Health care laws in North America, Europe, and Australia
Never has there been a more relevant time to discuss the many facets of healthcare than in the midst of a pandemic. I couldn’t have predicted our world’s current status when I read about the 1918 flu in school a year ago. I traveled to school unmasked, working in small classrooms where students were in close enough proximity to shake hands. Now, shaking hands where I live in America seems like a custom of the past.
It is important to note that, today, as my city reimplements coronavirus restrictions, some nations across the Atlantic have partially returned to normalcy. While it would be ignorant to imply that all, or even any, European countries have fully recovered from the pandemic, the virus shed light on large differences in healthcare among western countries. Parallels can be drawn between the universal care in Europe and their group mindset while handling the virus, while the United States has desperately clung to capitalist views and individualism throughout the roll out of safety measures.
When asking my peers in America their thoughts on European healthcare, their responses were rather simple. “Well, it’s free, right?”, one posed, shocked I may be questioning this utopian system. The perspective that European healthcare exists in a fairy tale is common amongst my friends; an idea perpetuated by our politicians, often to stifle the thought that it could possibly work here. Yet by examining the diverse nations throughout the continent, it can be seen that European healthcare actually exists in three main forms: single-payer, regulated privatized, and socialized healthcare.
The country of France is an example of socialized, universal healthcare. Other nations under this system include Britain, Italy, Norway, and Sweden. In 1945, Statutory Health Insurance (SHI) was gradually implemented in France to cover employed, unemployed, and self-employed residents. Universal Health Coverage (CMU) made in 2000 protected those not under SHI, and to further coverage, SHI became universal in 2016. The public plan covers most hospital visits, physician care, and prescription drugs. However, residents pay copayments or coinsurance on anything that exceeds the government set fees. Like many other countries, this is primarily paid for through payroll taxes. A main complaint of this system is its lack of dental and vision coverage, which explains the prevalence of supplemental private insurance by most French residents. The 95% of French people with some sort of private plan on top of the public option allows coverage for areas where the SHI falls short.
France faces the same issues as other nations when it comes to healthcare, that being the disparities between classes and for immigrants. While migrants who have applied for residency can be covered by state-sponsored insurance, only around 10% of undocumented immigrants in 2014 had access to this care. Other disparities exist for people with lower incomes and people in rural areas. There is an approximate 6.3-year gap in life expectancy between males in the highest income bracket versus the lowest, so in 2004, the Public Health Act aimed to reduce gaps in care based on geography and income. France has placed financial incentives for physicians who work in areas that are underserviced. Additionally, a law in 2013 limited aspects of private insurance to decrease disparities for those who can’t purchase one.
Despite the perception of all European care being the same, some nations have regulated-private plans. This includes Germany, the Netherlands, and Switzerland. However, Switzerland is actually similar to the US in a way where healthcare is mandated but not provided by the government. Despite this, almost 100% of residents are covered, and costs are lower overall. This is achieved through care that is highly decentralized by the regulations of the government. While they don’t own providers, private insurers are nonprofit and follow the standards for deductibles and copayments set by the government. Insurance is not purchased through one’s employer, but is managed by the Federal Office of Private Health. The government approves of certain prescription drugs provided as well as services. A small group of for-profit insurers in the country exist, but this is mostly used for residents seeking care on top of what the mandated plan provides.
Like France, the main issues with the system occur for those with lower income as well as immigrants. A constant struggle in many of these European countries is to provide care for the influx of refugees and migrants. The Switzerland government tries to compensate for the issues disproportionately impacting immigrants through educational tools. Other non-governmental organizations exist such as the Swiss Refugee Council, which aims to overall assist and advocate for refugees in the nation.
Moving forward to review North America, around 900 miles north of my home are my Canadian neighbors. I have always felt a connection to Canada as if they are a distant relative you only see in pictures. Similar in our accents and affinity for hockey, my state of Minnesota acts as the off-brand version of the country. Despite this bond, Canada could not be further from me in regards to healthcare.
Canada operates a single-payer, universal healthcare system. Their Medicare runs on 5 standards set in the 1984 Canada Health Act: publicly administered, comprehensive coverage conditions, universal, portable across provinces, and accessible. The federal government manages care, but each province or territory (P/T) creates their own plan. Most plans account for hospital visits, physician care, mental health care, and prescription drugs on the government list. Services such as dental, chiropractors, phycologists, and even cosmetic surgery are increasingly covered. The government limits out-of-pocket costs by providing tax credits to those with high personal spending caused by uncovered services. However, around ⅔ of Canadians have private insurance as well, usually through an employer to aid with other needs. Canada is also set to implement universal pharmacare in the future, as a recent report has set goals to fully achieve this by 2027.
Canada falls short in its services for First Nations, Metis, and Inuit residents. Overlapping in other issues such as housing and education, the health disparities for Indigenous populations are great. While a 2018 budget expanded funding towards these communities, many leaders in the Indigenous community have argued it’s not enough. Long-term impacts of the 1876 Indian Act echo through Indigenous communities today; the legislation made the government in charge of Indigenous healthcare and was made to promote assimilation and erasure of culture. First Nations face shorter life expectancy, higher infant mortality rate, and are more likely to develop serious illnesses such as diabetes. The First Nation Health Authority in British Columbia was created in 2011 to advocate for Indigenous health from providing primary care to working with health centers to reduce disparities. It is clear that issues in healthcare are just one symptom of the historical mistreatment of Indigenous peoples in North America.
Healthcare in Australia is similar to other universal plans. Officially established in 1984, Australian Medicare is provided for all, and the government runs public hospitals. This makes inpatient care at public facilities free and without deductibles. Similar to Canada, services and drugs on a list created by the government are covered under Medicare, but physicians can add a small charge to visits that are paid out-of-pocket. In 2016, almost half the population had private insurance on top of that, which makes up for some wait times for non essential services. The Australian government actually encourages the purchase of private insurance by putting a financial penalty in place for those with a high income without one.
Indigenous populations in Australia also face great disparities in healthcare. Like Canada, Aboriginal people have a short life expectancy and are less likely to receive proper care. The Council of Australian Governments set a goal in 2008 to close the life expectancy gap by 2031, but the target is not on track. The Australian Human Rights Commission works to advocate for Aboriginal and Torres Strait Islander residents, and they supported the 2008 goal. Currently, they compile data into reports that attempt to hold the government accountable for the promises that have not been kept in regards to healthcare. Additionally, they named March 21st ‘Close the Gap’ day to raise awareness of these issues.
Among a sea of universal, decentralized healthcare in the west lies the United States, sticking out like a sore thumb. However, in America, a sore thumb may cost you a $100 doctor visit. After living his whole life unallergic to bees, my dad found himself going into anaphylactic shock after being stung by the insect a few years ago. He called an ambulance to drive him to the hospital and easily recovered with medication. The only thing scary about this event ended up being the $1600 bill that arrived at our home weeks later. This price was not for the hospital stay, or medication, but instead the single ambulance ride.
My dad vowed never to call an ambulance again, opting for an Uber ride instead. Neglecting beneficial health services due to high costs is common in America. The nation operates with a mix of private and public health insurance. Under the current Affordable Care Act (ACA), public plans include Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). Medicare provides services for those over the age of 65, and Medicaid is used by lower income individuals and those with disabilities; both plans are funded at a state-level. The ACA put in place a marketplace for Americans to shop for private insurance, but the Veterans Health Administration and Indian Health Service are the only plans owned by the federal government.
Around 27 million Americans are without healthcare. While a 2018 report found an increase in quality of care over the past few years, it found that costs had not. Copayments, deductibles, and coinsurance remain at high prices for most Americans. Healthcare that runs on capitalism creates huge disparities for low-income and marginalized groups. Overall, white people in America receive greater care than other groups. Conversations of Medicare for all have increased in previous years. President-Elect Biden plans to expand upon the ACA by potentially offering a Medicare option for all. But some argue that universal care will raise taxes, increase wait times for services, and eliminate choice. Despite this, all previous countries mentioned are higher on the World Health Organization’s (WHO) rankings of global healthcare.
After assessing the healthcare plans of European and North American countries, there is a general trend towards universal, decentralized plans. Martin Luther King Jr. argued that the moral compass of the universe bends towards justice, so the question remains if these plans reflect that idea in regards to healthcare. Is universal coverage the ultimate healthcare solution? While the WHO ranking would point to that, the disparities for marginalized groups exist in all of these nations regardless of system. Arguably it seems “good” healthcare exists not only when all people are covered but when they are covered well. If the world is bending towards justice, can justice be found simply in healthcare for all, or equitable healthcare for all?