Europeans are often distinctly smug about the sufferings of Barack Obama as he struggles to introduce even a watered-down, but recognisably European-style, system of compulsory health insurance in his country.
One in five Americans is still uninsured, and illness remains by far the main cause of personal bankruptcy. Heart-rending stories abound. US insurance companies have spent hundreds of millions of dollars lobbying to make sure things stay that way, and to frustrate the president's plans to force insurers to cover people who are, or risk becoming, ill.
But this story is more complex than the clash of virtue and stone-hearted capitalist greed. Many of the underlying problems of the American health system are similar to our own.
A panel of prominent experts, including doctors, has just published a report for the influential US government advisory body, the Institute of Medicine. Its 18-month study concluded that some $750 billion (€582bn) – yes, billion – a year, almost one-third of the sum spent on healthcare in the US every year, is wasted, inter alia, on unnecessary treatments, inefficient health structures, and ill-thought-out, counter-productive payments systems.
To a practising European doctor like myself, this sounds uncomfortably familiar.
Despite 50 years of medical advances, the panel concluded, the US was currently “falling short on basic dimensions of quality, outcomes, costs, and equity”. But the answer was not to throw money at these problems. On the contrary: deep cuts were not just possible, said the report, but might actually improve the quality of US health-care.
This lesson has yet to sink in, either in the US or here. Since the crash of 2008, panicky European finance ministers have often cut essential services to the bone: 25% cuts in hospital salaries in Romania (resulting in 2,500 doctors leaving the country) is one of many examples.
Another is that Greece, which I thought was bankrupt, is still in the grip of a craze for high-tech CT and MRI scans, and has the highest concentration of these in Europe. But such scans are more often than not a complete waste of money, and the prelude to further unnecessary treatments.
My own country, Austria, is especially prone to over-diagnosis and over-treatment, and therefore to maintaining an excessive number of hospital beds, of which we now have 7.7 per 1,000 inhabitants. Germany has 8.2, the Czech Republic and Hungary 7.1 – all well above the European average. Local politicians are especially keen on local hospitals, which are vote-winners.
But good medical practice keeps patients out of hospital where possible, instead concentrating spending on specialised clinics that build up experience and expertise. One study after another has shown this delivers the best results.
The countries which are pioneering reform have cut bed levels: Sweden (2.8), Norway (3.3), and the Netherlands (4.7). This has not damaged people's health. On the contrary: in the latest annual Euro Health Consumer Index, Germany fell from sixth place to 14th, and Austria from fourth to 11th, while the Netherlands is leading the field in conquering hospital bugs.
In an age of austerity, these are issues that need to be confronted head-on.
Am I being a bad European in hoping that an initiative might emerge in Europe that is as courageous and to the point as the American campaign named ‘Choosing Wisely?
Launched earlier this year by nine US medical societies, it challenges the misconception that more healthcare – and healthcare spending – always means better. It can often mean the exact opposite, here as there.
Günther Leiner is a hospital doctor who spent ten years as a member of the Austrian parliament. He founded the European Health Forum Gastein in 1998. He will retire as its president after its meeting this week (3-6 October).