On the scene: What the U.S. can learn from other countries about health care

A Portland City Club panel discusses pros and cons of international health care models.


The Friday Forum speakers were Theodore Marmor, a Yale University professor who helped design Medicare in 1965, and Kieke Okma, a visiting professor at McGill University who spent 25 years working on healthcare policy for the Netherlands government. 

Universal healthcare in many countries may be superior to the U.S. system, but a public option is not the be-all and end-all to accessibility and affordability, the panelists said.

Citing examples from Canada, Germany and the United Kingdom, experts talked about private vs. public insurance, healthcare access and out-of-pocket spending.

As most people know, Canadian health care is publicly-funded. 

“The argument in Canada is if we permit private insurance for public and financed care, that means you’re violating the principle of access,” Marmor said.

The country spends about 11% of its gross domestic product on healthcare. The system does not cover dental care, which requires a supplementary health insurance plan. About 60% of Canadians pay for this additional coverage. On the downside, wait times are notoriously long. Patients have to wait up to 4 weeks for an appointment. Wait times are largely for specialists.

Health insurance is a requirement for all German residents, but the government does not regulate the health plan. The federal government instead approves an annual budget — about 10% GDP — and the benefits package. The insurance is then paid via payroll tax.

The total tax averages 15%, which is split between the employee and employer. There is a private insurance option, but only about 10% of the population — those with disposable income — opt for a private plan. Copays are rare but were recently approved for some services. For example, a day of inpatient treatment at the hospital costs 10EUR ($11.25).

“Those who go to the private sector, who are they? Wealthy and healthy. That’s a problem,” Okma said.

UK health coverage is publicly funded; the budget equals about 9% of the GDP. This coverage is largely free to residents. There are no copays. About 11% of the population has private insurance, which typically affords more rapid care than using the public system. 

Would any of these universal health care programs work in the U.S?Unknown 4

Okma said to make the shift the U.S. would have to consider standardization for administration, forms, cost, etc.

“It’s extraordinarily transparent and efficient,” she said.

Canada, perhaps because of its proximity, is often used as a benchmark for the U.S. Marmor said we could consider a system but there are drawbacks.

“If by some miracle we could become Canadians, we would be close to the Canadians but not equal to them,” he said. “They spend less on administration, but they also have lower prices per activity.”

In the 1970s, healthcare spending in Canada and the States was 7% of GDP. Those numbers began to deviate in the 1980s. By 2000, Canada’s cost was 10% while the U.S. was 14%. Now? The U.S. spends 18% compared to Canada’s steady 10%.

“The U.S. is spending more money on healthcare than anyone else in the world,” Marmor said.

“As a justification, some people claim we have the best healthcare in the world. In some sectors, sure it’s true. But the distribution of medical care and the overall expenditure of medical care is uneven.”

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