A Grain of Saul: Health Care Ideas So Brilliant We Should Steal Them From Other Countries

There are some amazing health care systems out there.

A Grain of Saul is a weekly column that digs into some of the biggest issues we face as a nation and as an international community in search of reliable data, realistic solutions, and — most importantly — hope.  

As the Republican Senate does their best to push through an almost unanimously hated health care bill, I'm reminded of Michael Moore's film Where To Invade Next.

The film poses an interesting question: what great ideas exist outside the United States that are worth adopting?

Moore addresses some health care issues in his film, and I think there's room to expand on his work. With over $60 trillion in private wealth, the United States is the richest country on earth. With that in mind, the United States should hold itself to the highest standard of healthy living, and consequently the highest standard of health care. Current health care law, like the Affordable Care Act, has hovered around 50 percent approval rating for a few months. But generally speaking, Americans still desire a cheaper and better functioning health care system. 

And who could blame them? The U.S. health care system is largely considered one of the least efficient in the world. While we have some of the top doctors and hospitals in the world, we spend more money on health care per person than any other nation on earth. At the same time, our average life expectancy and quality of life lag behind while hospital bill debt and citizens without health insurance are in every direction you look.



Health-care reform advocates march in the streets outside of a meeting of America's Health Insurance Plans (AHIP) on October 22, 2009 in Washington, DC.
Health-care reform advocates march in the streets outside of a meeting of America's Health Insurance Plans (AHIP) on October 22, 2009 in Washington, DC. Shutterstock / Ryan Rodrick Beiler

In recent years, there's another issue that has destroyed Americans lives: opioid addiction. Which brings me to one idea worth stealing that Moore explores in his film: Portugal's pivot to decriminalizing drug use and treating it as a health care issue.

Starting in 2001, if someone was caught with less than a 10-day supply of an illegal drug in Portugal, they were sent to a Commission for the Dissuasion of Drug Addiction. There, a group of doctors, lawyers and social workers offer the person treatment and counseling instead of prison time. Occasionally, there is a small fine associated with drug possession, but then the person is let free. 

16 years later, Portugal has seen drug-induced deaths plummet and overall drug use undergo a minor decline. For the United States, where opioid overdose is now a leading cause of death, this transformation from persecution to treatment is worth considering. 

And yet, one of the hold ups for that kind of major overhaul of our health care system is the partisan divide that exists in Congress. Generally speaking, conservatives favor a free market and private health insurance system where competition will supposedly drive prices down and access up. Liberals, on the other hand, generally want to see the government absorb some cost, subsidize and regulate the markets that they say will ensure more access and coverage for the old or needy. 

Democratic Senator and past presidential candidate Bernie Sanders delivers the keynote speech at the Kansas State Democratic convention.
Democratic Senator and past presidential candidate Bernie Sanders delivers the keynote speech at the Kansas State Democratic convention. Shutterstock / mark reinstein

And while the United States has both public and private health insurance markets, there are plenty of systems out there that do a better job forging both liberal and conservative principals. Switzerland's health insurance system is a regulated market with universal care, but also leaves private citizens the choice of what insurance to buy and leaves the government with — comparatively — minimal health care spending, according to Forbes. Unlike the United States, citizens are mandated to purchase health insurance, something most liberals would support. But also unlike the United States, there is less government spending and more choice for private citizens — something most conservatives would support.

It's not just about broad, partisan changes or appeasement either. There are also just features of other people's health care system worth striving for.

A CNBC round up of top health care systems alluded to some of these features: In Malaysia, you'll reportedly almost never encounter wait time to see a specialist and there is no need for a referral.

In Costa Rica, the government-provided insurance market can have wait times, but your health care is covered after a single monthly fee, including all doctors visits, testing, prescription and surgeries. On top of that, there are no pre-existing conditions or age exclusions. If you need faster treatment, you can always go to the private market, where cost is still significantly lower than in the states.

In the United Kingdom, things are similar. 

"Health care should be free at the point of delivery," Dr. Richard Kerr, a council member of the Royal College of Surgeons in the United Kingdom, told CNN. "There is a fee structure behind it, but when a patient comes to see me ... the issue of money never comes into it."

Norway has free health care for children under the age of 16.

In Cuba, an emphasis on preventative care leaves Cubans with longer life expectancies than Americans despite paying twenty times less for health insurance, a PBS report showed.

SANTIAGO DE CUBA, CUBA - Jan 15,2017: hospital in SANTIAGO DE CUBA.
SANTIAGO DE CUBA, CUBA - Jan 15,2017: hospital in SANTIAGO DE CUBA. By glen photo

Of all the fixes to the American health care system, this last one — a simple mentality shift towards prevention — could be both the easiest and the one that would reap the greatest rewards. Any lawyer could make a pretty solid, data-based argument that the biggest issue in the United States is lifestyle choices. Unusual amounts of obesity, smoking, and drug addiction leave us with unusual amounts of heart disease, cancer and overdose. 

If we could take the first step towards more preventative health care by focusing on making healthy choices, we'd end up with less sick people, cheaper insurance for the healthy and fewer lives lost far too young.

Along the way, we'd be wise to steal some ideas from our friends abroad. 

You can follow Isaac Saul on Twitter at @Ike_Saul

Cover photo: Shutterstock / Ryan Rodrick Beiler

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