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LONDON -- As President Barack Obama pushes to overhaul the American health care system, the role of government is at the heart of the debate. In Europe, free, state-run health care is a given.
The concept has been enshrined in Europe for generations. Even illegal immigrants are entitled to free treatment. Europeans have some of the world's best hospitals and have made great strides in fighting problems such as obesity and heart disease.
But the system is far from perfect.
In Britain, France, Switzerland and elsewhere, public health systems have become political punching bags for opposition parties, costs have skyrocketed and in some cases, patients have needlessly suffered and died.
Obama has pointedly said that he did not want to bring European-style health care to the U.S. and that he intended to introduce a government-run plan to compete with private insurance, not to replace it.
Critics fear that Obama's reforms will lead to more government control over health care. They cite problems faced by European health systems as examples of what not to do.
Other experts say Americans could learn from countries such as Germany, the Netherlands and Switzerland, especially in the debate on how to reorganize health insurance.
"These countries are in some way an inspiration for our reforms," said Uwe Reinhardt, a health economist at Princeton University. "All of these countries somehow manage to assess risk and compensate for it ... we could learn from that."
Still, experts say that before committing the U.S. to footing the bill for universal health care, Obama should consider what it has cost Europe.
A World Health Organization survey in 2000 found that France had the world's best health system. But that has come at a high price; health budgets have been in the red since 1988.
In 1996, France introduced targets for health insurance spending. But a decade later, the deficit had doubled to $69 billion.
"I would warn Americans that once the government gets its nose into health care, it's hard to stop the dangerous effects later," said Valentin Petkantchin, of the Institut Economique Molinari in France. He said many private providers have been pushed out, forcing a dependence on an overstretched public system.
Similar scenarios have been unfolding in the Netherlands and Switzerland, where everyone must buy health insurance.
"The minute you make health insurance mandatory, people start overusing it," said Dr. Alphonse Crespo, an orthopedic surgeon and research director at Switzerland's Institut Constant de Rebecque. "If I have a cold, I might go see a doctor because I am already paying a health insurance premium."
Cost-cutting has also hit Switzerland. The number of beds has dropped, hospitals have merged and specialist care has become harder to find. A 2007 survey found that in some hospitals in Geneva and Lausanne, the rate of medical mistakes had jumped as much as 40 percent. Long ranked among the world's top four health systems, Switzerland's dropped to eighth place in a Europe-wide survey last year.
Government influence in health care may also stifle innovation, other experts warn. Bureaucracies are slow to adopt new medical technologies. In Britain and Germany, even after new drugs are approved, access to them is complicated because independent agencies must decide whether they are worth buying.
