Every wealthy country other than the United States guarantees essential care to all its citizens. There are, however, wide variations in the specifics, with three main approaches taken.
In Britain, the government itself runs the hospitals and employs the doctors. We’ve all heard scare stories about how that works in practice; these stories are false. Like every system, the National Health Service has problems, but over all it appears to provide quite good care while spending only about 40 percent as much per person as we do. By the way, our own Veterans Health Administration, which is run somewhat like the British health service, also manages to combine quality care with low costs.
The second route to universal coverage leaves the actual delivery of health care in private hands, but the government pays most of the bills. That’s how Canada and, in a more complex fashion, France do it. It’s also a system familiar to most Americans, since even those of us not yet on Medicare have parents and relatives who are.
Finally, the third route to universal coverage relies on private insurance companies, using a combination of regulation and subsidies to ensure that everyone is covered. Switzerland offers the clearest example: everyone is required to buy insurance, insurers can’t discriminate based on medical history or pre-existing conditions, and lower-income citizens get government help in paying for their policies.
So where does Obamacare fit into all this? Basically, it’s a plan to Swissify America, using regulation and subsidies to ensure universal coverage.
Here is a chart of per-capita healthcare expenditures for 2007 throughout the OECD countries.
UPDATE: Krugman neglected to note that Switzerland does not allow for-profit insurers in its basic healthcare market. Per Russell Mokhiber: http://www.commondreams.org/view/2009/04/03-7
Last year, former Washington Post reporter T.R. Reid made a great documentary for the PBS show Frontline titled Sick Around the World.
Reid traveled to five countries that deliver health care for all – UK, Japan, Switzerland, Germany, Taiwan – to learn about how they do it.
Reid found that the one thing these five countries had in common – none allowed for-profit health insurance companies to sell basic medical coverage.
Reid’s bottom line for health care reform – don’t let health insurance companies profit from selling basic health insurance.
They can sell for-profit insurance for extras – breast enlargements, botox, hair transplants.
But not for the basic health needs of the American people.