Yeah, my post titles are pretty lame. But I was thinking about the fact that employer-sponsored insurance is part of the problem with healthcare — in large part because I think that employers ultimately have to offer one-size-fits-all plans (for national employers, for consistency among their locations, and for small employers, because they simply are too small to offer multiple plans and make arrangements with multiple providers) and the solution to high healthcare costs has to come from, let’s say, small start-ups, a hospital/provider system offering prepaid care (yeah, I’m still working on reading and digesting my latest library book The Rise and Fall of the HMO) or an insurance company creating a limited network of hospitals that actually care about limiting their prices. And employers are trying to bring about a price-awareness on the part of their employees, but there’s a difference between looking at the employer’s health insurance options once a year at open enrollment, and doing one’s own comparison-shopping.
So, anyway, the other statement that’s bandied about is that the Democrats want ObamaCare to fail, in order to pave the way for single-payer. So I thought I’d run through the single-payer and other universal healthcare systems that I know of, and how private insurance fits in.
Canada: their single-payer system is unique in that it prohibits private provision of those benefits which are provided through the single-payer system. In other words, if the waiting limit for an MRI isn’t acceptable, you can’t just pay out of pocket. In practice, the upper-middle-class goes to the U.S. What’s more, there is actually a significant prevalence of employer-sponsored healthcare, because the single payers system doesn’t cover everything. Private healthcare covers drugs, dental, upgrades from ward to semi-private or private hospital rooms, certain types of therapists, and coverage out-of-country, either for emergencies only or more broadly.
The UK: single-payer does cover pretty much everything, except dental (or maybe only limted dental). But a strong private market exists, which covers all those services that the NHS covers only with waiting lists or not at all, and allows access to private clinics. To encourage insureds to use NHS hospitals for routine situations (e.g., broken arm), the insurance will pay a daily rate when using NHS rather than a private hospital. Employers generally (this is going from memory) provide health insurance for employees only (not for families) and for “exempt”/managerial employees (because, unlike the U.S., there is no requirement that employers provide equal healthcare benefits for all employees). So, as much as bloggers such as Wesley J Smith share stories of NHS problems, the upper middle class is insulated from this.
Germany: health insurance is provided through quasi-public entities called Krankenkassen, which are based on regional and industry lines. Employees and employers contribute an equal percentage of pay (up to a ceiling, like the Social Security wage base, only lower), which covers the entire family, including any non-employed spouse. But a private market does exist: if you earn more than (going from memory, again) about 50K, you can opt-out of the public system and buy health insurance on the private market, which gains you access to a higher tier of providers (the more senior doctors at a hospital, for instance) and access to private rooms instead of 3-bedded rooms. To discourage opting-out, once you do so, there are restrictions on whether or how you can get back into the public system. But opting out of the public system is an entirely private manner, with no role for employers at all.
Switzerland: their system is pretty simple, a mandate to purchase a health insurance plan which means certain basic criteria, and subsidies for the low income. It would be interesting to look at the history of this mandate and their system in general, because employers simply are not a part of the equation, where, in contrast, employers are in fact required to provide pension benefits for their employees.
Mexico (and Central America): healthcare is free! free! free! but considered to be very poor quality. (As in, Mexicans sneak across the border to receive healthcare from American hospitals, with no intention of paying, due to our requirements that hospitals provide care to all who walk into their doors.) So the middle-class/upper-middle class will purchase health insurance (or receive it through their employers) which buys them access to a completely different set of providers, private hospitals, etc.
(Another post which seems not to go anywhere — but my hope is to tie these last couple posts together later on!)
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