Don't look to Rwanda for a model

The New York Times today presents a feature on Rwanda's national healthcare plan, with a none-too-subtle tsk-tsk at the U.S.: "Sunny Ntayomba, an editorial writer for The New Times, a newspaper based in the capital, Kigali, is aware of the paradox: his nation, one of the world’s poorest, insures more of its citizens than the world’s richest does." The New York Times author marvels at how Rwandans are guaranteed access to basic health care for a mere $2 per year in premiums, and more than 90% of Rwandans are covered. If Rwanda can make universal health care work, why can't America?

But Rwanda isn't making universal health care work. As the author of the article admits, more than half of healthcare expenditures in Rwanda are paid for by foreign donors. In other words, this system only survives because of charity from the outside. There's nothing wrong with voluntary charity, of course, but don't extrapolate from the Rwandan system that "we can and should do this, too." Who will pay for the healthcare of Americans whose premiums don't cover the cost? Blank-out.

Furthermore, even the extremely basic coverage (treatment in facilities that may not even have running water; forget about all but the simplest medical procedures, unless a foreign doctor happens to be passing through) that Rwanda's plan affords is already more than some Rwandans can afford. "Even $5 for a Caesarean section can be too much for people as close to the edge as the Yankulijes, who live by growing beans and sweet potatoes and wear American castoffs (Mrs. Yankulije’s T-shirt read 'Wolverines Football')." As important a need as medical care is in an emergency, there are needs still more pressing, like food and shelter, and "most of the world’s poor, including Rwanda’s, resist what they see as the unthinkable idea of paying in advance for something they may never get." That's rational -- if you barely make enough to cover the things you need right now, there is no sense in spending money on insurance for an expense you may or may not have. Again, why should America emulate Rwanda in that respect? If Americans decide they get more value out of renting a larger apartment or investing for the future than in having comprehensive medical insurance, that's a valid choice.

The author of this article clearly sees Rwanda's system as one we should look to for ideas on improving the American system. But, as I and many others have argued before, the way to improve health care in America is to free the market. Universal health care isn't working in Rwanda, and it won't work here.