Europeans Explore Consumer-Directed Health Care

Published January 1, 2004

Health policy debates taking place on both sides of the Atlantic are remarkably similar. Entrenched forces are determined to resist change, even if it means the decline and decay of programs they are trying to protect. At the same time, new voices are courting the transformative power of consumers and markets.

That was the theme of “Markets and Solidarity: Building the European Healthcare of Tomorrow,” a day-long conference held in October 2003 in Stockholm, Sweden. Helen Disney, director of the Stockholm Network coalition, and Johan Hjertqvist of the Swedish think tank Timbro, convened think tank experts from 13 countries to begin to explore ways to inject consumerism into socialized health care systems.

All but the most unbending leftists in Europe are interested in at least learning more. With information spreading at light-speed across the Internet, and with an explosion of new technologies and services in health care, consumerism is a force that cannot be restrained.

There is growing awareness that maintaining political power in Europe may well require heeding consumer demands to begin to free health care from centralized, bureaucratic control. European unification could spark an unintended consumer revolution. Already, if the government of a citizen’s own country can’t provide needed and timely care, they can seek a voucher to obtain health care in any other European Union member country.

This could encourage hospitals to move away from being nineteenth century establishments of socialized mediocrity to becoming “centers of excellence” built around the skills of talented doctors who attract patients from throughout Europe. (Think Mayo Clinic of Sweden or Sloan-Kettering in England.) That would represent a huge leap into consumer purchasing power in these socialized systems.

Unbending Leftists

Also at the Stockholm Network conference, one unbelievably entrenched representative of the British Dental Association guild was insultingly disrespectful of the United States, suggesting we are basically savages and practically shouting in anger at anyone who would even listen to our barbarian ideas.

Fortunately, my panel was up next. I described our system and explained that 44 million uninsured are not a permanent underclass but are flowing through the system of employment-based health insurance, with most uninsured for less than six months. I also explained how we work tirelessly on policy proposals to rectify this. I pointed out that the biggest problems in the U.S. are with our public health care programs that are centrally controlled, rule-driven, and resistant to innovation.

But even there, I pointed out, we are willing to experiment. Among almost everyone but this leftist, there was particular interest in the Cash and Carry Counseling experiment in Medicaid, which allows recipients to choose services and their own caregivers.

Also in Stockholm, American Enterprise Institute scholar Joe Antos described the AEI/Galen Institute proposal for a consumer-friendly Medicare drug benefit and explained to a keenly interested audience attending a separate conference how that card account model might be adapted to European health systems.

U.S. a Health Policy Laboratory

While some of our European friends think we are barbarians, they can learn much from us. The United States is a vast laboratory of experimentation in health care financing.

Like Europeans, we are struggling with the serious problems of government-run health programs. Like Europe, we have a single-payer health program (Medicare); a 50-state experiment with a joint federal/state program (Medicaid); and a nationalized system in which hospitals are owned and doctors employed by the government (veterans and Native Americans).

In the private sector, the U.S. has countless doctor networks, payment rates, coverage schedules, and financial cost-sharing for private health insurance plans offered through employers who cover millions of employees. Millions more Americans purchase individual policies.

Another asset we have, the philanthropic sector, is practically non-existent in Europe. Two-thirds of doctors here provide charity care, communities create free clinics, and the Shriners of North America raise money to build and operate free hospitals for children–just for starters.

That brief summary, of course, by no means captures the U.S. health care system’s complexity. But the key is our willingness to change and innovate. It’s high time we in the U.S. begin to acknowledge the diversity and strengths of our own system so that others, including Europeans, will be more open to learning from us.

Grace-Marie Turner is president of the Galen Institute in Alexandria, Virginia and contributing author to Health Care News. Her email address is [email protected]; she also can be reached by phone at 703/299-8900.

American Enterprise Institute scholar Joe Antos, who is AEI’s Wilson H. Taylor Scholar in Health Care and Retirement Policy, can be reached at 202/862-5938, email [email protected].