Can Americans Adopt a Universal Health Care System?

With the Presidential election looming in 2008, many Americans are concerned about how Presidential candidates plan to handle the health care crisis. As it stands now, health care reform is a major political issue. Both employers and employees are struggling to afford health insurance premiums. For many Americans, the cost of health insurance is simply not within their reach.

Virtually all Presidential candidates agree that health care reform is a serious issue. Some Presidential candidates are proposing a Universal Health Care system, where both the Government and citizens would be responsible for paying for health care insurance coverage. The big benefit of this health care reform solution is that every citizen will have access to affordable health care coverage. People would not be turned down by health insurance companies for having a pre-existing condition. Premiums would be regulated so that people with health conditions would not be forced to pay ridiculously high premiums to obtain health insurance.

The biggest problem facing the Presidential candidates who support the idea of Universal Health Care is how to implement a system that works for everyone while remaining affordable to both citizens and the Government over many decades. While the idea of Universal Health Care sounds appealing, the nuts and bolts of an affordable and functional solution are extremely complicated. It is not unreasonable to assume that the Presidential hopefuls will look to other countries that have Universal Health Care in an attempt to successfully implement a similar system in the United States. Before heading to the voting booth in November 2008, it would be prudent to know how a proposed Universal Health Care solution would work, the positives and the negatives of the solution, and how they could affect you.

This article will explore the Universal Health Care system in Japan as a potential model for health care reform in the United States. Japan has one of the lowest health insurance rates for citizens, making them an appealing model for Universal Health Care in America. While Japan's model of health care may make Universal Health care affordable to American citizens, is there a hidden price that we will pay?

The health care system in Japan offers free choice of health insurance by patients. Premiums are determined by income and ability to pay. Health insurance expenditures are financed through employers, employees, and by income-based premiums by the self-employed. In the United States, federal, state and local governments already finance 42.9% of all health care expenditures and 22% of out-of-pocket payments. By contrast, Japan finances only 31.7% of health care expenditures through national and local public funds. The remaining share of health care costs is financed through premiums paid by individual subscribers and employers. Yet, the Japanese enjoy lower costs of healthcare overall. While there is government regulation of health care financing and health insurance operation, delivery of care is controlled by medical professionals.

One of the ways that Japan helps to control the cost of health insurance is by increasing the patient-to-physician ratio. In the United States, the average patient-to-physician ratio is 1,000 patients to 2.3 physicians. In Japan, the average patient-to-physician ratio is 1,000 patients to 1.6 physicians. The increased number of patients to physicians has produced an average physician visit time of 6.9 minutes, versus the average 20 minutes a patient has with a physician in the United States. This raises grave concerns over quality of care being provided to patients.

Another tool used to keep health costs to a minimum is to reduce hospital admittance and hospital staff. Japan has the second lowest hospital admittance rate among the 24 countries belonging to the Organization for Economic Corporation and Development (OECD). A reimbursement system that pays hospitals on a per diem basis reinforces the desire to keep hospital admittance low. Hospitals in Japan have an average of 15.8 hospital beds per 1,000 persons, which is three times the rate of hospitals in the United States, yet maintains one of the lowest number of hospital staff members among the OECD.

Despite the encouragement of keeping hospital admittance to a minimum and having a high number of hospital beds, a woman died recently after having been refused admittance by 30 hospitals. The reasons for refusal were cited by the hospitals that they were either full, or did not have doctors available to immediately treat the woman (read the full article here). A second woman who was pregnant died for the same reasons after having been refused by 20 hospitals that stated they were full. Such incidences could be indicative of serious cracks in Japan's Universal Health Care system.

Japanese culture focuses heavily on using non-invasive procedures as much as possible, and this in turn, reduces their cost of health care. Survey data indicates that Japanese surgeons perform less than one quarter the number of operations in comparison to their American counterparts. Common procedures in the United States, such as caesarean sections, are performed half as often in Japan. The prevalence of surgeries in the United States could be indicative of a mixture of American culture (focus on fast and painless) and the fear doctors have of being sued for negligence or malpractice. In order to reduce health care costs in the United States, a cultural shift away from surgical procedures may be necessary.

Other cultural differences abound, which could make Japan's Universal Health Care system difficult to implement in the United States. Japan has long been a more centralized country, with a rather homogenous population that is accustomed to strong state intervention. Even so, the Universal Health Care system in Japan began to emerge as far back as 1905, but it wasn't until 1961 that all citizens had health insurance provided either by their employers or the government. Meanwhile, the United States is extremely diverse in ethnicity and accustomed to solving social problems at a local, state level. The enormous diversity that Americans enjoy may actually be the largest detriment when it comes to adopting a Universal Health Care system in the United States.

In conclusion, when considering whether a Presidential candidate's plan for Universal Health Care can actually work, it would be wise to plumb the depths of the plan. Would the plan put pressure on physicians to see more patients in a less amount of time? Would the plan cause overcrowding in hospitals to the point that patients in critical condition are refused? How would these obstacles be overcome? These are just a few examples of the many obstacles of providing Universal Health Care to a large and diverse population.