“Nationalism is an infantile thing. It is the measles of mankind.”
― Albert Einstein
Roy Smythe–(Forbes)–The concept and practice of nationalism will likely run its course in a few hundred years, as the world objectively becomes more of the “global village” envisioned in the late 1960’s by the technology intellectual Marshal McLuhan. Although national pride can be a powerful galvanizing force, the associated impediments to information, wealth and cultural sharing are difficult to rationalize, and the lessons of Nuremberg and the Balkans illustrate the carnage associated with its illogical extremes.
I believe that we are currently suffering (literally) in the U.S. from a form of “medical nationalism” – whereby we are resistant to incorporate ideas, or lessons learned, from other countries.
I recently had the opportunity to moderate a panel discussion comparing the U.S. health care system to those in Denmark, Finland and Canada, at the Health Evolution Partners Summit held in Dana Point, California. The panel included Richard C. Alvarez, CEO of Canada Health InfoWay; Hans Erik Henriksen, Chief Executive Officer, Healthcare Denmark; Laura Raty, MD Deputy Mayor, City of Helsinki, Finland; and Krishna Udayakumar, Head of Global Innovation at Duke Medical School.
I started by asking the panelists whether or not their citizens were happy with health care delivery, especially considering the higher income taxes that they are required to pay to support it. Henriksen stated that “in Denmark, our tax burden is high; however, EU studies indicate that Danish citizens are very happy about their healthcare system and in various indicators, Denmark is ranked 2-4 among the E.U.” Raty, who happens to be a practicing anesthesiologist in Helsinki in addition to her mayoral duties, simply replied, “of course, our citizens are happy… a majority of the Finns support the Nordic welfare state and its social security system, which covers risks associated with illness, old age and unemployment.” Alvarez simply laughed, and shook his head, “There have been a lot of rumors about Canadian health care, but Canadians literally wear their pride in this like a badge of honor – historically they have had an ongoing love affair with their health care system.”
Subsequent questions dealt with funding and structure of primary care, and how complex specialty care costs (a primary driver of overall cost) are controlled. Interestingly, both Denmark and Finland include nursing home, rehabilitation, and mental and behavioral health in the definition of “primary care,” and make relatively equivalent state-supported investment in all these areas, rather than just for the treatment of acute illness – improving both outcomes and access to care.
In addition, all participants talked about how specialty care is more or less provided based on demographic need in their respective countries, rather than what the market will bear. As an example, Denmark has closed many smaller, regional hospitals (more than a third of the original total), and is in the process of replacing them with many fewer regionalized facilities, including 8 new super hospitals with state-of-the-art health IT structure. The result thus far has been a significant reduction in overall specialty care cost.
I visited Denmark and Finland a few months ago. While there, I asked many whether or not they thought that the income tax burden was too high, considering resultant educational and health care benefits – I was surprised to find that no one said “yes.”
More than 50% of Americans feel their taxes are too high, and I count myself among them. However, at least in my case, I am less concerned about the amount I pay, than I am about what I feel I get in return for my annual investment. I wonder how many would agree?
In the ominously entitled 2013 Institutes of Medicine (the health care arm of the National Academies of Science) study – “U.S. Health in International Perspective: Shorter Lives, Poorer Health”, we are characterized thusly in comparison to the rest of the medically-developed world:
“The United States is among the wealthiest nations in the world, but it is far from the healthiest. Although life expectancy and survival rates in the United States have improved dramatically over the past century, Americans live shorter lives and experience more injuries and illnesses than people in other high-income countries.”
According to this report, and other reliable sources, countries such as Denmark, Finland and Canada are objectively achieving better health outcomes, at significantly lower per capita costs, than the U.S. In addition, a large amount of data cited in this report demonstrates that despite what many in this country claim, these differences are neither explained by our genetics, nor our racial or socioeconomic diversity.
Our inattention to health care delivery lessons learned elsewhere, a form of medical nationalism, are counter to the modern medical ethic of evidence-based practice, and the more ancient one of “first do no harm” – remembering in the latter case that harm can come from errors of commission, as well as omission.
If what John Milton once said about liberty is true, that it “hath a sharp and double edge, fit only to be handled by just and virtuous men,” then I imagine nationalism as the same sword, but with no protective handle covering the blade. No matter how one wields it, our how virtuous the intent, history tells us that everyone eventually gets hurt.
Roy Smythe is a Forbes contributor and the Chief Medical Officer for Valence Health, a Chicago-based health care consulting, services and operating company that seeks to facilitate the ability of providers of care to manage medical and financial risk.
