Universal Health Care does NOT require Single-Payer [View All]

[liberalpragmatist]

I am a firm believer in universal health care and I think it's an outrage that the U.S. is the only major industrialized country not to guarantee health coverage to its citizens.

I'm well aware of the arguments for single-payer and I do think that if we were starting from scratch, it would be the best system to put in place. I also believe that scaremongering about the Canadian system is ridiculous.

That being said, I think a lot of American liberals get too hung up on single-payer as the be-all/end-all of universal health care. MANY countries throughout the Industrialized world, including most nations in social-democratic Western Europe, do NOT have single-payer systems, yet have perfectly good outcomes with tightly-regulated private insurance markets or some public-private fusion.

Examples:

- Germany - 85% of the public is covered a Standard Health Insurance Plan, which, though a government-administered plan, is NOT single-payer. Rather, funds are contributed by individuals and businesses, as well as the government. People must pay premiums, which are indexed according to a person's income.

- The Netherlands - All primary and curative care is paid for through private insurance. Individuals have a mandate to purchase insurance and the insurance market is tightly-regulated, with no exemptions or charging people different rates based on their health history. Care for the long-term ill, the elderly, and the infirm is directly financed by the government. Overall, the funding spread is 62% publicly-funded, 38% privately-funded.

- France - In France - whose health care system is ranked the best in the world by the WHO - individuals must purchase insurance through one of several sickness funds, which are essentially not-for-profit insurers. The sickness funds are funded both by the government and businesses. Individuals pay premiums, although most of their medical costs are reimbursed. The government's major role is to act as a regulator and price fixer. The funds must not discriminate on the basis of health, and the government also negotiates the costs of medical procedures and drugs.

Additionally, on top of the basic services provided by the sickness funds, of which there are 5, 85% of the French have supplemental private insurance, which is often provided by the employer.

- Switzerland - Switzerland has a tightly-regulated private insurance market, in which a compulsory, basic level of service is mandated by all insurers, and patients are guaranteed nearly complete access to any doctor or medical provider in their region. Additionally, many Swiss opt to purchase complementary insurance on top of their basic insurance. The complementary insurance covers items like dental care.

- Japan - The majority of the public is covered by compulsory private insurance which is, again, tightly regulated. A basic level of care is mandated across different insurers, and nearly all hospitals are run as non-profits. Funding for the private insurance market, known as the Social Insurance System (SIS), comes through fees paid by employers, supplemented by premiums paid by individuals. Premiums are determined by income. The insurers - "health insurance societies" - are 1800 in number. 63% of the public is covered by these "health insurance societies," in the SIS. The other 37% of the public - mostly the self-employed - is largely insured through a government plan, or National Insurance, which is funded both by premiums on individuals and by government funds and which is administered by local bodies. Additionally, there is supplemental government-financed care for the elderly.

- Countries that do have a single-payer system, or something close to it are the UK, Canada, Australia and most of the Scandinavian countries. The UK's NHS is not merely a universal, single-payer insurer, but a provider, administering a large percentage of the health care system. Canada mandates single-payer, which is administered through the provinces. In Australia, basic care is provided by Medicare, with additional coverage provided by a large market that consists of private insurance companies, non-profits, and a government-run public plan called Medibank (which operates like a private insurer in that it's opt-in and is largely financed by individual premiums).

The take-away from all of this is that while single-payer is a perfectly defensible position, it is not the only way to provide good, universal, health coverage to people. Plenty of developed countries have managed to provide quality health insurance through other ways.

Update - Here's a good piece from http://www.newyorker.com/reporting/2009/01/26/090126fa_fact_gawande">The New Yorker that makes the point that virtually every country, when designing a universal health care system, has built upon what it already has. Britain's NHS was the result of the wartime emergency health system put in place during WWII. The French system was an extension of a voluntary social-insurance scheme. Etc., etc.