THE PLANK JANUARY 16, 2007
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In its latest edition, USA Today praises all the new proposals for universal health care -- and expresses the hope it will ignite similar action in Washington. That's great. What's not so great is the following line from the editorial, applauding the plans put forth by Governors Mitt Romney and Arnold Schwarzenegger:
Unlike European-style plans, they preserve private insurance, and therefore choice and innovation, with government oversight.
This one of the most persistent myths about universal health care in Europe -- and, by extension, proposals that call for greater government intervention than either Romney or Schwarzenegger have. So let's be clear: It's entirely possible to have even a single-payer health care system, where the government provides health insurance, while reserving a role for private insurance. In France, the government provides basic insurance; people can then purchase private supplemental insurance to cover expenses that the main program does not. In Germany, some (but not all) people can opt out of the public system altogether, and choose private insurance instead. England has private insurance, too; people use it to jump ahead of the system's relatively long queues. (For more on these and other systems, see Ezra Klein's "Health of Nations" series.)
Here in the U.S., we also have a system that works along these lines. It's called Medicare. Seniors can buy private supplemental insurance to cover gaps in Medicare's basic coverage. And they can opt out of the public program altogether, enrolling instead in a private insurance option.
One other thing worth mentioning: Whatever their design, universal health care systems can allow freer choice than Americans typically get nowadays. France, again, is the clearest example: The French can see any doctor they choose, any time they want. (Whether or not that's an entirely good thing is a topic for another day.) If you're an American and you think you have the same wide-open access, you'd better read the fine print in your insurance manual, the part where it talks about gate-keepers and approved networks of doctors.
(Thanks to Don McCanne, senior health policy fellow at
Physicians for a National Health Program, for sending along the clip. His own assessment of the latest plans also appears on USA Today's editorial page.)
-- Jonathan Cohn
7 comments
- teplukhin
January 16, 2007 at 3:39pm
Whatever their design, universal health care systems can allow freer choice than Americans typically get nowadays. France, again, is the clearest example: The French can see any doctor they choose, any time they want. Please tell us more about the French system - links, snippets, whatever. Thanks in advance, t
- teplukhin
January 16, 2007 at 3:40pm
I never understood why, in principle, public insurance means less choice than private insurance. I'm a bit wary of the hybrid-sounding solutions, because they sound like the failed Clinton plan (which was hard to sell) and they sound complicated. Anyone who has ever had to deal with a health insurance provider knows how ridiculously complex the coverage is and how much of a headache it can be to get the provider to pay out. Insurance dread routinely accompanies and compounds any major medical problem in the lives of even those Americans fortunate enough to have relatively good coverage. A chief selling point of any plan for universal coverage should be simplicity and security.
- jhildner
January 16, 2007 at 8:08pm
What about the rights of doctors? What are their choices? Can they opt out of government/public insurance and accept only private patients? If the answer is no, expect healthcare quality to fall rapidly if a national healthcare comes to pass. Most excellent doctors in established practices don't even accept assignment from private insurance companies because of all the paperwork involved. As one of my doctors said recently: "At some point it's just not even worth staying in practice". I suspect many experienced, highly regarded doctors would say the same thing.
- dorismathieson
January 17, 2007 at 6:12pm
Doris, How would single-payor increase the paperwork burden on doctors? Seems to me the reverse is more likely
- teplukhin
January 17, 2007 at 9:03pm
"The French can see any doctor they choose, any time they want." Yeah, if you don't mind waiting for months to get an appointment (unless you slip the doctor some cash under the table - and if you don't think this happens all the time, you don't know anything about how socialized medicine actually functions in other countries). Excessively long lines and waits for any specialist seem to be the norm in every country with socialized medicine. The other, equally disturbing feature is the enormous underinvestment in technology in such countries.
- litwinski
January 17, 2007 at 10:58pm
I tend to see hybrid solutions as invitations to corruption, first on the part of well-connected insurance companies, then of the sort acurately described by litwinski. Which is not to say it won't be a problem in any system. dorism's point about physician compensation (and ratio of patient-to-paperwork load) is a key one. In simple terms, it should be the responsibility of the state to provide basic healthcare, with an emphasis on trauma, prevention, incentives for healthy lifestyle choices, pre-natal and early childhood care. We should use this as a base upon which private insurance can cover the eighty-year-old alcoholic smoker's triple-bypass and the liposuction.
- Robert Powell
January 18, 2007 at 10:27am