Is European-style insurance the answer?
Universal Health Coverage Does Not Require Single-Payer System, Op-Ed States
Kaiser Daily Health Policy Report
July 3, 2006
“Many proponents, as well as opponents, of health care reform equate universal coverage with a Canadian-style, government-run, single-payer system,” but “a survey of successful health care systems around the world shows this is an incorrect assumption,” Steven Hill, a director of the New America Foundation, writes in a San Jose Mercury News opinion piece. According to Hill, a number of nations without a single-payer health care system — such as Austria, Belgium, France, Germany, Japan and the Netherlands — provide universal health coverage and quality health care “at a fraction of what we pay” in the U.S. Hill writes that the health care systems in those nations share “many similarities with the recent bipartisan health care legislation passed in Massachusetts that mandates a ‘shared responsibility’ between employees, employers and the government,” adding that the “key difference is that the Massachusetts plan does not include cost controls, which understandably are difficult to enact on a state level.” Hill writes, “The evidence is clear that cost controls are extremely important to any successful health care system,” and “the experiences of the public-private hybrid systems in France, Germany, Belgium, Japan and elsewhere show that it is possible to have your cake and eat it too.” The “take-home lesson for health care reformers is that it is important to expand the debate and recognize that universal health coverage does not mean single-payer,” Hill adds (Hill, San Jose Mercury News, 6/30).
http://www.kaisernetwork.org/daily_reports/print_report.cfm?DR_ID=38290&dr_cat=3
From Steven Hill’s Op-Ed referenced above:
The funding for health care in these nations is best described as a “shared responsibility” — employees, employers and the government all contribute a pre-determined amount. Both workers and their employers are subject to mandatory payroll deductions, and government chips in any shortfalls for poorer individuals, depending on income level or employment status.
The contributions from individuals, employers and government are deposited into private insurance funds that are non-profit and government-regulated (sometimes known as Sickness Insurance Funds, or SIFs). Additional private insurance can be purchased for premium services, such as a private room in the hospital.
But here’s the key part: the SIFs sit down at the bargaining table with the government and representatives from professional associations of doctors and health care professionals to set exact fee structures. They negotiate strict cost controls that have prevented expenditures paid by consumers from approaching anywhere near exorbitant U.S. levels. Cost controls are essential to the success of these “shared responsibility” systems.
http://www.mercurynews.com/mld/mercurynews/14937478.htm
Comment:
By Don McCanne, M.D.
Judging from my email, single payer advocates around the nation are quite concerned about this Op-Ed from Steven Hill of the New America Foundation. He suggests that we should dismiss consideration of single payer
and move forward with the “shared responsibility” approach of European-type private insurance funds which he parenthetically acknowledges are Sickness Insurance Funds (SIFs).
Ida Hellander, M.D., Executive Director, Physicians for a National Health Program, in a personal communication provides this helpful insight:
“I think the important thing to note is that the ‘sickness funds’ in France, as in Germany, Switzerland, etc - are nothing like a U.S. insurance company. The main reason people usually propose the German (or French, etc.) model for the U.S. is that they believe it will be more ‘politically feasible’ than single payer because we could avoid a showdown with the private insurance industry. But that’s false. Aetna has nothing in common with a sickness fund: Sickness funds are, after all, non-profit, and so tightly regulated that they don’t set either fees or premiums. U.S. insurers would resist being turned into ‘sickness funds’ exactly as much as they would fight single payer. So, there’s no political advantage. Plus, having multiple payers (even non-profit ones) does increase administrative overhead, and decrease ability to control costs.”
The mission of the New America Foundation is to bring new, innovative thinking into the public discourse. It is ironic that they are promoting the oldest approach to universal coverage, sickness funds, while rejecting the newest and most efficient form of universal coverage, single payer.
They use the rhetoric of shared responsibility, as if this were a new concept. Of course, all universal systems depend on shared responsibility. A single payer system partners a public funding system with a private health
care delivery system.
If they believe that highly regulated and controlled sickness funds administered by multiple insurers is a great idea, then maybe they might be interested in a newer innovation of that concept. Establishing a single, universal sickness fund, administered regionally by a single public entity, would improve the efficiency and efficacy of the sickness fund concept.
Does someone want to tell Steven Hill and his colleagues at the New America Foundation that the take-home lesson is that we don’t have to settle for the ancient model of multiple private insurers and sickness funds, when we have
the opportunity to adopt an improved universal system by applying modern single payer innovations?
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