Improving U.S. Health Care by Learning from Another Country

Improving U.S. Health Care   by Learning  from Another Country

Laurence Struck

larry_struck@hotmail.com

Picture yourself with a serious health problem and no medical care. This is not difficult to imagine for anyone without health insurance or with substandard coverage. If you are unable to pay to see a doctor, then you reluctantly learn to live with that low-grade fever, strange pain, rash, persistent cough, or deep ache in the gut. Your shortness of breath probably just means you have to take it easy if you can and maybe lose a few pounds. You hate to do it but you had better postpone checkups for the kids.

Now your personal health care guidelines have become: 1) deny or downplay your actual condition, 2) avoid or postpone consulting health professionals, and 3) resign yourself to suffering through illnesses that could be treated, often easily. As a result, you or your family’s health, and maybe lives, are at risk…unnecessary risk that is bewildering and unacceptable. All this could be avoided if the people of the United States, their institutions and representatives would summon the courage to truly change their health system for the better.

Currently more than 45 million U.S. citizens have no health insurance, not to mention the millions more with flimsy coverage that does not quite measure up to the level of, say, a member of Congress or fortunate Americans who seldom need to give their health premiums a second thought. Waiting in the wings are many more who are one major medical event away from loss of insurance or personal bankruptcy.

 The deepening economic crisis and rise in unemployment ensure that these numbers will grow.  Some may say that this is just a natural outcome of market dynamics, an unpleasant economic reality. If you are a favored citizen who has adequate medical coverage, you may think that the uninsured and sick will always be with us. But losing your job or watching a friend fall through the cracks might change your mind.

Americans increasingly believe that a workable and comprehensive health care system is an urgent priority. Recent research by the Kaiser Foundation and the Harvard School of Public Health shows that health care reform now ranks second only to economic recovery as the most pressing national mandate. More than 60% of the American public feel that in light of overwhelming economic problems facing the country, “it is more important than ever to take on health reform now.”

Can this type of sweeping reform be done? A more fundamental question is: should the United States organize its health care so that all citizens can receive affordable medical treatment when they need it? The answer to the “should we” question is yes, for two reasons. One: this country was founded and continues to thrive according to principles and values that provide for the common good. In that spirit, a right to decent health care for all should be seen as an essential part of U.S. citizenship.

A second reason to tackle the problem now is that a healthy citizenry is economically more productive, less wasteful of tax dollars and conducive to a higher quality of life. Dollars not spent on health care can fund schools, research or stay in the pockets of taxpayers.

Total health care expenditures in the U.S. for one year amount to $2.4 trillion, more than the entire economic output of Great Britain, or the combined economies of all the countries of Latin America. Of that amount, which is expected to double by 2017, it has been estimated that 30% is wasted or badly spent. Among 191 nations, the World Health Organization in 2000 ranked the U.S. health care system as the highest in cost per capita, 37th in overall performance and 72nd by overall level of health, a little behind Macedonia and Tunisia.

But is it possible to accomplish the far reaching change represented by major health care reform? There is no shortage of obstacles, among them: available money to pay for an overhaul and continued operation; complex planning and coordinating of a nation-wide system; and resistance from political opposition, interest groups and their lobbyists. Add to this the public education that will be needed to guide and reassure Americans in a different health care environment. The project begins to look like a very tall order.

What exactly would the new health care landscape look like?  Universal care, a term too often made to sound threatening, could take many forms ranging from a single payer to various public/private arrangements involving insurers, provider networks or employers. During the changeover to whatever the new system may be, special priority should be assigned to reaching the uninsured. They have waited long enough.

Since the U.S. has had trouble arranging health care for its population, an innovative example from another country may be helpful. Most industrialized countries have some form of universal health care. We should not be afraid to borrow workable ideas whenever we see them. They can be found in unexpected places.

The South American country of Venezuela places a high value on its citizens’ health, as reflected in its constitution which gives all Venezuelans the right to proper health care. In order to serve the large poor population there, a network of neighborhood clinics has been created so that anyone with a medical problem can see a doctor. Additional treatment, if needed, is handled by referral to second and third tier facilities. Their system focuses on prevention and early intervention, which saves needless expense and suffering. Serious conditions that require surgery or advanced procedures are evaluated and authorized for treatment without much delay.

One other interesting fact about the Venezuelan community health system: it’s free to the public. A person can walk into any of the more than 6500 clinics throughout the country and receive medical care at no charge. Venezuela is not alone among countries that have found low cost ways to deliver health care. The U.S. does not need to offer all free medical services or copy another nation’s system, but we can at least redefine “affordable” in a way that makes sense to out-of-work heads of families.

The Venezuelan approach to health care is still a work in progress and not without problems. Many Venezuelans have been slow to accept the new system, started recently in 2003. A traditional fee-for-service medical industry competes with the free clinics for those who want a private doctor. Staff and equipment shortages plague the system as well as budget shortfalls despite the country’s rich oil resources. Then there is the unpredictable and sometimes antagonistic leadership of President Hugo Chavez. His close ties with Cuba have raised eyebrows, even as that controversial island nation has provided Venezuela with guidance and personnel for its clinics.

Despite the hurdles it faces, Venezuela’s neighborhood clinic system, known as Barrio Adentro, is working, and helping people, many of whom had never in their lives seen a doctor because they could not afford it or no medical care was available where they lived. The clinics can also provide medications, dentistry, eye exams with new glasses and referrals for counseling or other community services. If a country with one quarter of the per capita household income of the United States and a much worse poverty rate can manage to create an effective health care system for its people, why can’t we?

To jumpstart an equitable health program for the American people, let’s consider a joint venture with Venezuela. Health care experts from each country would exchange visits to see for themselves how things work and plan improvements. Managers of the Venezuelan neighborhood clinic program could then travel to the U.S. where they would join forces with like-minded health professionals to set up basic walk-in clinics and help expand the limited community services already available. It may seem strange to have these foreign advisors poking around in the U.S., but how many times have we provided help to other countries expecting them to see the good sense that collaboration makes? (Think Marshall Plan, Peace Corps, Global AIDS Initiative.)

The challenge of financing a better health system, already under heavy scrutiny at all levels of government would be met with a better, cost-effective model based on early intervention and health education. In return, Washington might provide more favorable trade terms to Caracas as aid to their economy.

The timing for a nation-to-nation cooperative project like this could not be better. The Obama administration will be looking for openings to establish better relations with Latin America, while Chavez appears to be eager to form closer ties with the new U.S. president. What better platform for the international exchange of good will can there be than treating the sick and improving our health? It is about time for the United States to test new approaches that will build a solid infrastructure for expanded health care coverage.

No doubt there will be abundant problems and obstacles in starting up a project like this. But Americans have always been known as problem solvers, a quality we especially need now everywhere we look, whether in health care, jobs, public safety, education or international affairs. Finding solutions based on cooperation, rather than a “not invented here” mentality, can be just what the doctor ordered.

Laurence Struck is a training consultant visiting Venezuela.

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