There are lofty aims, ideals out of reach and visions which may never be realized. A better world for the children of this generation ought to be brought about in a manner consistent with the dignity deserved by all people; this comes at a cost. The piper will always be paid. In one fashion or another the national healthcare debate will be settled and begin accruing costs by way of individual accessibility, federal expenditure or a combination of both.
It’s the responsibility of our representatives to weigh the options and decide what is the appropriate amount of subsidized care, while remaining fiscally justified. Whether the United States retains its historical private healthcare model, or moves toward a centralized, single payer system, the costs and benefits lie heavy on these healthcare coverage fronts.
It’s easy to remark on Canadian, European and other socialized models of healthcare through an American lens. U.S. citizens are quick to note that Swedish citizens don’t pay private insurance premiums, and all doctor visits and procedures are included.
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Before an in-depth projection of what a centralized American healthcare system might look like, it’s useful to understand the caveats linked to observations like the one above.
It’s true that in many Scandinavian countries, for example, healthcare systems are state subsidized so individuals are not left with many out-of-pocket costs following a medical operation. The distinction here is that Norway and the U.S. are different societies with alternate means and notions of care. Finland is a nation of six million people — Arizona is home to seven million Americans for scale — with generous organic reserves of oil and natural gas, a largely homologous population, a multi billion dollar tourism industry and possibly most significantly, an appreciation for comprehensive tax-and-spend fiscal models which do not translate to American political philosophy.
Is Finland a nation without problems? Absolutely not. Does Finland’s economic and political situation provide an ideal catalyst for socialized medicine? Yes, it does. Objective patterns in availability and tolerance by the people of universal care and its differed costs allow for a relatively comfortable situation. This is not to attack Finland because of its effective and highly accredited healthcare structure. Rather, this comparison is included to dismiss claims that an American universal healthcare addition would be a politically or economically clean transfer.
This reasoning sounds an awful lot like an excuse for not implementing a single-payer, or full-coverage, system in the U.S. In a way, it is. However, vying for a new healthcare process in the U.S. is a popular talking point. It’s an old but necessary balancing act which must remain ridged to account for fiscal health, yet change based on the circumstances and the current public demands.
What if the U.S. attempted to design a radically new healthcare program? What would it consist of? What would be improved? Who would gain? Who would suffer?
Single-payer systems, like those of the United Kingdom, France and Canada are nearly comprehensive cradle-to-grave health coverage systems, most of which are completely centralized. In contrast to the absolutist single-payer models of these systems, a middle ground exists between this and the traditional American expectation of care. The German government has gone to great lengths to strike a balance between frugality and accessibility. Interestingly, if the U.S. were to have a health care sister-system it would be Germany’s.
According to a 2014 article in the Atlantic, Olga Khazan notes the similar intentions of the American and German coverage concepts, which emphasize quality and accessibility. Naturally, there are large schisms in the policy base which comprise these two methods.
First, the German system has established a series of nonprofit insurance collectives, or “sickness funds,” which are mandatory for all citizens to participate in. An individual pays half of their insurance tab and their employer splits the difference. There are roughly 160 sickness funds active in Germany today. The presence of these organizations represents a similar structure to the current Affordable Care Act in that a mandated coverage market from which the insured choose from.
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In fact, the U.S., should Affordable Care Act standards be maintained and American Health Care Act policy be gridlocked into submission, appears to be moving in the direction of a German or “Bismarckian” system of care, which refers to the German Health Care Bill of 1883 signed by Otto von Bismarck. Dirk Göpffarth, head of risk adjustment at the German Federal Social Insurance Office told Khazan, “I think [the United States is] moving more in the direction of international standards.”
Of course, this projection may be altered by the current administration’s intentions as well as many members of Congress, should their healthcare goals be achieved. Nevertheless, it’s not entirely naïve to presume that the American healthcare system will inevitably shift in the direction of a less decentralized market. It’s a bold assumption, but the popularity of these changes have proved key debates for decades, particularly during the 2016 election, considering the popularity of the policies proposed by Vermont Senator Bernie Sanders.
Multi-payer health coverage is not without its flaws. German, like American hospitals, respond to price freedom. That is, if there is a government mandated cap on how much an operation can cost, hospitals will over supply visits and procedures to make up for lost revenue.
The benefits of the multi-payer system are certainly relayed back to the consumer. More – not complete — regulation promotes affordability and timeliness to all citizens. In addition, the chances of medical debt are severely reduced, high co-pay costs are alleviated as well.
Furthermore, the Bismarckian model allows for certain individuals, mostly upper-income, to opt-out and remain in a system consistent with the pre-ACA private healthcare market. The point: Multi-payer systems are more regulated and many may find fault in that by principle of individual liberties. However, if we Americans are interested in reducing costs while still providing efficient, effective care we may need to compromise, and allow for more regulated medicine.
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