A Primer on Health Care Systems Across Countries
Discussions with the US about the American health care system often counterpose the well-known issues of the US health care system (high costs, lack of health insurance, unequal access to care, lower health outcomes than many other high-income countries) with a nebulous alternative often called “national health insurance, like all the other countries in the … Continue reading A Primer on Health…
Discussions about the American health care system often juxtapose well-known issues like high costs, lack of insurance, unequal access and poorer health outcomes with a vague alternative called "national health insurance" or "Medicare for all." This nebulous proposal seems to suggest these alternatives cover all needed health care with most costs paid by someone else.
However, over half of Medicare recipients now have their benefits managed by "Medicare Advantage" or Part C plans, where the government pays private insurance companies to provide care. Traditional Medicare, with its government payments to providers, also includes premiums, co-pays and deductibles, leading many users to buy "Medigap" plans for higher out-of-pocket costs and uncovered services.
Those advocating "Medicare for all" often don't envision government-paid insurance combined with out-of-pocket payments and private insurance companies. Projections based on current law show Medicare long-term costs could reach $60 trillion over 75 years, making its long-term solvency a concern before touting it as a solution. When discussing national health insurance models, it's crucial to specify which countries' systems are being compared since they vary greatly.
The Commonwealth Fund provides profiles for 31 high-income countries, including the US, Canada, ten European countries, Japan, Australia, Taiwan, Israel, and others. Comparing US health care spending to these nations reveals both attractive lower spending levels and significant differences in system organization. Both Canada and the UK boast 100% population coverage with about 11% of GDP spent on health care.
However, Canada has 69% of its population with private insurance supplementing the public program, while only 12% of the UK population does. In Canada, provinces are responsible for organizing health insurance, whereas the UK has a nationally organized system. This results in differences in how physicians' wages are determined; most British physicians are on salary, and most specialists are paid directly by the National Health Service, while Canadian physicians often work on a fee-for-service basis.
Other national models, like those in Germany, the Netherlands, and Switzerland, combine individual-level health insurance with regulated competition among insurers. A comprehensive discussion of US health care reform should learn from these diverse systems, but it's essential to go beyond general critiques and examine the specifics of each model.
The Commonwealth Fund's country profiles serve as a valuable starting point for gaining a deeper understanding of various health care policy options.
Written by urgent.news from Conversable Economist's reporting — not their text. Machine-written — may contain errors; check the original before relying on it.
