Prescribing Reform

By Stransky, Martin Jan | The New Presence: The Prague Journal of Central European Affairs, Autumn 2009 | Go to article overview

Prescribing Reform


Stransky, Martin Jan, The New Presence: The Prague Journal of Central European Affairs


The United States and the Czech Republic need to fix health care, and both countries must find a political middle ground.

Among established democracies, it is hard to find a country in which there is not a continual and often heated debate on health care. As health care increasingly chews up national budgets, legislators are reluctant to act because they know health care is a political and social landmine. In the United States, debate on health care reform has degenerated into angry shouting matches at town meetings, complete with citizens toting automatic weapons to protect their "rights" while protesting President Obama's "socialization." In the more socialist Czech Republic, the fall of the recent government was brought about in large part by public protest regarding the implementation of a mere 30 Kc ($1.70) co-pay fee for prescriptions and doctor visits, in an attempt to curb the country's world-leading average of 16 annual visits per patient to the doctor. (It worked.)

In most developed nations, health care spending is the single biggest inflationary sector and is thus threatening or ruining personal, business, and national budgets. In the United States, the inability to pay escalating insurance premiums, which have increased at three times the rate of wages in the past few years, is now the single leading cause of bankruptcy at both the company and individual household level. Though 90 percent of those who voted in the United States in the last election do have health care, it remains the only country in the developed world not providing universal health care for its citizens, leaving 47 million Americans uninsured, with one out of three Americans going without coverage at some point.

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Despite leading the world in health care spending--the United States spends 17 percent of its gross domestic product (GDP) on health care, or an average of $7,421 per year per citizen versus eight percent of GDP in the EU--the United States ranks 37th on the World Health Organization rankings of quality and efficiency in health care, making it the most inefficient country in the world as far as health care spending is concerned. This largely stems from the little-known fact that, in the United States, 50 percent of all money spent on health care is spent on 5 percent of the population, mainly to prolong life, sometimes for only a few days.

In the United States, death is the enemy; no one is allowed to die. If President Obama, other politicians, and the US medical establishment could succeed in putting physicians ahead of technology (How do I know it unless the test verifies it?) and pushing for a social realignment that would alter America's view on life, lifestyle, and death, billions would be saved without talk or need of any further reform. But this would be political suicide in the land and culture of the chosen.

For politics to succeed in any country, battles must be picked that can be won, even if they are picked from the middle or bottom of the list. The need to provide insurance to 47 million uninsured Americans strikes a justifiable and sympathetic chord in most American hearts. Control of rising insurance premiums--by far a much greater culprit in the US health care scenario of rising costs--is something harder for the aver age American to grasp. Hence, Obama has focused the debate in the United States on the need to create a "public" government-sponsored program for the uninsured, who--though they use emergency services excessively and do not participate in preventive medical programs--chew up only 10 percent of each health care dollar. For a country that requires citizens to insure their cars but not themselves, this will be a telling debate indeed.

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In Europe, the emphasis is not on avoiding death, but on living a good life and avoiding bad wine. Not having health care provided for you by the state is unthinkable, where socialist traditions prevail. …

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