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In the current discussion and debate about health care reform proposals the methods of paying for, administering and delivering universal basic health care benefits in other countries are often raised as models of either what we should emulate or what we should fear adopting. Although President Obama has said that we must find a "uniquely American" approach to health care reform, our current system utilizes different aspects of global approaches and various proposed legislation would move us closer to the models used in other countries. Therefore it is useful to understand what approaches exist in order to weigh the possible pros and cons of various reform proposals.
1. UK, Spain, Italy, Finland, Israel, Hong Kong, Cuba and New Zealand: Socialized Medicine or the Beveridge-Model:
The widely used and oft-referenced political term "socialized medicine" does not have a strict definition but is widely thought to mean health care delivered in a system where the government runs the hospitals and employs the doctors. This is the model used in Great Britain's National Health Service and used in the United States by the Veteran's Health Administration (commonly referred to as the VA).
2. Canada, Taiwan, South Korea: Single Payer or National Health Insurance:
Single payer, though often used interchangeably in political debate debates with socialized medicine, differs from government administered healthcare systems (which are also single payer) in that in these countries it refers to the payment mechanism for private health care delivery. Rather than individuals and employers paying health insurance companies and those health insurance companies separately paying doctors, hospitals, pharmacies and other health care providers, individuals and employers pay into a single, common fund which the government administers and uses to pay health care providers. In other words, there is one basic insurance plan and everyone has it. This model is used in the United States by Medicare.
3. Germany, France, Belgium, the Netherlands, Japan, Switzerland: Multi Payer, Private Insurance or The Bismarck Model:
In this approach, private insurance plans are regulated for-profit and not-for-profit and must accept everyone. Everyone is required to purchase insurance, premiums are paid through a mix of employee, employer and taxpayer contributions and low-income citizens receive government assistance in paying premiums. Because of the use of private insurance to administer payment, this model is closet to the current American system and thus Germany and Switzerland are often mentioned as the most realistic and likely models for reform efforts in the United States particularly in efforts to provide universal coverage. In the United States, Massachusetts has instituted a universal health care system similar to this model.
4. Numerous, including many poor, non-industrialized, non-Western countries: Out-of-Pocket:
In this model patients pay health care practitioners directly. In the United States, prior to the advent and widespread adoption of employer-based health insurance, this was the primary method for health care payment. In the United States this is the current method of payment for some without health insurance, for some elective surgeries such as cosmetic plastic surgery or laser vision correction and for some procedures not covered by insurance companies (e.g., those deemed experimental) or so-called alternative practices (e.g. chiropractic or acupuncture).
Current legislative proposals that may be voted upon when Congress returns to session in September include H.R. 3200 (AKA "America's Affordable Health Choices Act of 2009" introduced in the 111th Congress) which contains elements of approach number 3., The Bismarck Model, from above and H.R. 676 (AKA "United States National Health Care Act or the Expanded and Improved Medicare for All Act" originally proposed in 2003 and reintroduced every year subsequently) which would extend Medicare to all Americans and thus is a single payer proposal. There are no current proposals to adopt a UK-style, government operated health care system.
President Obama has explicitly rejected pursuing a Canadian-style single payer health care system and instead has advocated more of a hybrid, Swiss-style approach to reform. As part of health care reform with a goal of universal coverage, a so-called "public option' might offer a partial single payer approach to some Americans who do not receive employer coverage (like Medicare, not covering all Americans in a single payer system as in Canada) or it might offer a Bismark-style approach by allowing individuals to buy into the Federal Employee Health Benefits program which also covers members of Congress.
Remember that HR 676 and 3200 are just proposals in the House and will eventually have to compete and combine with Senate proposals before anything is
