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October 6th, 2008
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Healthcare price tag

Politicians are about to find out the cost of doing nothing
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June 18th, 2008 issue

By Weston Stacey

European countries face a healthcare dilemma: how to maintain quality as an aging population demands higher quantities of care.
Since the Czech population is aging more rapidly than most, policymakers here face a tighter deadline. Tight deadlines allow little room for experimentation and even less room for inaction.
An aging population puts less money into the system and takes more care from it. Therefore, even a small increase in the average age of a population can strain the ability to maintain the existing quality of care.
But a major shift such as the Czech Republic is about to experience can unbalance the system entirely.
The government will learn later this month — when a study on future costs is scheduled to be completed — what the estimated price tag is of doing nothing. There is little doubt, however, that continued inaction will force the government to charge you more or give you less, or both.
There are two great myths about Czech health care.
The first is that it is free. In fact, it is financed from the pockets of the working population. Those pockets better get bigger if it is going to pay for country increasingly in retirement.
The second great fiction is that the care is egalitarian. It is not equal in any way. Some people pay more taxes for the same rights — this is called solidarity. Some people pay the same, but live in areas with poorer facilities or worse practitioners — this is called fate. Some people slide an envelope across the examining table to get more or faster medical attention — this is called informal payment.
The truth is that care can never be equal: It can simply be equitable, and trying to hammer together a system that treats all patients the same mostly makes the system less transparent and therefore less fair.
Health Minister Tomáš Julínek and his team of advisers have stared reality in the face. Without reform, they know the costs per paying person will increase over the next decades just to maintain quality. They know that increased healthcare costs could drive companies away. They know the population will age and require more care. They know, too, that there is no perfect solution: You cannot have perfect quality and perfect quantity.
 The minister — with the support of the prime minister — has responded to this reality in the only responsible way: to present a comprehensive reform they believe will avoid this crisis.
Other politicians and policymakers now have a choice. They can hide behind easy ideology and kill the reforms, or they can sit down with Minister Julínek and try to piece together a compromise that comes as close as possible to a long-term consensus between the competing demands of quality and quantity.
Sitting down at a table with Minister Julínek does not mean agreeing with him on every aspect of his reform.
It means recognizing that a serious attempt is being made to fix a problem that will only get bigger the longer we wait. It means not judging the reform on whether health care is a private or public service or whether one of the many major interest groups benefits more than the other, but on whether the solution provides the highest possible quality to the largest number of people. It means, above all, backing criticism with workable counterproposals.
If coalition partners do not like co-payments, for instance, they could propose another way to reduce the overuse of the system by doctors and patients.
Co-payments aim to reduce this abuse by creating a financial disincentive to cheat. Unfortunately, it also makes the system cost more for those who are truly sick. Could abuse be curbed better by regulating doctors, adjusting insurance rates to benefit those who require less care, or by limiting the number of free visits to the doctor? Like all public policy, each of these solutions benefits some and penalizes others.  
The same is true about the argument over state-run or private facilities or insurers. Having a hospital or insurer in private or public hands is not good or bad — except ideologically.
Members of the majority Civic Democrats believe that private hospitals will improve quality of care by squeezing waste out. Social Democrats believe that private hospitals will cut quality by concentrating more on profit than care.
Neither is wrong; neither is entirely right.  
In reality, it will all depend on what regulations exist, how they are enforced and the competence of those running the organization.
Compare this with the United States, which has made a mess of its private healthcare system.
No one can argue that the quality of care in the United States can be the best available in the world. Thousands of foreigners travel to the country’s top clinics to receive care unavailable to them in their home countries.
But 46.6 million Americans — 16 percent of the population — do not have health insurance and cannot access this superior care.
Policymakers seem to be unable to balance the quality of the care to the quantity of care provided. So it seems like the main problem is spreading quality out over a greater quantity of people.
Back in the Czech Republic, politicians have a chance to get ahead of the curve by discussing planned reforms now.
It’s a great opportunity and a necessary event to have a comprehensive reform plan on the table. This plan gives politicians in all parties a chance to find a compromise. This is the job description of an able political leader.
Czech voters should watch this debate carefully — if our political leaders fail today, it is your health that will be affected tomorrow.
— The author is the executive director of the American Chamber of Commerce in the Czech Republic.


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Reader's comments:

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[11:56 20/06/2008] : I was with you all the way until you say 46.6 million Americans can not access the care. That is simply not true. They may be uninsured, but that does not mean they cannot access the system.
Many, many of these people are uninsured because they have made that choice and not because they cannot afford it. Nevertheless not having insurance does not mean no access - it just means someone other than the insurance company is going to pay the provider. All in all a very balanced view of subject matter.
Martin Smith
Fort Lauderdale, Florida
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