As our lawmakers struggle to come up with improvements to our failing health care system, we as concerned citizens have a responsibility to become more knowledgeable about this issue and to lend our voices and opinions to the debate. Since the United States is the ONLY industrialized nation without universal coverage, it may be helpful to compare the systems of other nations in determining what models might work here.
The most “socialized” system is exemplified by Britain’s National Health Service. All citizens and legal residents are covered by the NHS. Ninety-five percent of NHS expenditures are financed through taxes, with the remaining 5% through user charges such as co-pays on prescription drugs, dental and vision services. Because there are no bills to collect or claims to review, administrative costs are very low. The government owns the hospitals and employs the doctors, but citizens can choose their doctors and where they receive care. Doctors are paid based on the number of patients they see and get additional financial rewards for keeping their patients healthy. As a result, Great Britain is the world leader in the area of preventive care.
To control costs, the NHS does not cover certain high cost treatments that are often ineffective. The most common complaints about the NHS involve waiting times—particularly for elective surgeries such as hip replacements.
Britain spends only 8.3% of its GDP on health care, or an average of $2723 per person per year. The World Health Organization (WHO), which ranked the US 37th in the world in overall health care, ranked Britain’s system 18th. Other countries with systems similar to Britain’s include Spain (7th), Norway (11th), and Sweden (23rd).
The health care systems of Germany, France and Japan are “insurance based” systems, similar to the US, but with several major differences. The first is that insurance is provided on a non-profit basis. The second is that insurance is paid for by payroll deduction, similar to the way we pay for Social Security coverage. Another difference is that coverage is universal—no one can be excluded based on age, health status, etc. Unlike Britain, the government does not own or operate hospitals and doctors are in private practice or are employees of hospitals.
In Germany, workers and employers split the costs, with each contributing approximately 8% of payroll to 240 different “sickness funds”. Coverage includes dental, prescription drugs and long-term care. Germany spends 10.7% of GDP on health care, or an average of $3673 per citizen.
In Japan, employers and employees each contribute 4% of payroll to mandatory national health insurance plans. While taxes are lower, the Japanese pay more in deductibles and co-pays for inpatient and outpatient care (30% for outpatient care and 20% for inpatient hospitalizations.) The Japanese spend 8% of GDP, or an average of $2358 per citizen per year on health care. The WHO ranked Japan 10th and Germany 25th in overall health care.
The country ranked Number One in health care is France. The French system has the most comprehensive coverage in the world, with quality care, excellent choices of doctors and specialists, and with no waiting time. The French system taxes employers 13.1% of payroll and employees 0.75% of payroll. Most people (87%) have additional private for-profit supplemental insurance. Income taxes provide coverage for the elderly and unemployed. The French pay higher taxes, which they accept as a necessity. They spend 11.1% of GDP on health care and costs average $3374 per person per year.
Canada’s single-payer system is often mischaracterized as “socialized” medicine. In actuality, a single-payer system is publicly funded with private delivery. Unlike Britain, the government does not own the hospitals or employ the doctors. Our Medicare system is an appropriate analogy to the Canadian system. In Canada, all insured people are required to be covered for all medically necessary hospital and physician care without co-pays or user fees. About 70% of total health care spending is financed by the public sector through income taxes, payroll taxes and sales taxes. Many Canadians obtain private insurance to cover prescription drugs, rehabilitation services, vision and dental care, which accounts for the remaining 30%. Canada spends 9.9% of GDP on health care, or $3678 per person. While Canadians complain of long waits for elective procedures and to see specialists, surveys show that a majority of Canadians are happy with their health care delivery system.
Only about 40 developed countries in the world have established health care systems. In Africa, much of India, China and South America the rich who can afford to pay out-of-pocket get care and those who can’t afford to stay sick or die. According to T.R. Reid, a Washington Post correspondent who has written extensively on health care issues, our fragmented national health care apparatus has elements of all these models. Our veteran’s health care system is like Britain’s, Medicare is like Canada’s, our employer-based insurance is like Germany’s or Japan’s (with the exception that most of the insurance industry in the US operates on a for-profit basis), while our 47+ million uninsured Americans might as well live in India.
No country has the perfect health care system and perhaps none of these systems would be perfect for the United States. You should note however that, contrary to what the scary “Harry and Louise” type ads might imply, in ALL these systems, patients have a choice of doctors!
The US spends a larger percentage of GDP (15.3%) and more per person ($6714) than any other country in the world—and unlike the US, the other 39 countries with established systems cover all of their citizens. Whether we end up with a hybrid system like we have now or a system like the ones detailed above, we cannot solve our health care problems without finding a way to cover all Americans, without controlling administrative costs and without reducing wasteful, unnecessary and ineffective treatments and procedures.
(Carol Balderree of Heber Springs is one of three local contributors to Progressive Voice, a “liberal viewpoint” column which runs each Friday. Reach her at: cbalderree@suddenlink.net.)
