Health Care System Options for the United States

[Frodo]

Compliments to Physicians for a National Health Program:

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.

[Frodo]

There is also the out-of-pocket model, but that is essentially what we had before the ACA, and I am assuming no one in their right minds really want to go back to that.  Hence, I did not include it as an option.  

[DC Al Fine]

There is also the out-of-pocket model, but that is essentially what we had before the ACA, and I am assuming no one in their right minds really want to go back to that.  Hence, I did not include it as an option.  

We have libertarians, right-liberals etc. No sense keeping an option off the ballot because you find it disagreeable.

Bismarck option for me. While I'm ok with the Canadian model, I still think the healthcare consumer should have some (direct) skin in the game. I'd rather the Bismarck model with subsidized out of pocket premiums.

[Atlas Has Shrugged]

Bismark, but frankly, I'd prefer to have full blown Canadian style healthcare at his point over Obamacare, which is eventually going to implode.

[7,052,770]

I'm fine with giving Obamacare a chance for a decade or 2 before moving on to something else.

[Fed. Pac. Chairman Devin]

N/a. I prefer vouchers and tax credits.

[World politics is up Schmitt creek]

I'm fine with giving Obamacare a chance for a decade or 2 before moving on to something else.

But Obamacare isn't, itself, a real option. It's effectively a legislative and administrative Frankenstein.

[bedstuy]

I would basically do three things.

A Beveridge Model system for poor people with a real focus on community health, controlling costs and education.

National health insurance with high deductibles for rich people and middle class people.  People could buy supplemental health insurance from the private market.

Government rate setting and strong anti-trust and market regulation so we had a competitive market on price.

[TNF]

NHS model, with common ownership of Big Pharma as well.

[MurrayBannerman]

In my opinion, any system needs to be accompanied by doctor pay reform, tort reform, and tax reform on employer provided insurance. This assuming that any changes to Medicare, Medicaid and the way health care is managed is also included.

Ideally, state-bound insurance laws would be repealed and a national regulatory system would be installed. This allows for an oligopoly to emerge along with more competition, similarly to car insurance. I would be in favor of moving toward health-status insurance where everyone can receive insurance when they want to, but if they apply when they truly need it, they will be charged more.

This isn't totally thought out in this post, but I decided I wanted to be lazy.

[H. Ross Peron]

The German model

[AggregateDemand]

N/a. I prefer vouchers and tax credits.

Vouchers and credit will be required, imo.

Universal catastrophic insurance is a reasonable solution, and it could be brought to life with Medicaid-for-all policies. However, the citizens have no assurance that universal catastrophic insurance won't devolve into luxurious spendthrift. Refundable tax credits create incentives to purchase insurance and reduce insurance costs. Refundable tax credits are one of DC's least favorite "expenditures" (sad) so the program will probably have less cost-corruption.

[Antonio the Sixth]

Beveridge, most definitely.

[Randy Bobandy]

NHI, preferably.

[Antonio the Sixth]

NHS model, with common ownership of Big Pharma as well.

NHI, preferably.

I assumed hard-leftists like you would prefer the Beveridge model.

[TNF]

...The NHS is the Beveridge model, at least according to what it says in the OP:

You must be logged in to read this quote.

[Antonio the Sixth]

Yeah sorry. I admit I got confused by the names a bit before reading, but I thought people would use the same terms as the OP in their comments.

[Supersonic]

Bismarck, but I'm happy nudging more private sector involvement within the current Beveridge system.

[IceSpear]

There is also the out-of-pocket model, but that is essentially what we had before the ACA, and I am assuming no one in their right minds really want to go back to that.  Hence, I did not include it as an option.  

So basically you're excluding 90% of the GOP from voting in this poll?

[Hatman 🍁]

I voted for the Canadian model,  but perhaps I shoul've voted for the British model.  My problem with the British model is that private health care is still allowed, which I think is totally wrong. Rich people shouldn't have better access to health care than poor people.

[politicallefty]

I'd be okay with any of the first three options. However, I'd definitely prefer the National Health Insurance Model (i.e. the Canadian model), as I've mentioned many times already. I think at least 1/3 of Americans are already on government-provided healthcare (and recent Medicaid numbers show enrollment at 73 million with that program alone).

[muon2]

Modified Bismarck:

All individuals must have mandated catastrophic and acute medical coverage.

There is universally available additional coverage for wellness and long term regular medical expenses (checkups, long term meds, etc.).

Individuals may pay directly or through a payroll deduction.

Employers pay a tax per employee based on the size and performance of the firm, similar to workers' compensation and unemployment insurance.

All households get a standard tax deduction sufficient for mandated and some optional coverage. The deduction drops off with increasing income and functions like the earned income tax credit to provide coverage for low-income households.

[Franzl]

I voted for the Canadian model,  but perhaps I shoul've voted for the British model.  My problem with the British model is that private health care is still allowed, which I think is totally wrong. Rich people shouldn't have better access to health care than poor people.

This argument I don't accept. Mainly because: where does it end?

Short of establishing a truly communist society, I'm not sure why this argument wouldn't apply to everything. Why not limit the quality of food rich people can buy?

Ensuring access to high quality education, healthcare and a reasonable standard of living for all citizend should be a top priority, but that needn't involve senseless attempts at total equality just for the hell of it.

[Filuwaúrdjan]

I voted for the Canadian model,  but perhaps I shoul've voted for the British model.  My problem with the British model is that private health care is still allowed, which I think is totally wrong. Rich people shouldn't have better access to health care than poor people.

In practice all it tends to mean is a shorter waiting-time for routine operations and a guaranteed separate room (as opposed to being on a bay) when hospitalised. The actual care received is identical. People with private health insurance tend to have it so that they can brag about having it, because it shows that they are upper middle class and so on.

[Filuwaúrdjan]

Named after William Beveridge, the daring social reformer who designed Britain’s National Health Service.

Except that he didn't. The Beveridge Report recommended that - after the war - the government ought to create a 'National Health Service', but the details of how he wanted it to operate were rejected by the postwar Labour government and replaced with something more overtly socialist (and as it happened much more practical).