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DCWoody -> Healthcare refom in usa, what would americans on here do? (8/21/2009 6:31:43 AM)
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I'm going to assume that everyone here agrees that the current usa system is mindbogglingly bad, so the question is mostly what to change it to.
Open to other suggestions, but mainly going to be focusing on The UKs NHS and Frances compulsory insurance, because they can be thought of as 'best in class'.
The French system is widely regarded as the best in the world, and the majority of rich nations use similar insurance based systems, in the UK the govt runs the entire system...doctors are employed by the government, it doesn't stand up to the french, but it's much cheaper....hard to say which would be the better method if both nations spent the same per person.
In the UK: Almost everyone uses the NHS, there is private insurance too, but it's not widespread as only relatively expensive stuff for the rich can offer a better service than the NHS. The NHS is funded by taxes, they are non-optional....even if you choose to go private, you still have to pay taxes. The entire NHS is run by the government, although individual areas have a fairly high degree of self management to work to differences in their area, healthcare is generally free at the point of care, but there are highly subsidised charges for some things (e.g dentistry, cue the jokes), these charges aren't applied to people on benefits. Because everything is government run the methods and quality of care can vary somewhat if a different party takes control of parliament, e.g in the last 12 years of Labour control the service has improved considerably, but also got a lot more expensive for the taxpayer. Everyone gets the same relatively high standard of treatment, paperwork & legal stuff is minimal compared to other systems, nowhere else has a system which is both better and cheaper. It is a very authoritarian, left wing system. The cost is about 3/4 that of Frances, and ~1/2 of the usas.
In France everyone uses insurance, which is compulsory, all the insurance companies are non-profit, and heavily heavily regulated, if not controlled by the government outright. There is, again, a private sector but, again, only the rich use it. Treatment generates a bill, which is then mostly refunded by the insurance...because of this hospital visits are a little more tricky if you have no money, but the government works out the general welfare system so that everyone can get & pay for treatment. Many of the additional 'optional' insurance schemes are essentially for paying the difference between the actual bill and the government enforced insurance refund. Most actual practitioners are private practice, so you can choose to go to a very elite expensive Dr if you like....but you'll still only get the government set amount of refund for that sort of treatment/checkup. The refund system automatically means there's notable paperwork/bueracracy no matter how efficiently it's run. The quality of care is the highest anywhere in the world, ensures care for everyone, and allows a great variety of choice for the individual, giving an impression from the individuals point of view of being completely free market, except because it's not really, no-one ever finds themselves unable to pay. On the downside it's pretty much the most expensive system in the world, with the notable exception of the usas madness.
Singapores system has also had much praise, bit singapore is really a city not a country and it probably couldn't be replicated with the same results in a larger nation, Germany may also sound interesting as it's similar to the french but with less government interference behind the scenes, however despite spending almost as much as the french the results are distincly average.
Thoughts?
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