Is a Bismarck Health Care System a Foregone Conclusion for the US?

[Frodo]

Assuming President Obama is re-elected, is it a foregone conclusion at this point that for the foreseeable future we are going to have a health care system based upon the Bismarck model of Germany?

[Franzl]

I doubt it.

[Frodo]

I doubt it.

Why?

[minionofmidas]

What exactly do we define as a "Bismarck model"?

[anvi]

I guess two of the reasons Franzl (and he can certainly correct me if I'm wrong) says it's unlikely is that, in Bismarck systems, generally, while insurance companies are private and funded largely through employer-employee payroll deductions, they are also mandated to be non-profit entities.  They still offer competing plans, and in some places compete for the top 10% or so of the population's income-earners who might want to opt out of generally offered public plans and buy more expensive ones, or for people who want to buy supplemental coverage on top of the general package companies are mandated by law to offer.  Another reason is that, in general again, Bismarck systems give the government authority to annually "negotiate" with providers, though the providers are also private entities, to set inflation-adjusted price-caps on procedures, medicines, ect.  Legally mandated non-profit insurance and annually government-negotiated price-caps on widely available services and medicines are not likely to take hold in the U.S.--not at all likely, in my view.  Too bad, since I really like Bismarck systems.  They seem to have all of the advantages and very few of the drawbacks of "single-payer" (a misnomer) models, though they are generally a bit more expensive than the latter, while they at the same time avoid the fragmented and insufficient coverage and the runaway health care cost inflation of our own system.  But their hallmark features will likely never be adopted here.  

[I spent the winter writing songs about getting better]

Probably not by the end of Obama's second term, but probably what we'll be seeing in 10-20 years, if not an actual single payer system, though if implemented there will probably be some silly excuse or reasoning brought up as to why it's "not really" single payer. Might even happen under a Republican president, Nixon to China if you will.

[Person Man]

Probably not by the end of Obama's second term, but probably what we'll be seeing in 10-20 years, if not an actual single payer system, though if implemented there will probably be some silly excuse or reasoning brought up as to why it's "not really" single payer. Might even happen under a Republican president, Nixon to China if you will.

I mean, Obama's plan is a step in the right direction and that's basically what the goal of the mainstream Democratic platform is...we just have to chip away at the task. I say we just went from maybe 20% there to half way there under Obama. Who knows when we will get our next chance.

[Antonio the Sixth]

If such system were to be adopted, it would already be a huge improvement over the current one. That's why I think it's unlikely to happen.

[Frodo]

Given the troubles with the initial roll-out, it might be time to bump this.....

So what does everyone think? 

[H. Ross Peron]

I think it eventually will be the case as Puddle Splashers pointed out above. I'm surprised that very few people are advocating the German-model in the US with most of the moderate liberals considering Obamacare the final word on healthcare and the progressives calling for single-payer

[Sec. of State Superique]

The enrollment shouldn't be a big deal and it will grow even faster as the months pass.

[politicallefty]

I don't know that one system is a forgone conclusion for the US. I think the core of Obamacare will stand for the foreseeable future. There may be tweaks from the left and from the right on the federal level, but I don't predict any major changes for quite some time.

I think we could see innovations at the state level where states can get waivers to spend the money for a system of their choosing so long as they meet a certain standard. It's quite possible that states like California and those in New England can use the entirety of their allotted federal healthcare funds towards single-payer systems in their respective states. Other states may in fact evolve into a Bismarck system. I could see that happening in more moderate states, such as New Hampshire or Iowa.

[TNF]

Obamacare is an awful, byzantine scheme that will probably collapse under its own weight. The path of least resistance was always nationalization, but of course that was taken off the table five minutes into the administration, and so we got this useless bill as a result. I'm not sure we'll have real universal coverage in the United States for a very long time.