With the imminent rollout of open enrollment under Obamacare, we are all going to read and hear a great deal about health care and health insurance in the weeks and months to come.
To gain some international perspective on these issues, I highly recommend reading “The Healing of America” by T.R. Reid.
Reid, a correspondent for The Washington Post, writes of his journey around the world to experience the health care and insurance regimens of other countries. Citing a study from the National Academy of Sciences that claims 22,000 Americans die prematurely each year from treatable medical problems because they cannot afford to see a doctor, he asks the essential question:
“Should our country provide health care to all of its citizens who need it?”
To date, the United States is alone in the developed world to have answered with an emphatic “no.”
It is disgraceful that we allow tens of thousands of our fellow citizens to die prematurely because our decision-makers will not say “yes” to what is essentially a moral question.
Will Obamacare provide all Americans with the access to health care they need? Again, emphatically no. It will extend coverage to many who are now uninsured, but millions will continue to do without.
Obamacare extends coverage in the most inefficient way possible, building on the hodgepodge of health insurance regimes that already exist. And because Obamacare subsidizes the purchase of insurance coverage, it is essentially nothing more than a pipeline from taxpayer pockets to the coffers of the health insurance industry.
There are four health care delivery models, and the United States is the only country where all co-exist.
Americans are well-acquainted with the Bismarck model, which uses private health insurance plans and providers and is paid for by employers and employees through the payroll system. There are variations of the Bismarck model in Germany, France, Japan, Belgium, Switzerland and many parts of Latin America. Most working Americans under 65 get their health coverage this way.
In the Beveridge model – the inspiration for the National Health Service introduced in the United Kingdom in 1946 – the government pays for health care from general tax revenue. Medical treatment is a public service, and the government owns and operates the hospitals and clinics. The Beveridge model is what most Americans have in mind when they think of “socialized medicine.” Variations are found in Italy, Spain, Scandinavia and Hong Kong. Americans who get their health care this way are members of the military, veterans and American Indians.
The third model is national health insurance, which incorporates elements of both Bismarck and Beveridge. In countries using this model, every citizen pays premiums to the government, which in turn pays all medical bills. The medical providers are private, but the single-payer system gives the government considerable power to negotiate on price. Canada adopted its “Medicare” system in the 1960s, and newly industrialized countries such as Taiwan and South Korea have adopted variations. Americans over 65 should be familiar with this model as our own Medicare is an example.
Lastly, you have the out-of-pocket model found in most of the poorer countries where the rule is you get the health care you can afford. Think Burma and Rwanda – and the United States, where 45 million Americans are well-acquainted with this model.
Reid’s book concludes with a chapter that tries to answer the question: “Which are the best health care systems in the world?”
The United States ranks No. 1 in terms of absolute spending, per capita spending and spending as a percentage of GDP. The World Health Organization gathered all of the factors on which health care systems can be rated, synthesized the data and ranked the health care systems of 191 countries. We came in 38, just behind Costa Rica.
When you go to a Target store, banners proclaim, “Expect more. Pay less.” When it comes to health care, we in the United States have turned that around: “Pay more. Expect less.”
Contributing columnist Marc Landry can be reached at firstname.lastname@example.org.