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Victor Fuchs, writing in the Jan 2 edition of JAMA, has a slightly different perspective. He notes that American history is dominated by waves of immigrants who came here to escape oppression. We are far more distrustful of government. We are also less likely to support redistributive public policies. That may be partly due to a more heterogeneous population that is less sympathetic to the less fortunate when they fall outside the right social or demographic class. Last but not least, our system of government is quite inefficient compared, say, to a parliamentary system.
1. Government spending on health care is comparatively lower: 46% in the U.S. vs. 75% in Organization for Economic Co-operation and Development (OECD) countries. As a result, a) administrative costs are fragmented, and b) there is less ability to negotiate prices with providers and suppliers
2. There is a different mix of services: in the U.S., less top-down control means more high tech, specialists and amenities with relatively less reliance on physicians and hospitals to render health care services.
What is the way forward? Dr. Fuchs recommends that future health reform efforts not be modeled on Europe. Instead, Americans should scale back their expectations and focus on what is necessary, not desireable.
If government is to assume a greater share of health care costs beyond the current 46% level, it should probably worry about funding basic care, not all care. In addition, Americans are less likely to support total equality; they want to preserve the option of "buying up" when they can afford it. Last but not least, future reform is going to have to find a middle ground between all the advocacy groups, stakeholders and special interests that dominate the mix of services.
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