Pack your bags – we’re goin’ on a trip around the health care delivery system!

The Insurance Mom mentioned in last week’s post that there seems to be a huge misunderstanding of how America’s health care delivery system compares to those of other countries.   The divine Michael Lujan, shares his expertise:

The UK Model – In this mostly single-payer model, healthcare is provided and financed by the government through taxes. Except for small co-pays for prescriptions, there are no co-pays or deductibles as health care is delivered as a public service, like fire and police. With Britain’s National Health Service, most doctors and hospitals are owned by the government and patient wait times can vary by region or treatment type. As the sole payer, the government controls what doctors can do, and what they can charge. Our Veterans (VA) system is a close example. They also have private insurance options.

The Canadian Model – With this “National Health Insurance model”, the providers are private but the payer is a government-run insurance plan everyone pays into. Our Medicare system is a close example of this model. The private insurance plans are non-profit and manage their costs by limiting or delaying care.  Canada’s decentralized health system (coincidentally called “Medicare”) is technically a multi-payer system with slight differences for each of their ten provinces and three territories; some provinces/territories have co-pays at the point of care and others don’t.

The German Model – In this multi-payer system, providers and payers are private and largely funded through employer-based payroll deductions. Patients have co-pays at the point of care. The world’s first national health system (established around 1883) offers citizens 135+ private insurance plans called “sickness funds”. These private insurers negotiate prices with private hospitals and providers. Patient wait times are shorter than U.S. patients typically experience. This is the health care delivery system most familiar to most Americans and might be a good model to consider when devising our own national system

The American Model – As noted above, we have a unique combination of the above health care delivery system. With the exception of the VA, our hospitals and doctors are private and we have a multi-payer system that includes Medicare, Medi-Cal and private insurance. We also have an Out of Pocket model which means if you are uninsured you will pay for care on your own. This places us in rare company with some of the poorest countries in the world, like Cambodia and Nigeria, who have not yet established a universal system.

Universal health coverage can be achieved by a combination of private and public plans. California Healthcare Foundation data shows about a third of California’s almost 3 million uninsured are ineligible due to citizenship. Of the rest, most cite affordability as their reason for still being uninsured, and a smaller percentage say they “don’t need or want” coverage.

If universal health care is truly the goal, it seems more logical to build upon what already works for the vast majority of Californians and figure out how to best close this gap.  Tune in next week for more details on the previously proposed idea of single payer in CA.

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