Otte-Coleman - City Magazine

CM SMARTS |
Beginning Conversation:
Healing America’s Health Care System
A
good conversation to have these days,
with a variety of people, is about health
care reform. It helps to understand how
other countries’ health care systems
work, to see what some options are.
T.R. Reid, a Washington Post journalist, went
on an expedition to research alternatives to our
nation’s health care system, as well as hoping
to treat his bum shoulder. His new book, “The
Healing of America. A Global Quest for Better,
Cheaper, and Fairer Health Care,” offers a picture
of four different types of health care systems.
Reid describes Britain’s National Health
Service, inspired by Willliam Beveridge, as
probably closest to what Americans imagine when
they think of socialized medicine (Spain, Italy, and
New Zealand also follow this model).
In this model, the government is as responsible
for taking care of people’s health as they are for
picking up trash. It’s paid for with taxes. The
government owns the hospitals, employs the
doctors and nurses, buys the pills and pays the
bills. Patients must see a general practitioner first
and, if a specialist is needed, there’s a waiting line.
Administratively, it’s simple because it cuts out the
need for insurance.
Germany, Japan, France, Belgium and
Switzerland all utilize the “Bismarck Model”, which
has all private doctors, hospitals and insurance
plans. The difference is there are about 200
non-profit insurance companies in Germany. It’s
not single-payer, and you can drop it and switch
companies, and they can’t raise your premium.
By Candace Brannan Gerhardt
The third type is the Canadian Model which
is a blend of both the Beveridge and Bismarck
Models. They have private doctors and private
hospitals, but the payment system is public. In
some provinces, people pay a premium; in some
provinces, it’s a tax. But, you don’t get a hospital
bill, so anybody can go.
The last and most common model of health
care operates on one rule: if you can pay your
doctor out-of-pocket, you get treated. If you can’t
pay, you stay sick or die. Brutal, but that’s the fact
of life in most countries.
In the United States, all four models exist.
According to Reid, if you’re Native American or
a veteran relying on government care, you live
in Britain. If you share your health insurance
premium with your employer, you live in Germany.
If you’re a senior and you buy Medicare insurance
from the government and go to a private doctor,
you live in Canada. And, if you’re one of the tens
of millions of Americans who can’t get health
insurance, you live in Nicaragua or Honduras.
Reid points out this difference: all other
countries have decided that health care is a right,
not a privilege, and these countries have decided
that it’s more fair and affordable to provide one
model where everyone has access to the same care
at the same price.
How should Americans reform our health
care system? There are no easy answers, but we
can’t ignore it any longer. Let’s look at it, and let’s
continue this dialogue.
November 2009 9