I recently had the opportunity, for a school assignment (Yes, study-abroad students do actually study…a lot), to research healthcare systems around the world. Living in a foreign country as an abroad student, it is very easy to focus on the historical and cultural aspects of the experience while forgetting about the everyday institutions that allow a society to run smoothly (or not smoothly in some places), such as healthcare.
I was always aware that the American healthcare system is especially unsatisfactory, and this came first from growing up in a household with international, well-traveled parents who understand alternate approaches from the one offered in the United States. Furthermore, because my mom is a nurse, I have had many conversations with her about the problems in the current system, and the pros and cons of the most recent healthcare reform through The Affordable Care Act. One of her biggest worries is that doctors will no longer be able to run all the tests they think are necessary to diagnose patients because funding will no longer cover everything. Another worry she has expressed is that younger people who are the healthiest portion of the population will be required to purchase health insurance at a set price, which they may not be able to afford, even though it is called “affordable.” This would be a waste of money for young people who need their money, especially for education payments.
While I do believe that the recent push towards more universal healthcare in the United States is a step in the right direction, it still has many challenges. Based on my research, it seems to me that there are three things America still needs to do to match the successes of healthcare systems in other nations: 1) Keep our private hospitals and private doctors, but realize that there must be limits to the free market in the healthcare system, mainly that insurance companies must accept everyone, and they cannot make a profit on basic care; 2) Everyone must be required to buy insurance, with the government paying the premium for the poor; and 3) Doctors and hospitals have to accept one standard set of fixed prices.
However, I do see some problems that could occur when these ideals clash with the American mindset. First, Americans operate under the belief that those who can afford it should receive healthcare, better healthcare, than those who cannot afford it. It is a foreign idea that everyone should receive an equal standard, regardless of how much you can pay. This stems from our severely competitive society. “Why should we have to pay higher taxes for the lazy poor?” Americans don’t believe everyone has the right to healthcare, yet they do believe everyone has the right to education and equal representation under the law. At least, that is what we claim. But if you really think about our education system and our legal system, these ideals don’t hold true either. The richest people pay for private school because our public school system is extremely sub-par. Thus, the rich get the best education. Furthermore, if you can’t pay for a partner law firm to represent you in court, you get stuck with a public defender who is trying to manage dozens of cases all at once. Not that these lawyers aren’t equally as trained or competent, they just cannot devote as much time and energy to each particular case because they have so many to deal with at once. Is this true equality?
Moreover, insurance companies are going to cry foul on not being able to make profit. Because under the law, a corporation is a legal person, and under law corporations are legally bound to increase profits at whatever cost, they will argue that it is their basic right to gain profit wherever they see fit, and unfortunately, they will win. We need to change this mindset (and potentially, this law) before we can make healthcare work for everyone.
Let’s look at Switzerland, the second-most capitalist country in the world, after the United States, as an example. People in Switzerland own more guns than Americans, and they have an equally free market economy, but their mindset is different. They are more inclusive as a society. They believe that everyone should be able to have access to healthcare, regardless of whether or not they can afford it. And even the elite believe it is right that those that can pay higher taxes for the less fortunate should do it. This is a very inclusive, European perspective that comes along with being in such close proximity to many different peoples and many different cultures. I believe that because Americans are so isolated from the rest of the free world, and our education system is limited by the global standard, it is that much easier to develop the idea that we are something special, each and every one of us. We compete while forgetting to cooperate, and we marginalize those with more unfortunate circumstances, attributing their plights to their own personal faults.
In Austria, people believe that everyone is entitled to the same, excellent standard of healthcare regardless of their socio-economic status. This view is typical across Europe. The majority of Austrian citizens are under the Krankenkasse (KK), the national insurance system that goes into effect as soon as you are employed.
I had the privilege to interview a few Austrians about their perspectives of the healthcare system. The first was a bartender at my favorite café in Vienna, Pickwick’s. He was nice enough to stop working long enough to answer my questions. Being an English national who has lived in Austria for the past six years, he had a very wide perspective on the issue. He told me that when he was considering moving out of England, he thought about moving to the United States, but the healthcare system was one of the biggest factors that held him back. Here are some of his thoughts:
– What do you know about the healthcare system here in Austria?
- Healthcare is universal. The system is very convenient. You pay for it out of your taxes, and your employer pays the other half. There is one national system called Krankenkasse (KK). Health insurance is mandatory for all Austrian workers, and as soon as a person is employed, they are covered.
– Have you had personal experience with the healthcare system here?
- Yeah. A little while ago, I had an appendix operation here. I went to the regular doctor about the pain, and they refered me to a specialist. Only two weeks later, I had the operation. The process was really easy and quick, and I didn’t pay a cent for it.
– How is the healthcare here compared to that in England?
- It is a lot more convenient here. You don’t pay in England either, but the care is way better here. I had an operation in England before, and it took 18 months for the entire process, including doctor’s visits and other appointments, and then the actual surgery. The doctors here seem a lot more professional as well.
– When you go to the doctor, do you feel like you are treated well? Do they give you good medical service, or do you feel like they are limited in the way that they can or are willing to help you? Are they trained well, or do you feel like it isn’t worth visiting a doctor unless you have a private doctor?
- They treat the patients very well. Service is quick and professional. They have everything you could ask for. They are trained well, and the service of the public doctors is just as good as what it would be if you opted out of the system and went to a private doctor. But, most people don’t do that, even if they are rich here because the public service is so much more convenient.
– What is your favorite part about the system here?
- Everything that I already said is really great, but I also like that when you get insurance, they give you an e-card that has all your insurance info on it, and it keeps a record of your doctor’s visits. Just recently, they installed a system to where you can use it to view x-rays and test results. Soon I think you will be able to choose to upload your entire medical history on it if you want.
– Is there anything bad about the system?
- I don’t see any problems with it, but I know some people are worried that having too much information on the e-card is a threat to their privacy. But the good part about that is you can choose the information that is displayed and who is allowed to see it. Many Austrians also don’t like the fact that the rich population is allowed to opt out of the national system. They think that this has the potential to become like the American system if too many people opt out. But it doesn’t look like that is happening, since there is no difference in the quality of service.
To supplement my interview, I did a little bit of research on my own. Highlights of the system include long maternity leave, included annual physicals, paid sick leave, and treatment in other countries. Private medical insurance is also available if you are able to pay for it. In this two-tiered system, the private “comfort care” includes more flexible visiting hours, private rooms, and specialized care, but the quality of healthcare is no different if you pay for it yourself.
Insurance protection extends to school and university students as well as pensioners. Insurance contributions are calculated based on a person’s income. Half the premium for coverage is a set percentage paid out of a person’s salary, while the other half is paid by the employer. Permanent residents can also apply for the KK at the health care agency. You can also apply for self-insurance if you are self-employed or unemployed.
Some drawbacks to the system include long waits at the public doctor’s office, although these waits are not much longer than those experienced in America. Doctors are paid a minimum sum per patient by the government, so they don’t make as much money as American doctors. However, switching doctors is easy and can be done at the end of each quarter. Public doctors can also refer patients to private specialists for free, like what happened in the case of my interviewee. Insurers don’t make a profit here. Austria spends about 10% of its GDP on healthcare. The average life expectancy is 81.03 years, and the infant mortality rate is 4.2 for every 1,000 live births. Overall, Vienna, Austria has been listed number 1 in the world for quality of life.