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 sent to the president to consider signing. As the debate resumes with Congress's return presently, you can read and evaluate the proposals as they progress using the tools from The Sunlight Foundation that Nancy Watzman has been sharing with us, like Open Congress which I linked to the House Resolutions above.

Previously by this author: Health Care: Understanding the Policy Discussion and What Women Want

World Views From BlogHers:

PhD in Parenting: Public health care: Canadian perspective on myths and reality

Temporarily me dot com: I'll keep my dilapidated, aging 'Nazi Socialist*' health care system over yours any day. (Canada)

Kelly at Almost Frugal: Healthcare in France and Going to the Doctor in France

BlogHer Member Foreign Correspondent: À AIMER: Getting Sick Part Two, or The Joys of Civilized Medicine and French Versus American Income Taxes: Who Pays More? (Part Three of Getting Sick)

The Women's International Perspective (The WIP):
-Katie Thompson: National Healthcare? Too Many Hands in the Honey Pot (UK)
-Brittany Shoot: Say Hello to Yellow: State-Sponsored Healthcare in Denmark
-Aralena Malone-Leroy: À votre santé: Socialized Healthcare in France

Christina Geyer at AmiExpat:
- Health Care in Germany
- My Experiences with the US and German Health Care Systems
- More Real Experiences with the German Health Care Systems
- Experiences with Universal Health Care Around the World
- Universal healthcare: Taking on the myths

Related Reading:

Nancy Watzman for BlogHer: Health care reform -- reading the bill(s)

For those who want extra credit, you can go beyond reading the House version of the health care bill, America's Affordable Health Choices Act of 2009, H.R. 3200, over at OpenCongress.org. Thanks to my colleague Paul Blumenthal, who collected these from the various committees, you can see the versions of the the House bill considered by the three different House committees that considered it. You can also see a draft of the Senate version of the bill, which has yet to be assigned an official number:

House Energy & Commerce Committee Draft
House Education & Labor Committee Draft
House Ways & Means Committee Draft
Senate Health, Education, Labor & Pensions Committee Draft

Interview of T.R. Reid, author of The Healing of America: A Global Quest For Better, Cheaper, and Fairer Health Care, by Terry Gross on Fresh Air from WHYY: Audio and Transcript

T.R. Reid at The Washington Post: 5 Myths About Health Care Around the World

Nate Silver at FiveThirtyEight: Not All Socialist Countries are Alike (UK vs. Canada)

Princeton Economist Uwe E. Reinhardt at The New York Times:
- A Medicare-Like Plan for the Non-Elderly (possibility for a "public option")
- Pricing a Medicare-Like Public Health Plan (pricing Reinhardt's public option)
- Health Reform Without a Public Plan: The German Model
- What Is 'Socialized Medicine'?: A Taxonomy of Health Care Systems
- A German Import That Could Help U.S. Health Reform

Septimus at The Whig: Do You Want The Same Health Care That Congress Gets?

Jerry Flanagan at ConsumerWatchdog.org: What does the "public" in "public option" really mean? (Medicare-like or FEHB extension?)

The Henry J. Kaiser Family Foundation: Massachusetts Health Care Reform: Three Years Later (September 2009)

This fact sheet describes the basic components of the landmark Massachusetts health reform law, examines how many people have gained coverage and discusses cost containment and affordability goals and implementation challenges.

BlogHer CE Maria Niles also discusses health care reform on her personal blog PopConsumer