The Brief: Law School News and Events

The View from Abroad on U.S. Healthcare Reform

With 22 pens, President Barack Obama signed the healthcare reform bill into law last March ending the nation's status as the only developed country not to have universal health coverage. British academic Colm O'Cinneide said the decision couldn't have come sooner.

"There has been a trans-Atlantic divide in the philosophy on healthcare," said O'Cinneide, reader in law at University College London. "The British have long had bemusement and distaste towards the U.S. healthcare system."

O'Cinneide joined law faculty and students from across the globe during Penn Law's Global Forum on Comparative Healthcare Law and Policy last October. The three-day event offered Penn Law students a perspective from abroad on the Patient Protection and Affordable Care Act.

The symposium is part of the Law School's new five-year Global Forum initiative. By bringing together scholars from around the world, the Global Forum hopes to create an international intellectual community that is capable of providing solutions to the world's most challenging and urgent legal problems.

Next year, the roundtable will focus on securities regulation and will be held at Goethe University Frankfurt/Main.

In subsequent years, the Global Forum will be held at the remaining schools participating in the initiative: Tsinghua University in Beijing, University College London, and Waseda University in Tokyo.

At this year's symposium, O'Cinneide said the U.K.'s tariffbased National Health Service is central to the British identity and a source of pride to citizens. Like the NHS, most modern universal healthcare systems were implemented in the period following the Second World War, after the United Nations proclaimed the Universal Declaration of Human Rights. Article 25 of the doctrine says that all persons have a right to an "adequate" level of health. But the U.S. refused to ratify the section, spawning a chasm in sociopolitical beliefs, O'Cinneide said.

"If you don't think of healthcare in terms of rights, you start thinking about health and healthcare in a very utilitarian manner," he said. "In the U.S., health is not conceptualized as a right instead there's a discussion about the right to autonomy in health decisions. That shows different legal cultures, different political cultures, and very different ways of thinking about private freedom versus public good."

Universal healthcare in Germany predates the U.K. with origins dating back to the late nineteenth century. The German system, however, offers a public and private option. The public option covers 90 percent of the population while the private sector nets the remaining 10 percent, mainly the self-employed and civil servants.

Manfred Wandt, dean of law faculty at Goethe University Frankfurt/Main, said the two-tier system creates "necessary competition" in Germany but may not be a model for other countries.

"My impression is that there is no one solution for every country," he said, adding, however, that low administrative costs and incentives for the practice of good medicine were essential to any health care system.

One year before PPACA was signed into law, China announced that they would spend $123 billion to establish universal healthcare. Economists predicted the move would provide a jolt to the nation's economy as the Chinese often set aside large amounts of money for medical expenses.

But Wang Chenguang, professor of law at Tsinghua Law School in Beijing, remains cautiously optimistic that the resources will be distributed evenly among China's rural and urban populations. Fewer than half of the country's medical personnel work in rural areas where more than 60 percent of the population resides, he said.

"Everything is difficult, but everything is possible," he said.

"Insurance coverage on some basic level of care I think could be worldwide I don't have any doubt over that. The more difficult question is how do you unify the system?"