When I first started studying health care inequality as an undergraduate, one of the first facts I learned was that, “the U.S. is the ONLY major industrialized nation in the world without a universal health care system.” I was shocked! How was it possible that in my twenty-three years of life I had never learned this fact? The more I studied the more I realized that the reason I never heard this … and worse yet, the reason that I took for granted that getting health care is difficult for everyone, is due to the same, out dated archetype that has been afflicting many other disparities upon this country; our overbearing culture of individualism, and the belief that the United States is too “unique” to model ourselves after other countries.
With all of these thoughts in mind, I was overjoyed when the PBS series Sick Around the World came out. Reporter T.R. Reid travels to five countries (the U.K., Japan, Germany, Taiwan and Switzerland) each democratic, each capitalistic, and each with very different health care systems. He specifically notes three major things: the positive aspects of the system, the negative aspects of the system, and what aspects could possibly apply to the United States.
The United States spend 17% of its GDP on health care (making it the most expensive system in the world, and yet everyone is not covered. This statement on it’s own just seems like another statistic floating around about how much we consume. However, when you look at the fact that France (the country that is ranked the best health care system in the world by the World Health Organization, the United States is ranked 37th) only spends 9.6% of its GDP, that statistic seems a lot more drastic doesn’t it? WHO’s country rankings are decided by three main factors: attainment and performance, goodness and fairness, and goals and functions. Clearly if we are spending so much money more money on health care than nations that are providing access to everyone, we are doing something wrong.
So how do they do it? Well there are four basic models for health care in the world. There is The Beveridge Model, originally created in the U.K. and was also adopted in Spain, most of Scandinavia, and New Zealand. In this system, health care is provided and financed by the government through tax payments, just like the police force or the public library. Cuba represents the world’s purest example of government control.
The second is The Bismark Model, this system of providing health care would probably the smoothest transition from the American system. It uses an insurance system — the insurers are called “sickness funds” — usually financed jointly by employers and employees through payroll deduction. Unlike the U.S. insurance industry, though, Bismarck-type health insurance plans have to cover everybody, and they don’t make a profit. Doctors and hospitals tend to be private in Bismarck countries; though tight regulation gives government much of the cost-control clout that the Bismark Model provides. The Bismarck model is found in Germany, of course, and France, Belgium, the Netherlands, Japan, Switzerland, and, to a degree, in Latin America.
The third is the National Health Insurance Model. This system has elements of both Beveridge and Bismarck. It uses private-sector providers, but payment comes from a government-run insurance program that every citizen pays into. Since there’s no need for marketing, no financial motive to deny claims and no profit, these universal insurance programs tend to be cheaper and much simpler administratively than American-style for-profit insurance.
The single payer tends to have considerable market power to negotiate for lower prices. The classic NHI system is found in Canada, but some newly industrialized countries — Taiwan and South Korea, for example — have also adopted the NHI model.
Lastly there is the out-of-pocket model. Only the developed, industrialized countries — perhaps 40 of the world’s 200 countries — have established health care systems. Most of the nations on the planet are too poor and too disorganized to provide any kind of mass medical care. The basic rule in such countries is that the rich get medical care; the poor stay sick or die. The United States is unlike every other country because it maintains so many separate systems for separate classes of people. All the other countries have settled on one model for everybody. This is much simpler than the U.S. system; it’s fairer and cheaper, too.
The sort of pioneer spirit I mentioned before served our forefathers well in creating a foundation for this country based on what they felt was unjust, but it is not serving us, or the current leaders of our country, to be too cavalier to learn from nations that are serving their people well. It’s no secret anymore that our market based health care system is not working, with medical bills being the number one cause of bankruptcy in the nation I think it’s clear that the market doesn’t inherently take care of itself, and more importantly can’t take care of us. Right now with government and lobbyist relationships under the public eye more than they have been in years, it’s the perfect time to not only learn from the mistakes of the past, but also pay close attention to what has been proven to work, hopefully creating a new heath care system that serves everybody.