February 26, 2006

Healthcare Pt 4: Progressive Alternatives

Filed under: Random Stuff — Bob Gifford @ 4:44 pm

As I began to research single-payer health systems, I came across a great organization — The American Medical Student Association. They have a very helpful site with various primers on universal health care, which I am going to paraphrase liberally below, but I recommend their reports if you’re interested in learning more.

So first, some definitions:

  • Universal Health Care: Any healthcare system that provides access to medical care to all residents, regardless of how this outcome is achieved.
  • Single-Payer: A method of financing healthcare in which the government pays for all care, although it doesn’t necessarily deliver any healthcare. The government, whether at the county, state or federal level, takes over the role that health insurance companies and HMOs play in the U.S. E.g. Canada
  • Multi-Payer: An alternative financing arrangement in which healthcare is paid for by a combination private health insurance companies and the government. E.g. Germany, Japan
  • Nationalized Healthcare: A healthcare system in which the government is not only the sole payer, but is also responsible for the delivery of healthcare, owns the hospitals and clinics, and employs the physicians and nursing staff. E.g. United Kingdom
  • Employer Mandates: A legal requirement that employers provide healthcare benefits to employees.
  • Individual Mandates: A legal requirement that individuals obtain health insurance, whether from their employer, an individual health insurance policy, or a government program.


The AMSA has a report surveying the healthcare systems of various developed countries around the world, and one thing stands out: each is uniquely adapted to the needs and values of each country, and no two are exactly alike. Americans tend to assume that the rest of the world has nationalized healthcare, aka socialized medicine, which goes against our values of free enterprise and entrepreneurialism. But in fact, most of the developed world employs some combination of public and private financing and delivery of healthcare. Many (perhaps most) countries have multi-payer systems, not single-payer systems, and certainly not nationalized healthcare.

If we were to design the perfect universal healthcare system for the U.S., we would first have to choose between a single-payer and a multi-payer system, but that would only be the start. We’d find that there are quite a few other policy decisions to be made:

  • How are funds raised to finance healthcare, e.g. payroll taxes, income taxes, individual contributions, co-payments or co-insurance?
  • Can patients purchase supplemental private insurance to improve access to non-critical care?
  • What services are included in the guaranteed healthcare coverage, e.g. prescriptions, dental, optical, mental health, long term care?
  • At what level of government (federal, state/province, county/parish) is the healthcare system managed?
  • At what level of government is the healthcare system financed?
  • Are healthcare providers (hospitals, clinics) private or public, and if private, are they for-profit or not-for-profit?
  • And most importantly — how are patients grouped to pool their risk, and what cross-subsidies are provided across patient populations (e.g. younger patients paying more so that elderly patients pay less).

Organizations such as the American Medical Students Association and Physicians for a National Health Program are strongly advocating a single-payer system. But I am going to avoid coming down on the side of a single- vs. multi-payer system for now, much less all these other alternatives within those two models. For now I’m going to hypothesize an ideal American system that takes into account our unique history, values, laws, needs and political interests, but that provides for universal healthcare, which I’ll call the “liberal healthcare plan”.

Next: which is better, HSAs or the “liberal healthcare plan”?

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