Healthcare - Which System Do You Support?


#1

For whatever reason, health care is a touchy subject in the USA. Actually, several western countries in the world. U.K, Australia, and Germany come to mind but each has totally different reasons. Let’s just focus on the USA.

To start, just know there are about four basic health care models in the world. They are:

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[*] The Beveridge Model

Named after William Beveridge, the daring social reformer who designed Britain’s National Health Service. In this system, health care is provided and financed by the government through tax payments, just like the police force or the public library.

Many, but not all, hospitals and clinics are owned by the government; some doctors are government employees, but there are also private doctors who collect their fees from the government. In Britain, you never get a doctor bill. These systems tend to have low costs per capita, because the government, as the sole payer, controls what doctors can do and what they can charge.

Countries using the Beveridge plan or variations on it include its birthplace Great Britain, Spain, most of Scandinavia and New Zealand. Hong Kong still has its own Beveridge-style health care, because the populace simply refused to give it up when the Chinese took over that former British colony in 1997. Cuba represents the extreme application of the Beveridge approach; it is probably the world’s purest example of total government control.

[*]The Bismarck Model

Named for the Prussian Chancellor Otto von Bismarck, who invented the welfare state as part of the unification of Germany in the 19th century. Despite its European heritage, this system of providing health care would look fairly familiar to Americans. It uses an insurance system — the insurers are called “sickness funds” — usually financed jointly by employers and employees through payroll deduction.

Unlike the U.S. insurance industry, though, Bismarck-type health insurance plans have to cover everybody, and they don’t make a profit. Doctors and hospitals tend to be private in Bismarck countries; Japan has more private hospitals than the U.S. Although this is a multi-payer model — Germany has about 240 different funds — tight regulation gives government much of the cost-control clout that the single-payer Beveridge Model provides.

The Bismarck model is found in Germany, of course, and France, Belgium, the Netherlands, Japan, Switzerland, and, to a degree, in Latin America.

[*]The National Health Insurance Model

This system has elements of both Beveridge and Bismarck. It uses private-sector providers, but payment comes from a government-run insurance program that every citizen pays into. Since there’s no need for marketing, no financial motive to deny claims and no profit, these universal insurance programs tend to be cheaper and much simpler administratively than American-style for-profit insurance.

The single payer tends to have considerable market power to negotiate for lower prices; Canada’s system, for example, has negotiated such low prices from pharmaceutical companies that Americans have spurned their own drug stores to buy pills north of the border. National Health Insurance plans also control costs by limiting the medical services they will pay for, or by making patients wait to be treated.

The classic NHI system is found in Canada, but some newly industrialized countries — Taiwan and South Korea, for example — have also adopted the NHI model.

[*]The Out-of-Pocket Model

Only the developed, industrialized countries — perhaps 40 of the world’s 200 countries — have established health care systems. Most of the nations on the planet are too poor and too disorganized to provide any kind of mass medical care. The basic rule in such countries is that the rich get medical care; the poor stay sick or die.

In rural regions of Africa, India, China and South America, hundreds of millions of people go their whole lives without ever seeing a doctor. They may have access, though, to a village healer using home-brewed remedies that may or not be effective against disease.

In the poor world, patients can sometimes scratch together enough money to pay a doctor bill; otherwise, they pay in potatoes or goat’s milk or child care or whatever else they may have to give. If they have nothing, they don’t get medical care.
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To get this out of the way: The United States is the only country in the world with fragments of each system, causing different classes of patients, and thus is quite ineffective.

This is important to note because we tend to piecemeal shit together instead of following one specific plan and that sorta fucks us up when trying to deliver shit. It all becomes needlessly complex so much so that laypeople cannot understand the system they are participating in. And for the first time since the Second New Deal are Americans ready to do something new about health care, we just don’t know where to go.

So please, tell me which you think is the best option and why.

Myself? I like the Bismark model. I’ve seen it work very well in France and Belgium. The countries I’ve seen with it who are struggling (Japan and Germany) are doing so because of a declining young population. Since Americans like fucking so much and popping out kids, we should be fine with it.


#2

I like the Bismarck model, but the U.S. is too large and varies too greatly by state to implement such a model effectively. Not to mention that lobbyists and corporate interests would do anything to sabotage the implementation of such a model. The only downside is controlling which treatments are necessary and the urgency of need for operation. Major hospital emergency rooms are already filled up with a great deal of waiting involved. It would also be a new frontier for the liberal humanitarian and sex reassignment agenda, which would be 100% surefire way to piss off 50+% of the population. On the flip side, Veteran Affairs, Medicaid and Medicare and all that other business could be drastically reformed in the process.


#3

I like America’s Next Top Model.


#4

Not being poor is the best healthcare.


#5

That out of pocket model wouldn’t work in the US. We’re not gonna go back to house visits and not using the technology we currently have.


#6

Just to point out on the Beveridge Model.

Since the government decides what drugs/treatments are paid for people do sometimes still have to incur costs for healthcare when what they need hasn’t been approved by NICE (our body which decides what can and can’t be provided on the NHS), seems mostly to happen with drugs which can extend a patient’s lifespan but not actually cure them.

Still beats the American system though, at least most of us only worry about time away from work if we’re sick or need surgery and not doctors bills or insurance as well.


#7

Enjoy it while it lasts Iduno since the torys are hell bent on destroying it and giving us the same horseshit the americans need to suffer with.


#8

As someone who got screwed over and currently owes around 20k in health/hospital bills, I’d prefer either Beveridge or Bismarck, preferably the former.


#9

I don’t believe Razor actually wrote that. He’s never written more than a sentence and acts like a child despite being at least 40 years old.

Anyways I support the Pool System.


#10

Its ok, it’s not like Labour has a total hack in charge right now who won’t stand a chance against the Torys next election…

Or that the Lib Dems are still useless after they sold out and self destructed in the coalition…

…Fuck, NHS was good whilst it lasted.


#11

Saying France follows Bismarck model is not totally accurate since it still has more public than private hospitals and the system covers everyone (including foreigners), not only workers. It is still true though that it’s mostly based on insurance rather than on assistance.
I still think the Bismarckian principle is better because it’s based on contributions from labour rather than on taxes that are mostly paid (and hated) by the middle class.


#12

I’d rather just find hearts in the bushes or give a witch a mushroom from the forest to make me a potion.


#13

You’re on medishare aren’t you?


#14

Bismarck and Beveridge make the most sense to me.
What good is it living in a society if people don’t take care of each other?

It’s hardly the individual’s fault when economy goes bad and you can’t get a job to sustain healthcare anymore.


#15

The model works here, and our politicians aren’t far enough into the pockets of private interests to ruin it yet (even our conservatives are wary about suggesting increased privatization of healthcare). The obvious trade-off is higher taxes, but I’m completely fine with that.


#16

Out of what’s presented, the National Health Insurance Model.

Seems to be the best combination of providing for the public good on the insurance end, while still leveraging competition to drive innovation on the provider side.

Beveridge fails to leverage the beneficial aspects of capitalism and as such is more susceptible to stagnation and bloat, whereas Bismark artificially ties the healthcare market to the labor market in ways which constrain peoples’ practical options with regard to employment.


#17

"beneficial aspects of capitalism"
i lol’d


#18

Yeah that NHI model is doomed. Every time I see parliament in UK argue that shit never fails to come up.


#19

I think part of the reason insurance companies do so much damage is because the system is like the IRS tax laws in that it’s needlessly complicated. There’s no reason for health care to be as complicated as it is and I’d prefer to cut out a for-profit middle man company and just pay directly to the government or even a hospital for health care. It would take a lot of the guesswork out of it, and I think the care would be more reliable.


#20

At this point I’m for any system that doesn’t turn my health care into a for-profit scheme. I have 0 faith in a board member putting my health ahead of his wallet.