Is There a Country the U.S. Can Model Healthcare After?
In the current era of Health Care Reform, many Americans are crying out for an alternative to the “Obama Care” answer to the healthcare dilemma. There are as many differing ideas as to what would be the answer as there are politicians arguing about it.
On one front, there are supporters of a more government controlled approach as is used in Britain. On another, there are those that would like to see a National Health Insurance such as is used in Canada. Another group believes that we are a capitalist society and have a capitalist based health care system that is not broken; rather, it is insurance reform that is needed. The list of alternatives has become so unwieldy that it is becoming hard to understand enough about these proposed alternatives and how they would impact healthcare as we know it in this country.
There are roughly 200 countries, and each strives to meet the three basic objectives of a healthcare system. This is not to say that there are actually 200 inherently individual systems to choose from. In actuality each of these systems can be categorized into one of four basic models:
The Out-of-Pocket Model is basically a lack of system all together. The majority of the world’s countries are to underdeveloped and poor to actually organize a healthcare system. The general rule of thumb in these nations is that individuals who are too poor to pay for services must either stay sick or ultimately die.
This model does not rely solely on money as a means of meeting those out-of-pocket costs. In countries that fall under this system, people often trade goods and services in return for medical services, if those services are even available.
Examples of countries in this model are: Rural Africa, China, India and parts of South America.
This model is named for Otto von Bismarck, the inventor of the welfare state during Germany’s unification in the 19th century. This system comprises a basic insurance system that is mainly financed through employee and employer contributions. Bismarck called these insurers “sickness funds” as that was the main purpose.
While this may sound similar to health insurance in the United States, the Bismarck insurance plans must cover every individual and cannot turn a profit. Since the insurance companies are essentially non-profits, close regulations give the government the ability to control healthcare costs. In nations that utilize this system, healthcare is privatized, which mean that doctors do not work for the government and hospitals are not owned by the government. All healthcare decisions are made by healthcare professionals, not government politicians.
Some countries that follow this model are: Germany, Japan, Switzerland and Norway.
This model is named after William Beveridge, who was the social reformer responsible for designing the National Health Service of Britain. Under this system, healthcare is provided by the government and financed through taxation, just like education and the police force.
Most of the clinics and hospitals are government owned and the doctors are government employees. The few doctors who are private are not allowed to collect payment from the patient; they are paid by the government as well. This gives the government total control over what services may be rendered to each patient as well as which services the doctor is allowed to perform in general.
This system has the lowest cost per capita, mainly because the government is in total control over the health of the people and retains all decision making control in all health matters relating to each individual. Cuba is an example of the purist form of this type of healthcare system, total government control.
Examples of countries who utilize this system of healthcare are: Cuba, Britain, Spain and New Zealand.
National Health Insurance
This system is actually a conglomerate of the Bismarck and Beveridge models. While the healthcare providers are privatized, the payment comes from a national health insurance fund that is controlled by the government and financed through taxation. Since the insurance program is not-for profit, the per capita cost is less than it would be for private insurance.
This single pay method allows for cost cutting by basically being a monopoly of sorts; if providers and drug companies wish to receive payment of any kind, they will simply accept what the government insurance will pay. Cost are cut even further by the government placing strict limits on which services an individual can receive as well as increasing wait time for appointments.
Examples of national health insurance can be seen in Canada, Taiwan and South Korea.
US Health Care
The current health care system in the United States has elements of all four models. The system for treating our service veterans is the same as the system in Cuba and Britain. Medicare follows the same system as Canada for our population over 65. The working population with insurance is the same system as Germany. The 15% of the populace that is uninsured falls into the out-of-pocket system with the bulk of underdeveloped nations.
There are aspects of the healthcare system that are in need of overhaul. Interestingly enough, the areas that need the most reformation are those areas controlled by the government already: Medicare and veterans benefits. More government control through mandated government insurance and a panel of politicians making medical decisions is not going to solve this problem, nor will it solve the problem of the uninsured populace.
Making broad decisions that affect the population as a whole is a mistake. Differing demographics require different levels of individualized care. Geriatric care is a growing concern with the baby boomers needing more specialized care at this stage of life. Veterans require specialized care that can best be accomplished by another subset of healthcare provisions.
Insurance reform, followed by less government involvement in personal medical decision making should be at the top of the agenda. This can be followed by looking at countries with differing healthcare systems and seeing what works, what doesn’t and taking a multi-dimensional approach that benefits the majority of Americans without taking away their rights in the process. We have already lost too many of those.