging toward market practices in
likely to face waiting lists, rationing,
health care.338 Thus, even as Americans
restrictions on the choice of physician,
and other barriers to care. Those coun-
debate adopting a government-run sys-
tries with national health care systems
tem, countries with those systems are
that work better, such as France, the
debating how to make their systems
Netherlands, and Switzerland, are suc-
look more like that of the United States.
cessful to the degree that they incorpo-
rate market mechanisms such as compe-
Looking at other countries and their expe-
tition, cost-consciousness, market prices,
riences, then, can provide guidance to
and consumer choice, and eschew cen-
Americans as we debate how to reform our
tralized government control.
health care system. National health care is not
· Dissatisfaction and discontent with a
a monolithic idea, nor is it as disastrous as
U.S. critics sometimes portray. Some national
nation's health care system seems to be
health care systems do some things well.
universal. Undoubtedly, Americans are
Yet, those systems do have serious prob-
unhappy with the current state of our
lems. In most cases, national health care sys-
health care system. According to the
tems have successfully expanded insurance
most recent Commonwealth Fund sur-
coverage to the vast majority, if not quite all,
vey, an astounding 82 percent of Ameri-
of the population. But they have not solved
cans believe that our system either
the universal and seemingly intractable prob-
requires fundamental change or needs to
be completely rebuilt.333 Not surprising-
lem of rising health care costs. In many cases,
attempts to control costs through govern-
ly, polls suggest health care reform is the
mental fiat have led to problems with access
top domestic policy issue in the upcom-
ing presidential election.334 Yet, that
to care, either delays in receiving care or out-
right rationing.
same Commonwealth Fund study shows
In wrestling with this dilemma, many
large majorities in every country, ranging
countries are loosening government controls
from 58 percent in the Nether-lands to
and injecting market mechanisms, particu-
78 percent in Germany calling for funda-
larly cost sharing by patients, market pricing
mental reform or complete rebuilding of
their health care systems.335 Earlier
of goods and services, and increased compe-
tition among insurers and providers. As Pat
polling by the Stockholm Network
found similar levels of unhappiness.336
Cox, former president of the European
Parliament, put it in a report to the European
Not as bad as in the United States, per-
Commission, "We should start to explore the
haps, but certainly no ringing endorse-
power of the market as a way of achieving
ment of their systems.
The United States
· Although no country with universal cov-
much better value for money."339
can increase
erage is contemplating abandoning a
Moreover, the growth of the government
coverage and
universal system, the broad and growing
share of health care spending, which had
trend in countries with national health
increased steadily from the end of World War
access to care,
care systems is to move away from cen-
II until the mid-1980s, has stopped, and in
improve quality,
tralized government control and intro-
many countries the private share has begun
and control costs
duce more market-oriented features. As
to increase, in some cases substantially. Some
Richard Saltman and Josep Figueras of
evidence shows a growing shift from public
without
to private provision of health care.340 If the
the World Health Organization put it,
importing the
"The presumption of public primacy is
trend in the United States over the last sever-
being reassessed."337 Alan Jacobs of
al years has been toward a more European-
problems of
style system, the trend in Europe is toward a
Harvard points out that despite signifi-
national
system that looks more like America's.
cant differences in goals, content, and
health care.
Therefore, if U.S. policymakers can take one
strategies, European nations are general-
35