Monday, August 17, 2009

Healthcare around the world vs. America

Paul Krugman points out that Every wealthy country other than the United States guarantees essential care to all its citizens. Why doesn't America? Look at who is opposed to universal health care. The big money opposing health care reform is coming from the existing health insurers and from the big pharmacy companies because as long as there is no guarantee of health care with an organized and systematic national form of paying for it, they can exploit sick and frightened people and make big profits.

How big are the profits they get from the current system? Consider that they are conservatively estimated to be spending $1.4 million a day right now to kill the health care reform effort. They expect to recover that and much more if they are successful. But what does it mean that every other wealthy nation in the world guarantees essential health care to its citizens? Krugman provides a short summary of the systems.
Every wealthy country other than the United States guarantees essential care to all its citizens. There are, however, wide variations in the specifics, with three main approaches taken.

In Britain, the government itself runs the hospitals and employs the doctors. We’ve all heard scare stories about how that works in practice; these stories are false. Like every system, the National Health Service has problems, but over all it appears to provide quite good care while spending only about 40 percent as much per person as we do. By the way, our own Veterans Health Administration, which is run somewhat like the British health service, also manages to combine quality care with low costs.

The second route to universal coverage leaves the actual delivery of health care in private hands, but the government pays most of the bills. That’s how Canada and, in a more complex fashion, France do it. It’s also a system familiar to most Americans, since even those of us not yet on Medicare have parents and relatives who are.

Again, you hear a lot of horror stories about such systems, most of them false. French health care is excellent. Canadians with chronic conditions are more satisfied with their system than their U.S. counterparts. And Medicare is highly popular, as evidenced by the tendency of town-hall protesters to demand that the government keep its hands off the program.

Finally, the third route to universal coverage relies on private insurance companies, using a combination of regulation and subsidies to ensure that everyone is covered. Switzerland offers the clearest example: everyone is required to buy insurance, insurers can’t discriminate based on medical history or pre-existing conditions, and lower-income citizens get government help in paying for their policies.

In this country, the Massachusetts health reform more or less follows the Swiss model; costs are running higher than expected, but the reform has greatly reduced the number of uninsured. And the most common form of health insurance in America, employment-based coverage, actually has some “Swiss” aspects: to avoid making benefits taxable, employers have to follow rules that effectively rule out discrimination based on medical history and subsidize care for lower-wage workers.

So where does Obamacare fit into all this? Basically, it’s a plan to Swissify America, using regulation and subsidies to ensure universal coverage.
Would the Swiss plan be bad for America? Not for most Americans. Not even for most employees of American health insurance firms. Only for a few top executives who are currently vastly overpaid for any rational services that they perform, and for "investors" who are gambling money on the above normal profitability of health insurance firms once they kill the health care proposal. Against these undeserving groups consider the 45 to 50 million uninsured Americans and the almost equal numbers of people with insurance that pays so little if they or someone in their family gets ill that they are driven into bankruptcy.

What are the opponents of health care reform selling? Not health care, that's for sure. They are selling that old classic "Fear, Uncertainty, Doubt" to people who find the status quo satisfactory for right now. America can do much better, as all of the other wealth nations demonstrate. It's high time that America had a rational health care system that is not held hostage by extortionists and profiteers. Let's get universal health care passed this time.

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