Why can't we do what they do? National health reform abroad

Journal of Law, Medicine and Ethics

Volumn 32, Issue 3, 2004, Pages 433-441

  Jost, Timothy Stoltzfus ^a  

^a LEE UNIVERSITY   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

CONFERENCE PAPER; HEALTH CARE ACCESS; HEALTH CARE FINANCING; HEALTH CARE POLICY; HEALTH CARE SYSTEM; HEALTH INSURANCE; HEALTH PROGRAM; HEALTH SERVICE;

EID: 5044233199     PISSN: 10731105     EISSN: None     Source Type: Journal    
DOI: 10.1111/j.1748-720X.2004.tb00154.x     Document Type: Conference Paper

References (144)

1. Institute of Medicine, Care Without Coverage: Too Little, Too Late (Washington, D.C.: National Academy Press, 2002).
2. See T.S. Jost, "Private or Public Approaches to Insuring the Uninsured: Lessons from International Experience with Private Insurance," New York University Law Review 76 (2001): 419-492.
3. T.S. Jost, Disentitlement? The Threats Facing Our Public Health Care Systems and A Rights-Based Response (New York: Oxford University Press, 2003): at 14.
4. Id., at 235.
5. Id., at 204.
6. G.A. Ritter, Social Welfare in Germany and Britain: Origins and Development (New York: Berg, 1986): 33-48.
7. Tariffcheck 24, "Soll ich in der gesetzlichen Krankenversicherung bleiben oder mich privat versichern?" 〈http://www.tarifcheck24.de/ Tarifcheck24-1414/infos.html〉 (last visited June 9, 2004).
8. European Observatory on Health Care Systems, Health Care Systems in Transition: Germany (London: European Observatory, 2000): 49-50.
9. Id., at 26.
10. I b i d.
11. Under legislation adopted in the mid-1990s, most of the insurance funds were opened up so that anyone could join any plan. This allows the plans to compete on the basis of premiums, and has in general meant that many Germans have moved to the former-white collar or business-related funds, which had better risk-profiles and thus lower premiums. See Jost, supra note 3, at 240.
12. European Observatory, supra, note 8, at 41-44.
13. Id., at 40-42.
14. Id., at 245.
15. Id., at 25.
16. See Jost, supra note 3, at 244-45 (describing this process in greater detail).
17. I b i d.
18. The codes are weighted on a regional basis to provide higher compensation for primary care services and to diminish somewhat the overcompensation that might otherwise result for procedure-oriented specialists. There are also limits on how many points a doctor may bill per patient, and reviews to detect overutilitzation. Payments are also adjusted in other respects too complicated to go into here. For a fuller exploration of physician compensation, see European Observatory, supra note 8, at 102-06.
19. See Sozialgesetzbuch V., s71.
20. See Jost, supra note 2, at 247.
21. See World Health Organization, The World Health Report 2000: Health Systems: Improving Performance (Geneva: World Health Organization, 2000): 12-13.
22. I b i d.
23. J. Allsop, Health Policy and the NHS: Towards 2000, 2nd ed. (London: Longman, 1995): 17-23.
24. Jost, supra note 3, at 207.
25. European Observatory on Health Care Systems, Health Care Systems in Transition, United Kingdom (London: European Observatory, 1999): 41-42, 56.
26. Id., at 53-54.
27. Jost, supra note 3, at 219.
28. World Health Organization, supra note 21, at 12-13.
29. See Jost, supra note 3, at 451-52, 460-61.
30. Only in some Canadian provinces is the purchase of private insurance for publicly provided services illegal. Jost, supra note 3, at 491.
31. See E. Mossialos and J. Le Grand, eds., "Cost Containment in the EU: An Overview," Health Care and Cost Containment in the European Union (Aldershot, England: Ashgate Publishing Ltd., 2001): 1, 5-10.
32. Jost, supra note 3, at 451-52, 460-61.
33. Only 1 percent or fewer are uninsured. See Mossialos and Le Grand, supra note 31, at 5.
34. Australian Private Health Insurance Administration Council, Surcharges and Incentives, at 〈http://www.phiac.gov.au/insurenotsure/surcharges incentives/index.htm〉 (last visited June 2, 2004).
35. Australian Private Health Insurance Administration Council, Industry Statistics, at 〈http://www.phiac.gov.au/statistics/membershipcoverage/ hosquar.htm〉 (last visited June 2, 2004).
36. See e.g., G. Fattore, "Cost Containment and Reforms in the Italian National Health Service," in Mossialos and Le Grand, eds., supra note 31, at 513, 517-18.
37. See Department of Health, GP and Pharmacy Services - Introduction, at 〈http://www.oasis.gov.ie/health/gp_services/GP__services_introduction. html〉 (last visited June 2, 2004); Charges for Hospital Services, at 〈http://www.oasis.gov.ie/health/hospitals/hospital_charges.html〉 (last visited June 2, 2004).
38. See Department of Health, GP and Pharmacy Services - Introduction, at 〈http://www.oasis.gov.ie/health/gp_services/GP__services_introduction. html〉 (last visited June 2, 2004); Charges for Hospital Services, at 〈http://www.oasis.gov.ie/health/hospitals/hospital_charges.html〉 (last visited June 2, 2004).
39. European Observatory, supra note 25, at 42-43
40. Id., at 41.
41. See Health Canada, Canada Health Act: Overview, at 〈http://www. hc-sc.gc.ca/medicare/chaover.htm〉 (last visited June 9, 2004). See C.M. Grogan, "Who Gets What? Levels of Care in Canada, Britain, Germany and the United States," in J.A. Morone and G.S. Belkin, eds., The Politics of Health Care Reform (Durham: Duke University Press, 1994): 443-462 (discussing benefits and coverage in various countries).
42. See Health Canada, Canada Health Act: Overview, at 〈http://www. hc-sc.gc.ca/medicare/chaover.htm〉 (last visited June 9, 2004). See C.M. Grogan, "Who Gets What? Levels of Care in Canada, Britain, Germany and the United States," in J.A. Morone and G.S. Belkin, eds., The Politics of Health Care Reform (Durham: Duke University Press, 1994): 443-462 (discussing benefits and coverage in various countries).
43. Australian Private Health Insurance Administration Council, General Information, at 〈http://www.phiac.gov.au/insurenotsure/general1.htm〉 (last visited June 2, 2004).
44. Mossialos and Le Grand, supra note 31, at 32-36.
45. See R.B. Saltman, R. Busse and E. Mossialos, Regulating Entrepreneurial Behaviour in European Health Care Systems (Buckingham: Open University Press, 2002): 201-202, 215-216.
46. Mossialos and Le Grand, supra note 31, at 13-16.
47. I b i d.
48. G.F. Anderson, et. al., "It's the Prices Stupid: What the United States is so Different from Other Countries" Health Affairs 22, no. 3 (2003): 89.
49. U.G. Gerdtham and B. Jonsson, "International Comparisons of Health Expenditure: Theory, Data, and Econometric Analysis," in A.J. Culyer and J.P. Newhouse, Handbook of Health Economics 1A (Amsterdam: Elsevier, 2000): 13-53.
50. OECD, Life Expectancy at Birth (male, 2001), at 〈http://www.oecd. org/ dataoecd/13/41/31963112.xls〉 (last visited June 9, 2004).
51. See OECD, infant mortality data, (2001), at 〈http://www.oecd.org/ dataoecd/13/40/31963124.xls〉 (last visited June 9, 2004)
52. Anderson, supra note 46, at 97.
53. I b i d.
54. I b i d.
55. Id., at 101.
56. Jost, supra note 3, at 222-224.
57. Moreover, even those of us who are fully insured must sometimes wait for services. I was told recently that I would have to wait six to seven months to see a gastroenterologist with my health plan.
58. J. Cullis, "Waiting Lists and Health Policy," in S. Frankel and R. West, eds., Rationing and Rationality in the National Health Service (London: MacMillan, 1993): 15, 23-27.
59. Waiting lists also seem to be less of a problem in social insurance countries. See L. Siciliani and J. Hurst, Explaining Waiting Time Variations for Elective Surgery Across OECD Countries (Paris: OECD, 2003).
60. S. Frankel, "The Origins of Waiting Lists," in S. Frankel and R. West, supra note 56, at 6.
61. Jost, supra note 3, at 224-25.
62. Anderson, supra note 46, at 98.
63. Strategic Policy and Research Intergovernmental Affairs, Health Care Systems: An International Comparisons, at 〈http://www.pnrec.org/2001 papers/DaigneaultLajoie.pdf〉 (last visited June 2, 2004).
64. S. Woolhandler, T. Campbell, and D.U. Himmelstein, "Costs of Health Care Administration in the United States and Canada," New Eng. J. Med. 349 (2003): 768-775.
65. Anderson, supra, note 46, at 99.
66. I b i d.
67. I b i d.
68. I b i d.
69. Peter S. Hussey, et. al., "How Does the Quality of Care Compare in Five Countries," Health Affairs 23, no 3 (2003): 89-99.
70. R.J. Blendon, et. al., "Common Concerns Amid Diverse Systems: Health Care Experiences in Five Countries," Health Affairs 22, no. 3 (2003): 106-121.
71. R.J. Blendon, et. al., "Inequities in Health Care: A Five-Country Survey," Health Affairs 21, no. 3 (2002): 182-191.
72. Jost, supra note 3, at 216-217.
73. Id., at 243-248.iv. 29 U.S.C. § 1132, (1999 & Supp. 2004).
74. 29 U.S.C. 1132, (1999 & Supp. 2004).
75. Jost, supra note 3, at 34-46.
76. See Id., at 208-214; R. Klein, P. Day, and S. Redmayne, Managing Scarcity: Priority Setting and Rationing in the National Health Service (Buckingham: Open University Press, 1996): 39-40.
77. See Id., at 208-214; R. Klein, P. Day, and S. Redmayne, Managing Scarcity: Priority Setting and Rationing in the National Health Service (Buckingham: Open University Press, 1996): 39-40.
78. C. Newdick, "Judicial Supervision of Health Resource Allocation: The U.K. Experience," in T.S. Jost, ed., Readings in Comparative Health Law and Bioethics (Durham: Carolina Academic Press, 2001): 60-71.
79. Jost, supra note 3, at 248-252.
80. I b i d.
81. See summarizing this literature, C. Gordon, Dead on Arrival: The Politics of Health Care in Twentieth-Century America (Princeton: Princeton University Press, 2003): 2-8; C.H. Blake and J.R. Adolino, "The Enactment of National Health Insurance: A Boolean Analysis of Twenty Advanced Industrial Countries" Journal of Health Politics, Policy and Law 26 (2001): 679-708, 681-687.
82. See summarizing this literature, C. Gordon, Dead on Arrival: The Politics of Health Care in Twentieth-Century America (Princeton: Princeton University Press, 2003): 2-8; C.H. Blake and J.R. Adolino, "The Enactment of National Health Insurance: A Boolean Analysis of Twenty Advanced Industrial Countries" Journal of Health Politics, Policy and Law 26 (2001): 679-708, 681-687.
83. See L.C. Mayer, J.H. Burnett, and S. Ogden, Comparative Politics: Nations and Theories in a Changing World, 2nd. ed. (Upper Saddle River, N.J.: Prentice Hall, 1996): 46-49.
84. Id., at 51.
85. Id., at 54-55.
86. European Observatory, supra, note 8, at 110-116.
87. Jost, supra, note 3, at 226-27.
88. See S. Steinmo and J. Watts, "It's the Institutions Stupid! Why Comprehensive National Health Insurance Always Fails in America," Journal of Health Politics, Policy and Law 20 (1995): 329; C.H. Tuohy, Accidental Logics: The Dynamics of Change in the Health Care Arena in the United States, Britain, and Canada (New York: Oxford University Press. 1999): 108-112 (also gives qualified support for this explanation).
89. See S. Steinmo and J. Watts, "It's the Institutions Stupid! Why Comprehensive National Health Insurance Always Fails in America," Journal of Health Politics, Policy and Law 20 (1995): 329; C.H. Tuohy, Accidental Logics: The Dynamics of Change in the Health Care Arena in the United States, Britain, and Canada (New York: Oxford University Press. 1999): 108-112 (also gives qualified support for this explanation).
90. Steinmo and Watts, supra note 84, at 360, 362.
91. Id., at 363.
92. See discussing the concept of veto points, E. Immergut, Health Politics: Interest and Institutions in Western Europe (New York, Cambridge University Press, 1992): 226-231.
93. Blake and Adolino, supra, note 78, at 684; K.G. Banting and S. Corbitt, "Health Policy and Federalism: An Introduction," in K.G. Banting & S. Corbitt, eds., Health Policy and Federalism: A Comparative Study on MultiLevel Governance (Montreal: Institute of Intergovernmental Relations School of Policy Studies, Queens University, 2001): 1-38 at 4-6.
94. Blake and Adolino, supra, note 78, at 684; K.G. Banting and S. Corbitt, "Health Policy and Federalism: An Introduction," in K.G. Banting & S. Corbitt, eds., Health Policy and Federalism: A Comparative Study on MultiLevel Governance (Montreal: Institute of Intergovernmental Relations School of Policy Studies, Queens University, 2001): 1-38 at 4-6.
95. Jost, supra note 3, at 73-76.
96. Id., at 76.
97. R.J. Blendon, J.M. Benson, and C.M. DesRoches, 'American's View of the Uninsured: An Era for Hybrid Proposals," Health Affairs Web Exclusive, at 〈http://content.healthaffairs.org/cgi/reprint/hlthaff.w3.405v1.pdf〉 (last visited June 4, 2003).
98. J.S. Hacker and T. Skocpol, "The New Politics of Health Policy," in P.R. Lee, C.L. Estes, and F.M. Rodgriguez, eds., The Nation's Health (Boston: Jones and Bartlett Publishers, 2001): 200.
99. Jost, supra note 3, at 177.
100. Gordon, supra note 78, at 172-209
101. H. Maarse and A. Paulus, "Has Solidarity Survived? A Comparative Analysis of the Effect of Social Health Insurance Reform in Four European Countries," Journal of Health Politics, Policy and Law 28 (2003): 585-614, 588-590.
102. Id., at 608-611.
103. Blendon, Benson, and DesRoches, supra note 91.
104. I b i d.
105. It should be noted, however, that the public tends to be more supportive of collective responsibility for health care and less interested in market approaches than current policy elites. See M. Schlesinger, "On Values and Democratic Policy Making: The Deceptively Fragile Consensus around Market-Oriented Medical Care," Journal of Health Politics, Policy and Law 27 (2002): 889-925.
106. N. Laham, A Lost Cause: Bill Clinton's Campaign for National Health Insurance (Westport: Praeger 1996): at 211-213; T. Skocpol, Boomerang: Clinton's Health Security Effort and the Turn Against Government in U.S. Politics (New York: W.W. Norton and Company, 1996): 163-64.
107. N. Laham, A Lost Cause: Bill Clinton's Campaign for National Health Insurance (Westport: Praeger 1996): at 211-213; T. Skocpol, Boomerang: Clinton's Health Security Effort and the Turn Against Government in U.S. Politics (New York: W.W. Norton and Company, 1996): 163-64.
108. S. Glied, Chronic Condition: Why Health Reform Fails (Cambridge, Harvard University Press, 1997): 93-101.
109. Blake and Adolino, supra note 78, at 683.
110. See K. Minah, R.J. Blendon, and J.M. Benson, "How Interested Are Americans in New Medical Technologies? A Multicountry Comparison," Health Affairs 20, no. 5 (2001): 194-201.
111. V. Navarro, The Politics of Health Policy: The US Reforms, 1980-1994 (Oxford: Blackwell, 1994): 170-191.
112. Gordon, supra note 78, at 298.
113. Navarro, supra note 103, at 190; Blake and Adolino, supra note 78, at 686.
114. Gordon, supra note 78, at 279-280.
115. Gordon, supra note 78, at 281-284.
116. P. Starr, The Social Transformation of American Medicine (New York: Basic Books 1982): 249-251; Gordon, supra note 78, at 275-276.
117. P. Starr, The Social Transformation of American Medicine (New York: Basic Books 1982): 249-251; Gordon, supra note 78, at 275-276.
118. Hacker & Skocpol, supra note 92, at 189; Skocpol, supra note 99, at 153-157.
119. See T. Lieberman, Slanting the Story: The Forces That Shape the News (New York: New Press, 2000).
120. Gordon, supra note 78, at 297.
121. See e.g. R.G. Evans, "Going for the Gold: The Redistributive Agenda Behind Market-Based Health Care Reform," Journal of Health Politics, Policy and Law 22 (1997): 427-465; R.G. Evans, "Tension, Compression, and Shear: Directions, Stresses, and Outcomes of Health Care Cost Control," Journal of Health Politics, Policy and Law 15 (1990): 101-128, 102-104.
122. See e.g. R.G. Evans, "Going for the Gold: The Redistributive Agenda Behind Market-Based Health Care Reform," Journal of Health Politics, Policy and Law 22 (1997): 427-465; R.G. Evans, "Tension, Compression, and Shear: Directions, Stresses, and Outcomes of Health Care Cost Control," Journal of Health Politics, Policy and Law 15 (1990): 101-128, 102-104.
123. N. Laham, supra note 99, at 206.
124. See Steinmo and Watts, supra note 84, at 364.
125. See e.g. Tuohy, supra, note 84, at 40 (U.K.); Tuohy, supra note 84, at 53 (Canada).
126. See R. Harris, A Sacred Trust (Baltimore: Penguin, 1969).
127. Gordon, supra note 78, at 255: Laham, supra note 99, at 208-210.
128. Laham, supra note 99, at 208-10; Hacker and Skocpol, supra note 92, at 186, 189.
129. Gordon, supra note 78, at 211, 257; Skocpol, supra note 99, at 134-39.
130. Jost, supra note 3, at 72, 205-06.
131. This also happened in the United States when the Medicare program was created in 1965, and private insurers were brought in as carriers and intermediaries to operate the program. Health insurance coverage of the elderly was thin enough at that time, however, to make this strategy possible.
132. Skocpol, supra note 99, at 138-39; Tuohy, supra note 84, at 155
133. See Letter from Douglas Holtz-Eakin, Congressional Budget Office, to Representative Jim Nussle, Chairman, House Budget Committee (Feb. 2, 2004), at 〈http://www.cbo.gov/showdoc.cfm?index=4995&sequence=0〉 (last visited June 2, 2004).
134. Indeed, an attempt to use Boolean Analysis to test the power of these hypotheses found that all of them seemed to contribute to the explanation, though it found the veto points hypothesis most powerful. It also found, however, that the United States is the only country where all of the obstacles to change discussed above coexist, and also the country in which all but one of these factors was most unfavorable to reform. Blake and Adolino, supra note 78, at 699-670.
135. Tuohy, supra note 84, at 6, 123-124.
136. Id., at 6-7, 123.
137. Ritter, supra note 6.
138. Tuohy, supra note 84, at 38-41.
139. See European Observatory, Health Care Systems in Transition: Spain (London: European Observatory, 2000): 12-14; European Observatory, Health Care Systems in Transition: Portugal (London: European Observatory, 2000): 1999.
140. See European Observatory, Health Care Systems in Transition: Spain (London: European Observatory, 2000): 12-14; European Observatory, Health Care Systems in Transition: Portugal (London: European Observatory, 2000): 1999.
141. J.W. Björkman and K.G.H. Okma, "Restructuring Health Care Systems in the Netherlands: The Institutional Heritage of Dutch Health Policy Reforms," in C. Altenstetter and J.W. Björkman, eds., Health Policy Reform, National Variations and Globalization (New York: St. Martin's Press, Inc., 1997): at 79, 81.
142. T. Mamor, The Politics of Medicare, 2nd. Ed. (New York: Aldien De Gruyter, 2000).
143. Hacker and Skocpol, supra note 92, at 199.
144. Hacker and Skocpol, supra note 92, at 193; Skocpol, supra note 99, at 173-178. The recent adoption of a prescription drug benefit for Medicare would seen to contradict this, but so much of the benefit of that legislation goes to special interest groups, most notably drug companies and managed care organizations, that it is perhaps better viewed as special interest legislation than as a social program expansion.