Thursday, January 23, 2014

Models of Public Healthcare: An Overview

Are you working class but working a job without insurance?  Or perhaps you're barely getting by and have no real spare money for much these days.  Do you avoid the doctor cause of the cost of the office visit plus the cost of the lost pay from work?  There are simpler and more efficient solutions out there in the world about how we deliver healthcare services to our citizens.  So, how would a national single-payer system established in the United States look?

Let's examine a few models for single payer healthcare that we already see in this country.  Let's start with Medicare/Medicaid.  Both programs do the same thing but for different demographics.  If we created a system like Medicare...but for all, the system would create a single base policy that all states would adopt as their state-managed policy.  States then would choose whether to leave that policy intact or to add to it at their expense.  In Medicare, each state manages it's own program, uses it's own employees to enroll people in the program, pay the bills incurred by that state's program participants, and so forth.  It's mandated and paid by the Federal Government, managed by the State government.  Such a relationship would easily work for our nation, because the infrastructure is already in place.

Another model for care that the US could employ would be complete nationalization of all healthcare resources like that of the VA Healthcare System or the UK National Health Service.  These services are truly a pure socialist system.  In these systems, the primary care providers, ER doctors, surgeons, specialists, and other professionals are "state" employees (State meaning publicly paid federal employees).  In the UK, most hospitals and doctors are public employees which are paid salaries by the state and who centrally manage appointments, doctors, the master policy of the program...the works.  Private healthcare doesn't exist for the most part in these kinds of systems.  The VA system is modeled on the UK system, and for the most part works very well.  The quality of care is great and the attention to the patient's need is paramount.  The focus of the UK and VA healthcare systems is enabling access to all equally with a relatively strong amount of triage being taken into account as well.  Such a system is very effective in the UK and works very well.  The only complaint about such systems are they tend to be a tad backlogged for generic appointments and can result in long queue times.  However, for people who are ill, it's a nice benefit to be able to walk into a doctor's office and be seen when you're ill without any worry about cost to yourself.

Finally, another model which would likely be the model we use could be the Canadian Single Payer model.  This model is essentially each state having it's own healthcare program with a baseline program that the Federal Government creates to make it Universal.  In this arrangement, each state would be responsible for funding and managing it's own health program with transfer payments from the Federal Government to assist...likely based on a "per head" formula.  Some states can compete for which offers the best care by providing access to additional kinds of care like dental or vision services.  Such care would likely be paid for by either a consumption tax or a flat-rate percentage excise tax that all citizens pay equally. Each state would be responsible for determining what funding model to use to pay for their services whether income-based or consumption-based.

All these models are not out of reach for our nation.  Each has a strong history of success and the persistence to provide healthcare for all our citizens.  The Single Payer question has been one about human rights.  Is healthcare a profit-based service or an inalienable right as a member of a nation?  I, personally, believe it's a right for all citizens.  And that the quality of life is paramount to the right to offer for-profit service in this regard, but I also want to be clear...that I believe every person's labor is worth the effort and education and demand that is due, and that no person should be required to "give" their labor away for free.  Individuals who work in such systems get paid, and paid quite well.  Doctors in nations like Canada and England enjoy a posh salary, no worry about malpractice insurance, and the opportunity to help those in need without worrying about insurance companies.  Ultimately, the fabric of our society is what will determine the answer tot his question for the next two generations.

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