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Summary of Universal Healthcare Models
Prepared for Study Group Discussion-2009
A. Misuse of the term “Universal Health Care” within the US:
In the U.S., the term “universal” applied to healthcare is misused by politicians and others opposed to single payer –contributing to a general misunderstanding of the term for many Americans. Rather than a plan adhering to the characteristics listed below, these sources have defined “universal” to mean a requirement that everybody must purchase a health insurance product. It is “universal” only in the sense that everybody is subject to the mandate for obtaining private coverage. This is an abuse of the entire concept of “universal health care”.
Definition of “Universal Health Care” outside of US:
All information that follows pertains to Universal Health Care models around the world (but not in U.S.)
Two basic models of Universal Health Care: (Note: Some sources describe more than two but for simplicity this outline sticks with two): Single Payer and Social Insurance Fund Models. The latter is a plan that operates much like single payer and is based on the same core principles, and underlying cultural beliefs, of single payer.
These Are:
1. Strong central public process for planning for comprehensive healthcare and for annual review
2. Widely shared cultural belief that all people should take care of one another
3. Shared belief that no one should go bankrupt, or suffer financially, in order to receive medical care
4. Belief that profit should play no role, or a very minimal role, in the design of a healthcare program.
5. Commitment to equalaccess to qualitycare regardless of income.
7. Strong protections for doctor patient privilege
8. Comprehensive Care and uniform benefits: prevention through long term care
9. Premiums or contribution to the system is based on ability to pay.
10.
The sicker you are, the less you pay. This applies to major illness and multiple illnesses within a family.
Single Payer:
Government financed (or funded), publicly accountable health care system
Single payer can be either a socialist model (medical providers employed by the government) or a totally privately provided model. (Socialist models include: UK, Spain, Scandinavian countries, Finland, Cuba)
Note: Even “socialist” models are often a mix of publicly and privately employed providers. (ex:UK) Canada is not a socialist model; VA system in U. S. is a “socialist” approach
Social Insurance Fund Model:
Social Insurance Funds are organizations having cultural roots in European countries . They began as early welfare, or benevolent associations, of crafts or trades people to care for the destitute, widows, orphans, and providing other support benefits. They are trusted parts of the culture. The national plan developed around these not-for-profit funds, but follows principals of single payer.
There are some slight differences in how funds flow--most flow to the government and then to the individual funds- but all are strong, comprehensive national plans based on not-for-profit funds.
The word “insurance” means nothing like what we experience as insurance. Plans include ways to adjust revenues of funds in event of unintended health disparities of enrollees. “Not for profit” is taken very seriously in the social insurance fund model as well as the single payer model.
B. For-profit Components in some Universal Healthcare Models: (These can occur in either of the two models above: single payer or social insurance fund)
1. Supplementary Insurance:
Some countries only permit not-for-profit supplementary plans, but some permit for-profit plans
The range of benefits in for-profit plans can vary from “enhancements” (private rooms) to inclusion or expansion of vision and/or dental benefits. Supplementary plans are low priced because expensive medical costs, such as in-patient care and out-patient medical care, are all on the national public plan.
2.Core Services Private Insurance:
UK, Germany, Netherlands, Switzerland, France allow purchase of private for-profit plans offering core services (mandated services in the public plan). Restrictions vary regarding what can be offered in core service, for-profit policies and include whether physicians can participate in both the public and private plans. Generally people use the public plans for most medical care but carry private insurance (which is much less expensive than in US) for faster access or a particular specialist. In countries offering for-profit core service plans, a fairly small percentage of population enrolls in this service.
Switzerland and the Netherlands have plans that include fixed premiums and that make greater use of a private insurance market. As a result, they are often cited as models appropriate for the U.S. It is important to recognize that universal plans in these two countries, although more complicated, still adhere to the core principles of “universal health insurance” described earlier.
Private, for-profit coverage of core services is permitted subject to extensive regulation, including fees that can be charged, no pre-existing exclusions, limitations on whether physicians can provide services to both public health service and private pay, who can apply and other considerations. Making a profit on any aspect of provision of health care is not considered a right, as in the U.S.
IMPORTANT!!!!
In all of these countries, whatever mix of public/private, core or supplementary, not-for-profit and for-profit, there is a strong commitment to a quality, national, not-for-profit plan. Any private offerings are treated as exceptions-and those arguing for them do not speak of replacing the national plan. Also, all private offerings, not-for-profit and for-profit, exist subject to approval by elected officials, within the context of their relationship to the public plan-the reverse of the public/private discussion in the U.S.
Over the last few years the entrepreneurial pressures have grown in these countries, unfortunately, but perhaps the current U.S. fiasco will cause some to re-think their support of an expanded private for-profit industry market.
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