Getting health care right: Paris and Amsterdam

Jonathan Cohn, senior editor at The New Republic, has an article in today’s NY Times on what we can learn from the health systems of other countries. Republican opponents of health care reform are fond of saying: “I don’t want America to begin rationing care to their citizens in the way these other countries do.” They hold up as examples Canada, which has a single-payer system, and the UK, which is labeled socialist because doctors are paid by the government. Opponents like to paint pictures of sick people, waiting in long lines, who receive inadequate care once they’re finally seen.
The insurance practices and medical cultures of France and the Netherlands have more in common with the situation in the US. They get less attention than Canada and the UK because, according to Cohn, they don’t fit the negative stereotypes of what health care is like when the government is involved in medical care. Based on his extensive research, Cohn reports:

People in these countries were getting precisely what most Americans say they want: Timely, quality care. Physicians felt free to practice medicine the way they wanted; companies got to concentrate on their lines of business, rather than develop expertise in managing health benefits. But, in contrast with the US, everybody had insurance. The papers weren’t filled with stories of people going bankrupt or skipping medical care because they couldn’t afford to pay their bills. And they did all this while paying substantially less, overall, than we do. …
[I]n both countries, people pay for health insurance through a combination of private payments and what are, by American standards, substantial taxes. …
[B]oth the Dutch and French appear to have easy access to basic medical care – easier access, in fact, than is the American norm. … 60 percent of Dutch patients and 42 percent of French patients could get same-day appointments. The figure in the US was just 26 percent.

How long does it take to see a doctor?

I’ve been impressed with the ability to get a same-day appointment from my health care provider, the HMO Kaiser Permanente in northern California. Since I rarely see my primary physician anyway, it doesn’t matter to me who I see. Physicians at Kaiser are paid a salary, BTW, not on a fee-for-service basis.
It’s also possible to get these last-minute appointments from Kaiser in the evening and on weekends. According to Cohn, this is typical of health care in France and the Netherlands.

If you live in either Amsterdam or Paris, and get sick after your family physician has gone home, a phone call will typically get you an immediate medical consultation – or even, if necessary, a house call. And if you need the sort of attention available only at a formal medical facility, you can get that, too – without the long waits typical in US emergency rooms. …
[This] leave[s] hospital emergency rooms free to concentrate on the truly serious cases. Tellingly, a Dutch physician I met complained to me that waiting times in her emergency room had been getting “too long” lately. “Too long,” she went on to tell me, meant two or three hours. When I told her about documented cases of people waiting a day, or even days, for treatment in some American emergency rooms, she thought I was joking.

There was a notorious case last year in New York City, caught on hospital security cameras, where a woman collapsed onto the floor of an emergency room, died over an hour later, and no one tired to help her. Her family recently won a $2 million settlement.
Patients in France and the Netherlands do wait longer than Americans for specialty care. Unlike Americans, however, they don’t avoid specialty care because they can’t afford it. And there’s very little evidence that increased waiting time leads to less effective care.
Cohn concludes:

[T]he changes now under consideration in Washington are relatively modest, by international standards. But insofar as countries abroad give us an idea of what could happen, eventually, if we change our health insurance arrangements, the experience of people in Amsterdam and Paris surely matters as much as – if not more than – those in Montreal and London. In those countries, government intervention has created a health system in which people seem to have the best of all worlds: convenience, quality, and affordability. There’s no reason to think the same thing couldn’t happen here.