Thursday, July 5, 2012

Can the U.S. catch up to Rwanda?

The one thing that many people know about the country of Rwanda is that there was a terrible genocide there in 1994. Over 800,000 Tutsi and moderate Hutu people were killed in the awful conflict which roiled the country at that time.

Since 1994, Rwanda has been ruled by one man, Paul Kagame. At first he was the de facto leader and then in elections in 2000 he was selected as the country's president. He has been in power since then. His regime is autocratic and repressive and doesn't really brook criticism from any source. He is justifiably excoriated for his record of suppressing dissent.

Paradoxically, he is also considered one of the most effective leaders in Africa. His country is safe and clean and relatively free of government corruption. Per capita income has tripled in 18 years, average life expectancy has increased by 10 years (10 years!), deaths of children under 5 have dropped by half in five years, and malaria deaths have dropped by roughly two-thirds.

The remarkable achievements of Rwanda in the field of public health have come for one reason: Rwanda has universal health care! Their government health insurance plan, called Mutuelle de Sante', reaches all but four percent of its citizenry. The cost to patients is minimal and the health care is good and effective. What an amazing story this is for a small and poor country. What a testament to what can be achieved by human beings when there is the political will to do it.

Every developed country in the world besides the United States currently has some form of universal health care for its citizens. Moreover, many developing nations like China, Brazil, and Thailand also provide universal health care. Many Americans have become medical tourists in recent years, traveling to one of these countries which provides universal health care without exorbitant costs such as we have in this country. It is becoming a more and more common phenomenon.

With the Supreme Court decision on the Affordable Care Act that was announced last week, this country now has a chance to take a giant step toward joining forward-thinking, socially advanced countries in providing a very necessary social safety net - some would say a human right - which every one of us will need at some point in our lives. The ACA is a jerry-rigged system created by a committee dominated by insurance companies and it is far from the best we could do if we had the will. But it is a start.

Who knows? In ten or fifteen years, we might even catch up to Rwanda.

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