Like it or not, health care is going to be a big issue in the coming election. Bernie Sanders is an unapologetic supporter of universal government-provided healthcare and has pulled the entire Democratic party over to his corner on the issue. Health care was a top concern of Americans going into the 2018 mid-term elections. It won't be far off the top of the list in 2020. If there is corona virus epidemic in America this year, it could be the issue in the election.
As we grapple with how to deal with health care in America, it might be useful to look at a couple of other options which preserve much of what we value in our current healthcare system - freedom of choice for both patients and physicians. Here are a couple of articles that look at healthcare systems in Australia and Switzerland.
A Public Baseline: The Australian Health Care Model by Rosalind Dixon and Richard Holden describes the Australian health care system in fairly glowing terms. It is not a single payer system like that in Canada, the United Kingdom or some European countries; it is a combination of both public and private medicine. Their "Medicare" system provides a base level of services: emergency, critical care, non-elective surgery, primary care coverage and coverage for essential pharmaceuticals. It isn't fancy but it's enough for the basics. The government pays for this.
They do have private insurance. If you want anything at all extra, you pay out of pocket or take out insurance coverage. In fact, the government strongly encourages you to get insurance coverage. If you fail to sign up early or only do so when you get sick, expect no help; they freely allow insurers to charge significantly higher premiums. In addition, if you're well off with a high income, you're penalized (with higher income taxes) if you don't have some sort of insurance. The net effect of this is to take a lot of pressure off what otherwise would be an overloaded system.
The authors maintain this works very well, striking the right balance between allowing patients freedom to chose and physicians freedom to practice. It appears to deliver solid outcomes:
Total health care expenditures (public and private) in Australia are around 10 percent of GDP, compared to 18 percent in the United States. And the Australian system works well—contributing to a life expectancy of 82.8 years, the fourth highest in the world.
It's an interesting idea and they freely admit there might be problems implementing such a system in America. With relatively open borders for example, such a system might exacerbate our illegal immigrant problem. Perhaps with modifications it might work.
Kevin Williamson at National Review provides another view, based on the Swiss health insurance scheme. This apparently was the model Massachusetts used in designing their system, a precursor to the Affordable Care Act. The way it works is that there is no government provided health care service - none, zip, nada. Instead, all citizens are required to buy health insurance and the government strongly penalizes you if you don't. They provide generous supplements to poor folks but it is still everybody's responsibility to go out and get coverage and prove they have it. If you don't, the government signs you up for very basic coverage and comes after you with the bill, including missed payments. He proposes a modified form of this program, which strangely for a libertarian Republican, has a lot of similarities to the Affordable Care Act.
It's safe to say the ground has shifted in America with respect to health care. Our old employer-provided system is a legacy of World War II when wages were capped and companies were permitted to compete for employees by offering "free" healthcare. They were also allowed to expense the costs in what can be considered an indirect government subsidy to large corporations. It hardly helped the self-employed and those working for small businesses. Nowadays, employer-provided health care is a dream for a very large group of us. Finally, neither of these articles deal with problems within the health insurance industry, abundantly clear to those of us dealing with huge co-pays, rising premiums and gaps in coverage.
Nonetheless, this election cycle there is going to be a debate about the fundamental structure of our health care system. Other countries have experimented with various schemes and we can profit from their experience. We should do so and use it as a guide to build a system where all Americans have access to affordable quality healthcare.
-- Mike Power
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