LENS


Barack Obama recently told Americans something most of them already knew:“Year after year,”he said,“our leaders offer up detailed health plans with great fanfare and promise, only to see them fail.”

This, the president-elect said at a news conference, “simply cannot continue.”

But what exactly can or should Mr.Obama do about health care- A look around the world shows the United States is hardly the only country grappling with the issue.

In Britain, Gardiner Harris reported in The Times, a board that sets medical spending limits has come under heavy criticism. The National Institute for Health and Clinical Excellence, or NICE, has refused to pay for a new cancer drug from Pfizer, because at $54,000 per patient, it is simply too expensive.

That has provoked protests from patients, but it has not stopped other countries from looking to Britain as a model of cost containment. Dr.Andreas Seiter, a senior health specialist at the World Bank, told Mr.Harris, “All the middle-income countries - in Eastern Europe, Central and South America, the Middle East and all over Asia - are aware of NICE and are thinking about setting up something similar.”

That could include China, where the harshness of the medical system is compounding the problems of the economic slowdown. The consumer economy is suffering as families hoard their money against the specter of catastrophic medical expenses.“Health care is so expensive and distorted that no matter how much you save, if you get sick you’re going to end up poor,” Wang Tao, a Beijing-based analyst at USB Securities, told Andrew Jacobs of The Times.

But, in contrast to China, another Communist state is emerging as a touchstone of how a national health care system can work well. As Roger Cohen reported in the Times Magazine, Cuba - despite a stagnant economy and limited civil liberties - has a health care system that affords its citizens life expectancies on par with the United States. Cuba also offers free training for doctors from other countries, and in the process exports its ideas of how universal health care can succeed.

An American student at Cuba’s Latin American School of Medicine, Pasha Jackson, 26, of Los Angeles, told Mr.Cohen: “I feel more valued here than where I grew up. And when I finish, I’m going to go back to my community and bring that same philosophy.”

If he does, he may find health care needs even more pronounced than when he left. As more Americans are losing their jobs in the recession, they are also losing their employer-subsidized health insurance.

In Ashland, Ohio, Janet M.Esbenshade told Robert Pear of The Times that she was buying no Christmas presents for her two daughters this year since being laid off from a local factory. The girls, 6 and 10, both have asthma. Ms.Esbenshade said she had told them,“I would rather you stay out of the hospital and take your medication than buy you a little toy right now, because I think your health is more important.”

But for all Mr.Obama’s promises to protect people like Ms.Esbenshade, Jonathan B.Oberlander, who teaches health politics at the University of North Carolina, has his doubts.

“The history of health reform is replete with instances of reformers believing this time it’s inevitable,”he told Kevin Sack of The Times.“Those prior tipping points all turned out to be mirages.”