The access, quality, and cost of health care are part of the debate preceding the U.S. presidential election. But the issue will last beyond November no matter who wins, and it influences U.S. companies doing business overseas and foreign firms operating here.
"What will not disappear is the significant cost and the significant increases in cost year to year," said Christopher Burns, chief executive officer of Willis Global Solutions, part of the global insurance brokerage the Willis Group Holdings P.L.C.
Burns was a panelist last week at a meeting of the British-American Business Council of Philadelphia at the Union League, the theme of which was "Health Care Reform: Decisions and Implications for Cross Border Employers."
American and British health-care systems are often compared - sometimes heatedly - in part because of the historical and current ties between the countries, but also because of the stark differences in health-care systems.
"Many people in both countries view the other as having a pariah health system that is not to be copied in any circumstance," doctors David Blumenthal and Jennifer Dixon wrote in a paper published Oct. 13 by the British medical journal the Lancet. "The English National Health Service (NHS) covers all citizens, is tax-funded, is free at the point of service, and is governed centrally. Conversely, the U.S. health-care system is funded by a patchwork of private and public insurance, imposes large point-of-service fees on many users, and provides care through private, not-for-profit, and public providers in a largely competitive delivery system that is proudly ungoverned."
As the authors noted, Britain also has budget challenges and is trying to save money and improve care in its system.
According to the Census Bureau, there was $74 billion of trade between the two countries through the end of August, the sixth-highest figure among U.S. trading partners.
Two of the world's largest pharmaceutical firms - GlaxoSmithKline and AstraZeneca - are based in Britain but have large operations in this region, so they are part of each country's health-care marketplace, with sales and as employers.
Like other large multinational companies, Glaxo has staff in each country to handle employee benefits for that locale.
"We spend more on medical care for U.S. employees than for U.K. employees, since in the U.K. our plan coordinates with the federally provided medical care," Glaxo spokeswoman Jennifer Armstrong said by e-mail. "However, GSK (like other employers in the U.K.) also contributes through employer taxes to the HMS (Her Majesty's Service)."
AstraZeneca declined to comment, according to a spokesman.
The Internet has allowed global business expansion for more small companies, but some companies still want people living in-country to shake hands and make deals. Those employees and their families need and want health care, so the systemic differences can be huge.
Monice Barbero, senior counsel with Cigna Global Health Benefits, said employees going overseas have to be prepared for differences as varied as the names doctors use for conditions to how taxes are calculated by the IRS back home.
Willis' Burns said a company considering placing employees in the United States needs to recognize the changes involved in President Obama's Patient Protection and Affordable Care Act, some of which will roll out over many years. That plan increases insurance coverage for millions of Americans. Though he had a similar program as governor of Massachusetts, Mitt Romney says he will scrap Obama's program if elected, without saying what he will put in its place. Regardless of outcome, the costs will be hefty, at least in the next few years.
"That tends to be a big surprise, that the average is nearly $10,000 per employee per year," Burns said.
The Organisation for Economic Co-operation and Development (OECD), which includes 34 of the world's developed nations, says the U.S. health-care system is the most costly and among the least effective in many categories.
The OECD data through the end of 2010 indicated that the United States spends via public and private sources $8,233 per person, 21/2 times the OECD average, almost $3,000 more than the next highest country, Norway, and more than twice as much as the United Kingdom.
At 17.6 percent of gross domestic product, U.S. health-care spending is 11/2 times the OECD average.
Sen. John Barrasso (R., Wyo.), who was an orthopedic surgeon, is among the doctors who dislike Obama's changes - including cuts in reimbursements to doctors through Medicare and Medicaid - and prefers restrictions on malpractice lawsuits as a remedy for costs.
"I do believe we have the best health-care system in the world," Barrasso said in 2010 during a public meeting between Obama and congressional leaders. "That's why the premier of one of the Canadian provinces came here just last week to have his heart operated on. He said, 'It's my heart; it's my life; I want to go where it's the best,' and he came to the United States."
The American system is famous for the great expertise in difficult procedures and attracts foreign leaders for whom money is no object, but as Obama responded to Barrasso, it leaves out Americans at the bottom rungs of the economic ladder.
With that group partly in mind, Obama used a recess appointment to put Dr. Donald Berwick atop the Centers for Medicare and Medicaid Services. Berwick resigned late in 2011, in part because Barrasso and 41 other Republican senators wrote a letter saying Berwick was the wrong choice and would not be confirmed because of his "controversial" statements about the value of Britain's health-care system.
"You could have chosen an easier route. My nation did," Berwick said in a 2008 speech in London on the 60th anniversary of Britain's NHS. "It's easier in the United States because we do not promise health care as a human right. Most of my countrymen think [that promise is] unrealistic. In America, they ask, 'Who would assure such a right?' Here, you answer, 'We do, through our government.'
"In America, people ask, 'How can health care be a human right? We can't afford it.' We spend 17 percent of our gross domestic product on health care - compared with your 9 percent. And yet we have almost 50 million Americans, one in seven, who do not have health insurance. Here, you make it harder for yourselves, because you don't make that excuse. You cap your health-care budget, and you make the political and economic choices you need to make to keep affordability within reach. And you leave no one out."
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