Dem Centrists Need To Read About Rwanda on Health Care

I'm amazed at how the so-called liberal press lets the Democrats off the hook. Eduardo Porter has a good piece in the Times about single payer health care around the world in a letter to Republicans. He might as well have included most of our Democratic Party leaders. This article should be read out aloud in every hall of legislature and also to convince the public -- instead we hear all about Russia all the time. This would be the best way to fight Trump and the Republicans but the Dems spin their wheels.

In Health Care, Republicans Could Learn From Rwanda

Republicans, you are probably tired of hearing how so many Americans are sicker than their peers in other rich countries, lacking access to needed medical care. There are only so many times one can take being unfavorably compared to Denmark.

As you regroup after the collapse of your bill to repeal the Affordable Care Act, hoping to figure out some new approach to dismember it, you might want to think not about Denmark, but about Rwanda.

Rwanda’s economy adds up to some $700 per person, less than one-eightieth of the average economic output of an American. A little more than two decades ago it was shaken by genocidal interethnic conflict that killed hundreds of thousands. Still today, a newborn Rwandan can expect to live to 64, 15 years less than an American baby.

But over the past 15 years or so, Rwanda has built a near-universal health care system that covers more than 90 percent of the population, financed by tax revenue, foreign aid and voluntary premiums scaled by income.

It is not perfect. A comparative study of health reform in developing countries found that fewer than 60 percent of births there were attended by skilled health workers. Still, access to health care has improved substantially even as the financial burden it imposes on ordinary Rwandans has declined. On average, Rwandans see a doctor almost twice a year, compared with once every four years in 1999.

Rwandan lives may be short, but they are 18 years longer than they were at the turn of the century — double the average increase of their peers in sub-Saharan Africa.

More than 97 percent of Rwandan infants are vaccinated against diphtheria, tetanus, pertussis, hepatitis B, Haemophilus influenzae Type B, polio, measles, rubella, pneumococcus and rotavirus, noted a 2014 study led by Dr. Paul Farmer, of Harvard Medical School, and Dr. Agnes Binagwaho, then Rwanda’s health minister.

Almost all Rwandan adolescent girls are vaccinated against human papillomavirus, which causes cervical cancer. That compares with about four in 10 girls in the United States.

Republicans, I know Rwanda — with its poverty, illiteracy and autocratic government — is not in the same peer group as the United States. But in some dimensions of health care, it gives the United States a run for its money.

Its infant mortality rate, for one, dropped by almost three-quarters since 2000, to 31 per 1,000 births in 2015, vastly outpacing the decline in its region. In the United States, by contrast, infant mortality declined by about one-fifth over the period, to 5.6 per 1,000 births. In Portugal — a developed country that is not quite as rich — it fell by almost half, to 3.

Critically, Rwanda may impress upon you an idea that has captured the imagination of policy makers in even the poorest corners of the world: Access to health care might be thought of as a human right. The idea is inspiring countries from Ghana to Thailand and from Mexico to China to develop, within their political and financial limitations, universal health care systems to offer some measure of access to all.