Tuesday, September 5, 2017
The Three Types of Universal Healthcare
Fresh from visiting the disastrous healthcare system in Cuba, and feeling acutely ashamed of the travesty of it in the US, I write to briefly explain three types of universal healthcare.
It is much mis-understood.
It need not be.
Americans somehow fear socialism, even though the educational system (through the 12th grade), as well as the police and fire services, are socialist. Socialism doesn’t need to be such a bad word. Taxpayers support these basic human services, as well they should. Wealth is re-distributed, through taxes, to provide these educational, police, and fire services.
Healthcare needs the same universal support.
For all of our truly advanced medical equipment and well-trained medical practitioners, we are not a healthy group of citizens. 28 percent of Americans (!!) suffer from chronic health conditions, like diabetes or arthritis. As of 2015, we ranked fifth on the list of countries who lose children to death before the age of five—behind Turkey, Argentina, Mexico and Slovakia.
Further, we consume health services like crazy. We spend 17 percent of our GDP on health care. No other developed country spends more than 12 percent. 8 percent of US health care costs are administrative; in the UK, administrative costs run only 2.5 percent. (In 2013, the Duke University Hospital had 400 more billing clerks  than hospital beds ).
OK, on to the three paradigms, one of which we citizens of the US desperately need:
First, the single-payer system. In this method, utilized in Cuba and in the former Soviet republics, all medical services are provided and paid for by the government. Health insurance does not exist. Physicians, nurses, and medical equipment providers work for the government; citizens of the government are entitled to care at clinics or hospitals.
Sadly, no evidence exists of this system working. I was alarmed to learn in Cuba, for example, that many physicians work as hotel clerks on weekends or holidays to earn extra money. Worse, their medical facilities are notoriously poor.
A fellow I befriended to show me around the country asked if I could bring him a blood pressure cuff. He had responded sheepishly to my request to bring him a gift. It turns out his sister and his mother are physicians. Even they cannot obtain such basic supplies as blood pressure measuring devices.
The second paradigm works something like the Affordable Healthcare Act passed during the Obama administration. In this system, the government either mandates or provides universal health insurance, but leaves the provision of care to the private sector.
In the third system, one which Adam Smith and Jon Stuart Mill would have loved, healthcare is entirely deferred to the private sector. Governments might offer subsidies, or make regulations, to ensure more individuals are covered. But all practitioners are private and all citizens pay with their own earned money.
In reality, most country’s heath care systems fall somewhere between these three paradigms.
Britain, Italy, Spain and Sweden essentially use the first system, albeit much more successfully than the communist countries. Even in these counties, though, private medical providers and private insurers exist. However, citizens are ensured healthcare by virtue of their citizenship. It is considered a basic, universal right.
France’s and Canada’s health care systems work much more like the second paradigm. Physicians are mostly in private practice, but basic insurance schemes provide national health insurance which is also government-subsidized.
Germany’s massive health care system, a success story since its introduction decades ago, combines models two and three. Most citizens are covered by government-administered systems, but those earning above a certain amount can purchase private health insurance to supplement the basic coverage.
In the Netherlands and Switzerland, private health insurance companies continue to exist. Physicians and hospitals are generally private. However, similar to Obama’s idea, coverage is universal because citizens are required to have it. This ensures that younger people stay in the system, holding insurer’s costs down.
OK, that’s it.
Three basic ways to universalize health care in any country.
Now for some advocacy:
Marx’s idealism worked well when he wrote his Communist Manifesto in 1848, but the world has since evolved. Nothing will completely removed class distinctions. People are not, contrary to the US Constitution, born equal.
It is sad.
It is nonetheless true.
As I have argued in previous posts, the solution lies close at hand. We simply expand the current Medicare system to encompass all American citizens from birth. The Medicare program which, by the way, is a form of insurance. It works well. When combined with the VA system, it already covers healthcare costs for more than HALF of all Americans.
What are we waiting for?
Finally, by adopting the ten health care essentials already part of the Affordable Care Act, Medicare would provide every American—including the poorest homeless person of any age—with a basic level of medical and mental health care.
Private insurance companies can then compete for differing levels of supplemental insurance, reducing deductibles or including other services like dental or vision.
In essence, the system would work much like the fire department does now. When your house or apartment goes up in flames, you dial 911. Firemen (inevitably handsome) soon arrive.
They care not what type of insurance you have.
They care not whether you are even home or not.
They extinguish the fire.
Those of us lucky enough to have good incomes purchase extra coverage, like for smoke or water damage. We insure our more expensive possessions—watches, art, sculptures, whatever. However, we need not worry about having tall, physically fit persons race over to put out the fire.
In like manner, we Americans need not continue to face the pathetic reality that health care expenses are the greatest cause of bankruptcy. Despite being the richest of the world’s countries, the American healthcare system is, in truth, one of the world’s worst:
Great providers and wonderful facilities do little if you lack the money to afford insurance or even your co-payment.
Let’s change it, using a combination of the methods above, so as to provide fair healthcare to all.
(In composing this post, I relied significantly upon the August 12th issue of The Economist which also simplified an explanation of universal health care on pp. 22-23).
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Alan Karbelnig, PhD, ABPP