Who leads the world in health care innovation?
Plus: When skills should trump credentials in hiring; what we can learn from Texas about land management; and meet another new FREOPP scholar
Key findings from the 2022 World Index of Healthcare Innovation: Once again, Switzerland comes out on top in FREOPP’s World Index of Healthcare Innovation (WIHI). The Swiss system of universal private health insurance has earned the #1 spot among the health care systems in high-income countries since our inaugural 2020 report. FREOPP President Avik Roy, Resident Fellow Gregg Girvan, and Visiting Fellow Grant Rigney summarize their findings by noting that—contrary to the perception of many in the U.S. that universal coverage can only be achieved through a “single-payer” system in which private health insurance is abolished and replaced by a government-run insurer—five of the top six countries in the 2022 WIHI have achieved universal coverage using private insurance. These systems empower patient choice and create room for insurers to organically evolve their benefit designs without having to wait for politicians or regulators to act. They also tend to be more fiscally sustainable. That’s because most of the top countries means-test their subsidies and phase them out as one ascends the income scale.
Where does the U.S. land in the 2022 rankings? The U.S. dropped seven places to #11 this year. The decline was fueled by a lower ranking for the quality of care and by a drop to last place in fiscal sustainability, due in part to the federal government’s enormous amount of COVID relief spending.
→ Avik went on the “A Second Opinion” podcast with Senator Bill Frist when FREOPP released its first WIHI analysis and explained how Switzerland shows that it is possible to have a system that spends far less than the U.S. and still does an excellent job of making sure that everyone who is vulnerable is protected.
State governments should hire based on skills, not degrees: This week, North Carolina became the latest state to reduce barriers for prospective employees by eliminating degree requirements for many state jobs. Historically, state governments have been far more likely than the private sector to require college degrees for middle-class jobs, and many are struggling to hire and retain workers. FREOPP Senior Fellow Preston Cooper contends that, unlike private-sector employers, states often demand college degrees for jobs that do not pay enough to make college worth it. That’s why states should remove degree requirements for government jobs whenever possible—especially for those that do not pay high salaries. Looking instead to skills and experience will open opportunities for individuals who can’t afford the time and expense of a degree but who have the willingness and ability to get the job done.
State land management can strengthen public services: The federal government owns more than a quarter of all the land in the United States, and the Bureau of Land Management (BLM) is the largest resource and landholder of all federal bureaus and services. With 10,000 employees, more than 27,000 volunteers, and 245 million acres of land, the BLM generated $451 million in revenue in 2021. In contrast, Texas generated $1.8 billion—nearly four times as much—with only 56 employees and 13 million acres. FREOPP Senior Fellow George P. Bush describes how Texas is a model for smart land management that generates income to fund public services for the states’ residents. The federal government should give states greater responsibility and autonomy when it comes to managing public land and resources in order to build meaningful sources of revenue for education and other vital public services.
Meet Grant Rigney: Working on FREOPP’s 2022 World Index of Healthcare Innovation required Grant to analyze countries from Australia to Poland, but his interest in health care started much closer to home, observing the challenges faced by the rural Americans he met during his years playing the fiddle and mandolin with his family’s professional bluegrass band. Grant translated this interest first into becoming a Certified Nurse’s Assistant, and then into two Master’s degrees, a 2019 Rhodes Scholarship, and his current role as a medical student at Harvard University. Grant makes time for policy research because he believes it is important to being the best possible advocate for patients: “I’m excited to be a part of FREOPP because I believe we’re asking the right questions and making real progress towards finding answers, all in the name of improving the well-being of those who are struggling the most.”
→ For bonus Grant content, bluegrass fans should check the award-winning musician’s mandolin performance as part of The Rigneys.
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