You have heard the arguments.
In the first corner: “We have the best health care system in the world. People travel to this country from all over the world to get the best health care. the parking lots in hospitals bordering Canada are full of cars with Canadian license plates.”
In the second corner: “There are 100,000 deaths per year from hospital infections and a similar number from prescription drug errors, and an equally horrific number of people who need to be re-admitted to the hospital for complications. And what about “Never Events”, those medical errors that are described as adverse events that are unambiguous (clearly identifiable and measurable), serious (resulting in death or significant disability), and usually preventable.
And there is a voice in a third corner: “We have the most expensive health care system in the world yet the United States is not ranked among the top twenty nations in infant mortality, maternal mortality, longevity, or hospital admissions avoidable with access to health care.”
It’s a bit like arguing who won the Super Bowl (this is Super Bowl weekend, after all) by comparing rushing yardage, passing yardage, first downs, time of possession. Unlike football, in health care there is no touchdown metric, no definitive “points on the board” that decides health care quality.
Which corner would you pick?
This past spring, Health Affairs, the premier health policy journal, had an interview with the German Minister of Health, Ulla Schmidt. The interview focused on reforms to Germany’s health system instituted principally in 2007. Minister Schmitt was asked what were the goals of the reforms. Her answer – she wanted to preserve the principles of social solidarity and affordability that had always been a part the German health system.
In comparison to health care in the United States, the Germans system could hardly be called a system in crises. The per capita costs were about half of what they were in this country $3,200 per person in Germany compared to $6,400 here. But they did have too many uninsured – about 0.2% of the population. The United States, by comparison has 15% uninsured.
So the question is, What do Germans understand by social solidarity? Minister Schmitt explained that everyone in Germany has guaranteed access to health care and everyone contributes to the financing based on their ability to pay. Well, if that is social solidarity, where does affordability fit in? For Minister Schmitt, if the entire system is not affordable, the social solidarity begins to break down.
Too much of the health care debate in this country is muddled by ideology on both sides. For many in this country, European health care sytems smack of “socialism.” Yet, two of the defining characteristics of the German system are not real popular among progressives in this country. The Germans have an individual mandate and they rely on insurance companies, although in Germany they give them a more accurate name, Krankenkassen, or Sickness Funds.