By Aaron E. Carroll and Austin Frakt
The New York Times, September 18, 2017
To better understand one of the most heated U.S. policy debates, we created a tournament to judge which of these nations has the best health system: Canada, Britain, Singapore, Germany, Switzerland, France, Australia and the U.S.
“Medicare for all,” or “single-payer,” is becoming a rallying cry for Democrats.
This is often accompanied by calls to match the health care coverage of “the rest of the world.” But this overlooks a crucial fact: The “rest of the world” is not all alike.
The commonality is universal coverage, but wealthy nations have taken varying approaches to it, some relying heavily on the government (as with single-payer); some relying more on private insurers; others in between.
Experts don’t agree on which is best; a lot depends on perspective. But we thought it would be fun to stage a small tournament.
We selected eight countries, representing a range of health care systems, and established a bracket by randomly assigning seeds.
To select the winner of each matchup, we gathered a small judging panel, which includes us:
* Aaron Carroll, a health services researcher and professor of pediatrics at Indiana University School of Medicine
* Austin Frakt, director of the Partnered Evidence-Based Policy Resource Center at the V.A. Boston Healthcare System; associate professor with Boston University’s School of Public Health; and adjunct associate professor with the Harvard T.H. Chan School of Public Health
and three economists and physician experts in health care systems:
* Craig Garthwaite, a health economist with Northwestern University’s Kellogg School of Management
* Uwe Reinhardt, a health economist with Princeton University’s Woodrow Wilson School of Public and International Affairs
* Ashish Jha, a physician with the Harvard T.H. Chan School of Public Health and the director of the Harvard Global Health Institute
So that you can play along at home and make your own picks, we’ll describe each system along with our choices (the experts’ selections will decide who advances).
(Interactive comparisons follow.)
(The conclusion is available at the link but is omitted here for those who wish to make their own choices in the matchups before knowing the final conclusion.)
NYT Reader Comment:
By Don McCanne, M.D.
Although this is an interesting exercise, it might be more productive to look at these systems from the perspective of the major problems that we have and what features of other systems might ameliorate them.
The uninsured: Make enrollment automatic. A mandate falls short because of compliance problems.
The underinsured: Reduce cost sharing to levels that will not create financial barriers to care.
High costs: Publicly-administered pricing comes closest to getting it right – legitimate costs plus fair margins.
Lack of choice of physicians and hospitals: Do not create artificial panels that serve third party payers at the cost of patient choice.
Impaired access to specialized services: Do not segregate low-income individuals into chronically underfunded welfare programs.
Profound administrative waste: Hundreds of billions of dollars could be recovered with a much more efficient financing system.
Now look again at how the various systems address these issues. Oops. There is not enough information here since the field of health policy is so much more complex than can be boiled down to simple comparisons. But when you add the other features that cannot be included here, you would end up with a single, equitably-financed, publicly-administered program – not an exact duplicate of any of the nations listed. That could be accomplished by improving our Medicare program and expanding it to include everyone.
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