Monday, August 31, 2009

Health Care Stories: Oslo, Norway

David explores the differing European and American attitudes towards universal health care.

I’ve lived all 58 years of my life in countries with some form of National Health system: the United Kingdom, France, Holland and now Norway. In all of these countries, a publically-subsidized healthcare system is something that is pretty much taken for granted. If you have something wrong with you, no matter how trivial it is, you go to your doctor. You don’t worry about how much it will cost you, because it will cost you little or nothing. And even if you have nothing wrong with you – if you simply want your health status monitored as a precautionary measure – you can still make regular appointments with your doctor and again it will cost you little of nothing.

I think I’m reasonably accurate in saying that the average Brit, Frenchman, Dutchman or Norwegian regards the debate that is now taking place in the United States with a mixture of incredulity and amusement. We find it incredible that the richest country on earth has no effective system of social healthcare. We find it incredible that there’s even a debate going on about something that we regard as an inalienable right – the right to be healthy. And we find it amusing that so much hysteria is being whipped up and that government-subsidized healthcare is being branded as socialism.

And, as we all know, a large section of the American public is scared of anything that even remotely smacks of socialism. From an outsider’s perspective, it would seem that the Cold War mentality is not entirely dead and neither is McCarthyism.

However, this does not seem to stop 15.4 million Americans from being members of labor unions. Let’s get one thing straight: a labor union is an institution based on socialist principles. Unions were created to protect the interests of working people – to give them adequate salaries and working conditions, among other things. Yet, as we know, modern unions are not necessarily socialist, or even left-wing, in their political leanings.

Similarly, adopting a healthcare system on socialist principles does not mean that democracy is under threat or that there will be parades of tanks and missiles down 5th Avenue on May 1st. In fact, a national health system finally has little to do with politics – it is simply a way of ensuring that EVERYONE in the country receives adequate healthcare irrespective of their income level.

And it is income level that is the important point here. For the roughly fifty percent of the U.S. population that can roughly be defined as “haves”, the concept of a national health system is irrelevant. They may or may not feel that it is important to have an efficient and socially just health system but, on a personal level, they have no need of it.

But let us turn our attention to the “have nots” (bearing in mind that 58.5% of Americans will spend at least one year below the poverty line between the ages of 25 and 75). These are the vulnerable people, the people who prefer to risk their health rather than seek medical attention that they cannot afford. The people for whom a serious illness will also mean increased deprivation.

There are people living below the poverty line in all of the countries in which I have lived. But in none of those countries does poverty need to mean ill-health. Affordable medical care is available for all. It is not always perfect, and in the U.K. for example, there have often been long waiting lists for interventions that were considered non-essential, or at least not life-threatening. There are cases of misdiagnosis and there are some medical professionals who are clearly sub-standard. Yet, these are situations that can equally occur just as frequently in private systems. And the general quality of service that I have experienced has been uniformly high.

In Europe, the actual structure of national health systems varies from country to country. In the United Kingdom, for example, the health service is free for all, with a flat-rate prescription charge that covers all prescriptions – everything from aspirin to the latest and most sophisticated drugs.

One thing that you will never get in any of the European countries I have mentioned is unpleasant surprises. Should you be unfortunate enough to have an accident, you will be taken to the nearest hospital. Treatment, of whatever nature, will be thorough, effective and free. Treatment costs will be either covered by the state and/or by a form of private health insurance that provides a standard level of cover set by the government. Everyone in all of these countries benefits from some form of total health insurance. By contrast, in 2006, 16 percent of the population of the United States were without health insurance for at least part of the year.

You are free to choose your own doctor in all of the 4 countries I have mentioned. You are also free to discuss your best options for medical treatment. You will never find either a national health system or even a private health insurance company refusing a form of treatment on grounds other than its suitability as a remedy to the medical problem concerned. And, contrary to some of the propaganda put forward by opponents of healthcare overhaul, insurance companies in Europe – even those specializing in healthcare – continue to make very healthy profits.

Surely, the issue should not be about the so-called political implications of a form of national health system (non-existent) or the damage it might cause the private sector (negligible) but of how such a system should be best implemented.

Article 25 of the Universal Declaration of Human Rights states that: “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.”

As a signatory of the 30 articles comprising the Declaration of Human Rights, the United States of America is committed to implementing their provisions. If it wishes to occupy the position of leadership in the world to which it aspires, it would do well to ensure that each and every one of those 30 articles is rigorously observed. Then, and only then, will the United States be morally justified in persuading other countries to do likewise.

Free or low-cost healthcare for all is not an option but a moral imperative.

Oslo, Norway

Check out David Wray's blog, The Opposite.

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