As California takes a few fledgling steps into the world of single-payer health care, with state senators this week voting to create a $400-billion universal system, lawmakers might want to look at how other places around the world have implemented such plans.
he challenges facing single-payer proponents are daunting: lawmakers in the Assembly must first sign off on Senate Bill 562, the state will need to figure out how to fund such a tax-hungry behemoth, and a two-thirds vote in both chambers would ultimately be needed to get the thing off the ground.
While Sacramento crunches the numbers and figures out how to sell taxpayers and businesses on what could be a 15-percent payroll tax to fund the program at a cost of $200 billion each year going forward, here’s how five countries around the globe have pulled off their own individualized version of what many heath-care reformers in California now aspire to:
BOTSWANA
Like the more than 60 nations around the world that employ some version of single-payer health-care, this landlocked Southern African nation of 2.2 million people runs a sprawling network of public medical centers, with 98 percent of the facilities operated by the government. Every citizen is entitled to be treated in public facilities free of charge, though a small patient’s fee of about $70 is usually tacked on, except for reproductive-health and antiretroviral therapy services, which are free.
According to the World Health Organization, the services are decentralized down to the district level and delivered through a network of health facilities. They range from referral hospitals and primary hospitals, along with smaller clinics and health posts run by the Ministry of Health, and also get some funding from faith-based organizations and mining companies. Botswana’s universal network includes over 800 mobile units that serve populations in remote areas or those living further than a few miles from a health facility. The country also has a separate private-sector network and a number of nongovernmental organizations, or NGOs, providing mostly HIV/AIDS-related services such as counseling and testing.
A banner against AIDS is seen on the border of the township of Naledi in Gaborone, 15 October 1999. More than one in four adults in Botswana is infected with the HIV/AIDS virus, official figures show, statistically making it one of the world’s most affected countries.
US News and World Report ranks Denmark’s health-care system Number One on the planet. And its universal public health system, funded largely by taxes and administered by local municipalities, is similar to those of other Scandinavian countries with equally admired single-payer networks. Denmark’s 5.6 million residents receive primary care from a general-practitioner service run by private doctors who contract with the local municipalities and are paid on a mixed per-capita and fee-for-service basis. With most hospitals run by the municipalities, only about 1 percent of hospital beds are in the private sector.
The people of Denmark, which also happens to be ranked as the world’s happiest country, are apparently happy to pay high taxes in exchange for quality public health care and other social benefits, including free education. The Danes pride themselves on their modern facilities and a corps of physicians who, for the most part, also speak English. Health care is available free of charge to Danish citizens as well as anyone living in the EU and free emergency treatment is available to visitors from all other countries.
The system is divided into two sections: Primary health care handles general health problems and is usually the first point of contact for anyone requiring medical attention; these services include general practitioners, dentists, physiotherapists and others. The “Hospital sector” offers care to patients with more serious issues who require specialized treatment.
GERMANY
Germany boasts the world’s oldest national social health insurance system, dating back to Otto von Bismarck’s Sickness Insurance Law of 1883. Like other nations with single-payer plans, Germans have access to a decentralized system, with independent and mostly non-profit hospitals offering most of the inpatient care for patients. Approximately 92 percent of Germany’s population is covered by a so-called “Statutory Health Insurance” plan, a portal to a standardized basket of services paid for, in part, by more than 1,000 public or private so-called “sickness funds.”
Germany’s health system also gets funds from other sources, including employee and employer contributions, along with government subsidies on a sliding scale that is dependent upon a patient’s income level. As in many countries, Germans can choose to pay a tax and opt out of the standard plan and instead buy “private” insurance.
Like Obamacare, which essentially makes health care mandatory for everyone, insurance coverage is compulsory in Germany. The goal is that nobody gets into financial difficulties just because they get sick. Germans therefore pay none, or only a reasonable portion, of any treatment costs; anyone who gets sick in German is also protected against lost earnings. And if you’re a high-wage earner, you can always buy your own private insurance and bypass the universal health care system entirely.
Health care in Germany is financed largely through the premiums paid by insured employees, depending on their income level, and their employers. But regardless of the premiums you pay, everyone in the single-payer system is entitled to the same health care. And you are free to choose any doctor, dentist or psychotherapist you like; for their part, doctors are obliged to treat anyone who is insured. Finally, the family doctor (”Hausarzt”) or pediatrician (“Kinderarzt”) is usually the first stop for people with health-related issues. That doctor then serves as a gatekeeper, referring the patient to a specialist, such as a gynecologist or dermatologist, if needed.
Historically, the level of provider reimbursement for specific services is determined by negotiations between regional physician associations and sickness funds. Since 1976, the German government has convened an annual commission, including members of the business community, labor unions, doctors, hospitals, as well as representatives of the insurance and pharmaceutical industries. That panel then makes recommendations on how much and in what manner the nation’s health-care funds are spent on various services provided.
CUBA
Single-payer or universal systems, of course, are not always the well-oiled machines that proponents might paint them as. In Cuba, where there are no private hospitals or clinics and all health services are run by the government, the system today is underfunded and, more recently, understaffed. Part of the reason is that medical missions in other countries have drained Cuba of much of its medical talent pool. And like the rest of the Cuban economy, the country’s medical system has been denigrated since the end of Soviet Union subsidies in 1991 and the simultaneous ramping up of the US embargo against Cuba which aggravated that funding shortfall.
Still, the system seems to be chugging along despite its own shortcomings: Cubans have long enjoyed a life expectancy similar to Americans’, despite widespread poverty on the island. There’s a saying in Cuba: “We live like poor people, but we die like rich people,” and researchers have found that the rate of infant mortality in Cuba, for example, has been lower than in some neighborhoods of Boston. And these successes come as the country spends just $813 per person annually on health care compared with America’s $9,403, the Atlantic reported.
“In Cuba, health care is protected under the constitution as a fundamental human right,” said the report. “As a poor country, Cuba can’t afford to equivocate and waste money upholding that. This pressure seems to have created efficiency. Instead of pouring money into advanced medical technology, the system is forced to keep people healthy.”
AUSTRALIA
Like many nations that offer some form of universal health care, a broad concept that has been implemented in a number of iterations around the globe, Australia’s system offers services that are mostly provided by a combination of private medical practitioners and government-run hospitals and clinics, all funded by both government agencies and private insurers with a portion paid for by the patient.
Medicare, first launched in 1984, is Australia’s universal health-care system and it covers the majority of medical costs for all citizens and permanent residents. Australia also relies on health-care funding from a wide range of sources, including agencies that work with veterans or indigenous people, along with money from motor vehicle insurance and workers’ compensation programs. Like most countries, Australians can opt out and pay for their own private health care if they choose. And the government also funds and runs a separate “Pharmaceutical Benefits Scheme” which offers generous subsidies for a range of prescription drugs.
Typically, Medicare covers 75 percent of the fees charged by a general practitioner, 85 percent of a specialist and 100 percent of public in-hospital costs. The program is financed by a Medicare levy, which is compulsory and administered through the tax system. And while supporters of the universal-health-care program in Australia proudly point out that its residents’ life expectancy is the third longest among comparable nations, there are still problems, including a rapidly aging population, rising levels of obesity and widespread cases of mental illness, and the burden of chronic disease. Still, health-care expenditure represents approximately 9 percent of Australia’s GDP, close to comparable nations but much less than the US.
Date:June 02, 2017