This from this morning’s NY Times by Paul Krugman. Are these the big options for Obamacare?
Let’s talk about health care around the advanced world.
Every wealthy country other than the United States guarantees
essential care to all its citizens. There are, however, wide variations
in the specifics, with three main approaches taken.
In Britain, the government itself runs the hospitals and employs the
doctors. We’ve all heard scare stories about how that works in
practice; these stories are false. Like every system, the National
Health Service has problems, but over all it appears to provide quite
good care while spending only about 40 percent as much per person as we
do. By the way, our own Veterans Health Administration, which is run
somewhat like the British health service, also manages to combine
quality care with low costs.
The second route to universal coverage leaves the actual delivery of
health care in private hands, but the government pays most of the
bills. That’s how Canada and, in a more complex fashion, France do it.
It’s also a system familiar to most Americans, since even those of us
not yet on Medicare have parents and relatives who are.
Again, you hear a lot of horror stories about such systems, most of
them false. French health care is excellent. Canadians with chronic
conditions are more satisfied with their system than their U.S.
counterparts. And Medicare is highly popular, as evidenced by the
tendency of town-hall protesters to demand that the government keep its
hands off the program.
Finally, the third route to universal coverage relies on private
insurance companies, using a combination of regulation and subsidies to
ensure that everyone is covered. Switzerland offers the clearest
example: everyone is required to buy insurance, insurers can’t
discriminate based on medical history or pre-existing conditions, and
lower-income citizens get government help in paying for their policies.
In this country, the Massachusetts health reform more or less
follows the Swiss model; costs are running higher than expected, but
the reform has greatly reduced the number of uninsured. And the most
common form of health insurance in America, employment-based coverage,
actually has some “Swiss” aspects: to avoid making benefits taxable,
employers have to follow rules that effectively rule out discrimination
based on medical history and subsidize care for lower-wage workers.
So where does Obamacare fit into all this? Basically, it’s a plan to
Swissify America, using regulation and subsidies to ensure universal