It is no secret that our current health care system is a mess. It is inefficient, confusing, and even though the United States’ total health expenditure in % of GDP ranks highest in the world, it does not cover every resident. Despite the passing of the Patient Protection and Affordable Care Act, also known as Obamacare, we will not secure universal coverage nor will we drastically lower the cost necessary to run our system. But why are we unable to create a system that works to cover everyone at a cheaper rate? Is there no established system we can borrow ideas from? Is the idea of universal coverage, at a lower cost, with satisfied patients an impossible task? The answers to these questions can be found if we look at the health care systems set up by other wealthy and industrialized countries around the world.
Across the pond we find our long term ally Great Britain, a country so proud of its National Health Service that even Margaret Thatcher, a Prime Minister known for privatization, did not dare remove the government from its structure. Great Britain’s health care system is based on the Beveridge Model that runs on the conviction that nobody should ever have to pay a medical bill. British residents enjoy no-fee health care paid for by the government through taxation. The government owns the hospitals, sets the prices for the medicine and treatments, and pays the doctors. Keeping NHS low cost has been possible through low administrative costs, the involvement of mostly private general practitioners as gate keepers, exercising preventive care, and controlling the range of medical treatments and medications that the NHS will cover. As a further incentive to keep all NHS users healthy, general physicians are not only paid for the amount of patients they have on their roster, but also if they do their job well completing what the NHS considers quality indicators.
A little further to the East we find another world superpower, Germany, which has accomplished universal coverage at a lower expanse than our insufficient system requires. The German health care system is based on the Bismarck model in which every German resident gets top-quality health care for a low insurance premium paid for by the resident and his employer, or government in the case of unemployment. Insurance is made available through private companies the premiums of which are fixed at the same price across the country by the government. The non-profit insurance companies are able to maintain their business because every German resident is required to sign-up for an insurance plan. In this manner the premiums paid by the healthy cover the expenses of those in need of treatment. Insurance companies are also able to provide private insurance plans that people can purchase to cover elective procedures not covered in the basic plan. The government’s ability to keep treatment and medication costs low, coupled to low administrative costs, and requirement of everyone to pay an insurance premium has made it possible for the German health system to function at a low cost.
Finally, looking at our neighbor to the north we are able to learn from Canada’s universal coverage health care system known as Medicare. Canadian residents enjoy a taxpayer-funded insurance program that covers a predetermined base of medical and psychiatric care in and out of a hospital. While each province is allowed to set their own rules regarding the health system, the federal government provides guidelines that the provinces must follow if they want to receive funding from the federal government. These rules include the use of non-profit insurance companies that must cover medical “necessities” for each resident equally regardless of age or social standing. To ensure fair treatment across all residents, private insurance can be purchased but only to cover procedures or treatments not covered by Medicare. Canada is able to run Medicare at a low cost by minimizing administrative costs, eliminating profit for medical “necessities” by insurance companies, and by using nationally set low prices for all treatments and medications.
Looking at these three superpowers and their health systems that allow for universal coverage at a cost much lower than what the U.S. pays for spotty and insufficient coverage, it is hard to imagine that we can’t learn a few things. The United States must come to terms with the fact that even though our health care system is not functioning well there are ways we can fix it. A look over the Bismarck, Beveridge and national health insurance models described above can aid us in determining the route for the next much needed health care reform.