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One-size health plans don't fit all

By Judy Garland • Oct 22, 2017 at 12:00 AM

Many of our politicians speak of health care in other countries in terms that demonstrate not so much ignorance as deliberate deceit. When Senate Majority Leader Mitch McConnell, who is well informed and artful with language, speaks of “single-payer,” “socialized medicine,” “government takeover of health care” and “European health care” as though they are the same thing (and all bad, of course). He actually knows better.

Even moderately informed Republicans in Congress know those phrases don’t mean the same thing, and are designed for scare talk to stir up perceived popular fears. It takes only a cursory investigation to understand that those countries that provide health care to all their citizens follow no common model.

An informative article titled “The Expanding Universal” in the Aug. 12 Economist magazine is a brief, but essentially complete description of the main approaches. I’ll summarize here. To call a single-payer system a “single-payer health care” is in itself incorrect. Single payer refers to insurance programs which Canada and France have, for instance, while most of their medical service providers are private for-profit businesses.

Even in those countries that have government-run insurance and provider systems for all their citizens — Britain, France, and Spain, for instance — private for-profit insurance and service is allowed for any who want it and can afford the extra cost.

Many European countries – such as Switzerland, the Netherlands and Germany — don’t even have a single-payer insurance system. Those countries provide universal health care for all citizens through a combination of private, for-profit and not-for-profit insurers. There is much variety in all these, but three main approaches can be identified.

First, there are those where government manages both the insurance and the provision of care. Everyone is enrolled in the national health care plan, their care is paid for by the government and most doctors work for the service. Countries that use this system are Britain, Italy, Spain and Sweden. For any who choose and can afford them, there can be private doctors and hospitals and extra insurance.

Companies offer supplemental policies, but most folks use, monitor and value the public system.

Second, there are those that provide universal public health insurance, but leave much or most of the provision of care to the private sector. This is the Canadian and French model. Some people in Canada and many in France top up their public insurance coverage with supplementals.

Finally, in countries like the Netherlands and Switzerland, insurance is handled almost entirely by private insurers, and doctors and hospitals are for the most part private. Everyone has insurance because everyone is required to buy it, which keeps healthy people in the system holding insurers’ costs down.

The government provides generous subsidies based on ability to pay and bars insurance companies from excluding anyone. Sound familiar? This is essentially Obamacare. With three major differences — these countries provide more generous subsidies, enforce the mandate more strictly and regulate providers, including drug providers, to control prices and administrative costs.

In none of the three major approaches do either insurers or providers have the power to call all the shots. The public does, through its elected government. It’s telling that no one seeking public office in these countries, even right wingers, runs against government involvement in health care, or ever wants to be seen as sabotaging the system, like some of our politicians are doing. Although it may sound complicated, the European and Canadian systems are basically simple in the way they operate, and, when problems occur, they can be identified and corrected.

Compare that to our bewildering hodge-podge of separate public and private systems with few cost controls, and where the complexity itself fosters confusion and soaring costs. Administration alone consumes an inordinate amount of our health care dollars. The article’s author used this astounding example to demonstrate that fact. As of 2013, Duke University’s hospital had 1,300 billing clerks, 400 more clerks than its 900 hospital beds.

No wonder health care consumes 17 percent of our GDP without covering everyone, which would be a terrible bargain even if our health outcomes were better, which they are not. We have more chronic health problems than Europeans and Canadians and we don‘t live as long. For us to ever have universal and affordable health care there has to be acceptance that our system is a complicated and exorbitantly expensive mess. There has to be a willingness to consider and investigate alternatives.

We need constructive conversation and debate and less scare talk. We must have some respect for experts in the field and special interests must not be allowed free rein. And  there has to be a concession by all that health care cannot be viewed simply as a commodity. It’s not a commodity that we can afford to do without. That’s why our leaders must be judged, and shamed, according to their willingness to use health care as just a way to score political points.

Judy Garland of Johnson City is a community health care activist.

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