European health care

European health care is universal, but contrary to popular perception, it is not all nationalized. Facing rapidly aging populations, many European countries have gone much further than the United States in using market forces to control costs. At the same time, regulations are stronger and often more sophisticated.

Most of Europe spends about 10 percent of its national income on health care and covers everyone. The United States will spend 18 percent this year and leave 47 million people uninsured.

Europe has more doctors, more hospital beds and more patient visits than the United States. Take Switzerland: 4.9 doctors per thousand residents compared with 2.4 in the United States. And cost? The average cost for a hospital stay is $9,398 in relatively high-cost Switzerland and $17,206 in the United States.

"In Switzerland, rich or poor, they all buy the same health insurance," said Regina Herzlinger, chairwoman of business administration at Harvard University and a leading advocate of the Swiss system. "The government gives the poor as much money as the average Swiss has to buy health insurance."

The Swiss and Dutch buy their own coverage from competing private insurers. Both systems address market failures that pervade U.S. health care: Insurance companies must provide a core benefit package and everyone must buy coverage. Consumers can shop for value and pocket the savings, as opposed to U.S. patients who hand the bill to someone else. Switzerland does not have a public program like Medicare or Medicaid.

Far from leading to poor quality and rationing, both countries and Germany, where government has a much larger role in health care, outperform the United States on many quality measures. These are not just broad measures such as life expectancy that could reflect higher U.S. poverty or obesity.