Universal Coverage: The Success Story Of European Health Insurance – “The goal of the Democrats since Franklin D. Roosevelt has been to create a universal health care system, guaranteeing health care for all people,” began Vermont Senator Bernie Sanders’ incredible speech as he promoted his Medicare-4-All (M4A) law. “Every other major industrialized nation did.”
He’s right. All major industrialized nations have either a direct single-payer system (Korea, Canada), a Beveridge-style single-payer system (UK, Sweden, Norway), or another type of universal coverage system (Germany, Australia, Spain). The US is among the industrialized countries in the way it treats health care.
Universal Coverage: The Success Story Of European Health Insurance
But Sanders is wrong to assume that all Democrats share the goal of universal health care. In fact, the party was and remains deeply divided on this issue. If the party were as united as Sanders suggests, they would have adopted a single-payer system in 2008 instead of Obamacare, which was passed without Republican support.
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Why didn’t the Democrats pass a single payer system? Because the vested interests in the current employer-based private health care system—doctors, drug companies, and insurance companies—are too strong within the Democratic Party to allow the passage of a single-payer system that would drastically reduce physician incomes, virtually eliminated the private health insurance industry and forced US pharmaceutical companies to face real price competition.
Any conversation about the US health care system must begin with this indisputable fact: Americans pay more and receive less than citizens of other industrialized countries.
According to the Organization for Economic Cooperation and Development (OECD), health care spending accounts for over 17 percent of the U.S. economy, compared to 10.1 percent for Western European countries (see Figure 1).
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Republicans Head for Epic Destruction — Their Own” Not only have Trump’s legal woes changed the electoral calculus, but so has the election environment itself. Portugal decriminalized drugs in 2001, paving the way for Oregon. A recent Washington Post article suggests that the country’s positive trends are reversing.
PORTLAND, Ore. — In the run-up to the November 2020 election, proponents of Measure 110 cited the European nation of Portugal as a positive example of what decriminalizing drugs can achieve for users. But now there are signs that the country’s once-promising program has run into trouble.
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‘s The Story has previously reported how Oregon’s Measure 110 may not mirror Portugal’s model closely enough. Consequences for drug users, which Portugal uses as a method of getting people into treatment, are much less severe in Oregon. Portugal also has universal health care, which ensures that everyone can seek help when they need it without being turned away.
For progressives in the Pacific Northwest, Portugal was a shining example of how much good could be done by decriminalizing drugs. The argument was that addiction was a health problem, not a criminal one. Instead of dealing with the police and the courts, most people caught using drugs in public were given counseling and a fast track to treatment if that’s what they wanted.
Portugal did see dramatic results soon after its new law was passed in 2001. But the Washington Post recently reported that 22 years later, Portugal is struggling with drug users who openly flout the law and police who are losing motivation to issue tickets.
The Post story quoted the mayor of Porto, a large city on Portugal’s Atlantic coast, as questioning whether the country should rethink its drug plan.
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“Nowadays in Portugal it is forbidden to smoke tobacco outside a school or hospital. It is forbidden to advertise ice cream and sugar candies. And yet it is allowed to have people who inject drugs,” the mayor told Publish.
According to the article, police say the city’s visibility of the drug problem is at its worst in decades, and state-funded NGOs, which have mostly taken up the response to substance users, appear less concerned with treatment than with the approval of this drug for lifetime use should be seen as a human right.
Porto’s police chief was quoted as saying: “At the end of the day, the police’s hands are tied.” He added that now the situation is comparable to the years before the start of decriminalization.
The article also cites a recently released national survey showing that the percentage of adults using illicit drugs is on the rise. In 2001 it was 7.8% – now it’s 12.8%, and overdose rates have hit a 12-year high.
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Last November, The Story’s Pat Dorris spoke with the architect of Portugal’s drug decriminalization, Dr. Joao Gulao. He then painted a rather rosy picture of the country’s success since 2001.
“We estimate that when our strategy, which includes decriminalization, is approved, we think we will have 100,000 people using heroin alone,” Dr. Goulão told Dooris. “That means 1% of our population. Nowadays, we estimate that we could have about 33,000 who use all kinds of drugs in a problematic way.’
But after this Washington Post article, Goulão changed his tune. He publicly admits that things are not going well in Portugal.
Last week, he spoke at Georgetown University’s O’Neill Institute for National and Global Health, acknowledging some of the problems emerging in his country.
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“It is true that nowadays we have some difficulties in providing treatment, timely treatment without a waiting list, for example,” Gulao said. “We have the visibility of unorganized users on the streets in Lisbon and Porto, mostly in the big cities. And we are concerned about that.”
The Washington Post article also noted that Portugal cut funding for its drug enforcement operation in 2012. It dropped from an estimated $83 million a year to $17 million. This is why most drug distribution is now done by non-profit groups.
Goulão said the layoffs were a big mistake, although he suggested the numbers weren’t entirely accurate.
“We have people on the street. And I would say that at the given moment our political leaders were convinced that such problems in Portugal had been solved. Right?” he said. “So there was stagnation or even a reduction. Not exactly the same reduction as the Washington Post article says. But it’s not his fault. We probably explained it wrong. There was a misunderstanding about redundancies. But we’re not actually investing as much as we should.”
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When Portugal began its decriminalization in 2001, there were plenty of beds for anyone who needed intensive care. There was no waiting. But that’s not the case today, the Washington Post reports — sometimes the wait can now last up to a year.
In some ways, what Portugal is going through now can be compared to what Oregon is going through after the passage of Measure 110. Oregon has never had the kind of access to care that Portugal had when it decriminalized drugs, and waiting lists in residential treatment facilities were common even before Oregon decriminalized drugs.
But there are signs of hope. If funding cuts are indeed a major driver behind Portugal’s retreat, Oregon may end up in an even better position than its European predecessor.
Portugal has a population of about 10.33 million people. Oregon’s population is less than half that, closer to 4.25 million. Yet thanks to Measure 110, Oregon allocated about $300 million to drug treatment programs in the current biennium alone, compared to Portugal’s $17 million per year, the Post reported.
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This is not a one-to-one comparison—Portugal still has the advantage of a publicly funded health care system, which does not translate into the funding it places on supervision. Oregon already handles most of its addiction coverage through nonprofits because state and local governments never had the infrastructure to take it on. And even among American states, Oregon is starting from a historic deficit in access to drug treatment and mental health care. But at least Oregon is working to expand that access now, instead of reducing it.
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