All animals are equal, but some animals are more equal than others
Hamsters being a prominent theme at the moment, here's a thought you might want to think on [or not] -- for a couple of generations now we've all been guinea pigs in a huge medical experiment. Having [cough] borrowed the graphic from YES! Magazine, I'll go ahead and lift the opening paragrapghs of the accompanying article as well.
Should the United States implement a more inclusive, publicly funded health care system? That's a big debate throughout the country. But even as it rages, most Americans are unaware that the United States is the only country in the developed world that doesn't already have a fundamentally public--that is, tax-supported--health care system.
That means that the United States has been the unwitting control subject in a 30-year, worldwide experiment comparing the merits of private versus public health care funding. For the people living in the United States, the results of this experiment with privately funded health care have been grim. The United States now has the most expensive health care system on earth and, despite remarkable technology, the general health of the U.S. population is lower than in most industrialized countries. Worse, Americans' mortality rates--both general and infant--are shockingly high.
The article goes on to detail how 35 years ago Canadians and Americans were equals in health status, the amounts they paid for health care, and the methods by which they paid. But the Canadians, like all other civilized countries [and some not-so-civilized], figured out that the much-vaunted private market was delivering a lousy product.
There are a number of systems for publicly funding health care [more on those in a future post maybe]. The Canadians chose a national health insurance model and implemented what we've been calling 'single payer' -- where the government is the one and only entity that manages the money in the insurance pool and pays out as needed.
Canada's isn't quite single payer, actually. Each province/territory is its own payer, making their system an amalgamation of 10 single payers. Nor did the whole country switch at once. In the 1960s Saskatchewan made the leap, and by the 1970s the rest of the country wanted what they had, so in the 1970s all of Canada switched over to Medicare, which works pretty much just like our Medicare, except that in Canada everybody can go to the doctor, not just the old folks.
The transition was not a smooth one. Rioting broke out in the streets, doctors went on strike, and predictably the blood-sucking, money-grubbing insurance companies refused to give up the fight gracefully. Tommy Douglas, the Premier who was back then vilified for trying to bring socialism to Saskatchewan, was in 2004 voted The Greatest Canadian of all time. The current crop of Presidential candidates should take note.
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The same thing happened elsewhere...
It did not come easy. eg in Australia, a newly elected federal govt brought in Medibank national insurance in 1972, but it was dismantled only 3 years later, by the Opposition Conservative
govt Party returning to power.
Was not until 1983, when the centre-left Party regained power, that Medicare was introduced for a second time, and it was like Canada, and other countries - almost blood-in-the-streets, from doctors, hospital consortia, to drug and insurance companies etc. Even so, there were some compromises with doctors, such as allowing doctors to charge co-payments on non-hospital doctor's clinic visits.
It was not a popular move, and the mandatory 1.5% income tax hike (or Medicare Levy) on all income-earners was very (very) unpopular.
Really unpopular. Here is a vid-clip of the original Public Service govt ads, the fellow in the ad was the newly elected Prime Minister of the day:
http://www.youtube.com/watch?v=sN2JaGLsL6o
Funny how quickly people can change their minds though.. despite the years of pain and grief, rhetoric, fear-mongering, drama, protest, argument and struggle, within 2 years of its introduction, no drama at all - once people saw it actually working, so much better then before - and the sky didn't fall in, and by the next election term rolled around, Medicare became National Sacred Cow.
Doesn't mean it doesn't have its own problems, some very serious ones too, and doesn't stop people complaining bitterly about it, and still makes headline news at election times.
Until someone mentions, comparing it to the USA's system ... and then they all STFU
.... until the next scandal LOL :)
Unlike Canada however, some countries have more "mixed" systems - Australia for example, kept a small, but highly regulated, private health insurance sector, for "extras" or "top-up" cover - like private rooms, or in fancy private hospitals etc, choice of treating doctor and ability to "jump the queue" on public-hospital surgery waiting lists, and for things that Medicare wouldn't cover, eg cosmetic surgery.
One such insurance company was established by the govt, known as Medibank-Private, with all profits returned to govt as revenue rolled in with taxation revenue. They started advertising their plans, along the lines of "When Medicare isn't enough..."
But the private health sector became highly regulated with national clinical standards, on quality of product and payout determinations, (no more litigation - the law is the law, for all services and procedures) NO cherry-picking, no discrimination on pre-existing conditions etc, and mandatory cross=insurance underwriting, or industry-wide risk=sharing arrangements.
As a health economist, recently working with OECD Health directorate, my understanding is that it would not be possible for the USA to go to single-payer or even a "mixed" system in one fell swoop. Far too much disruption to various related industry sectors, and would need to be phased-in step-wise, over time, through some form of 'Mixed" system.
My understanding of the Clinton/Edwards plan is to take a first baby-step to transitioning, or phasing-in, by firstly regulating the health insurance companies. Enforcing mandatory coverage, for starters, provides great leverage on the companies. Mandates on people, also means mandates on the companies. Can't have one, without the other.
Obama's plan is corporate welfare. Subsidise some extra people to take out insurance, but that gets paid to the companies, with nothing in return. Just means more people are covered with the same crap coverage that Americans are already complaining about. If you read the fine print of his plan, its all based on "voluntary compliance" with industry standards, and "optional" buy-ins by insurance companies etc. Similar to all the "voluntary compliance" clauses he made for Exelon on the nuclear leaks legislation.
With mandates, to operate their business, they will need to comply with regulation on national standards on things for example: portable products, risk-sharing arrangements with all the other companies in the sector, no cherry-picking, no discrimination etc, no special deals with certain hospitals, the list goes on, mandatory reporting against industry-wide criteria - ie they will have to compete on a level playing field on basic product standards set on clinical benchmarks, as agreed with national clinical schools of medicine.
Add to the competition in the market-place with a government-owned insurance company, and people will shop around for the best deal, and over time people will probably move to the government insurance scheme, and mergers and restructuring will happen slowly in the remaining private sector. In the end, those that can offer the best quality insurance products, on price and quality of service, consumer trust and goodwill, will survive and do well, but in a smaller market.
I can well understand why there is so much resistance in the USA's corporate world to this sort of regulation.
Because, the other issue, that several OECD countries are watching the US elections for - is very much focussed on how the US moves with their "corporate" healthcare debate.
In simplistic economic-speak, the US-based HMOs are now operating in a "saturated market". Basically, this means Americans are paying as much as they possibly can, they've been bled dry, can't bleed any more - and the only way the HMOs can survive is to expand internationally. Laissez-faire capitalism 101 - bleed one market dry, then aggressive expansion into new markets. Obama's partial subsidisation, as corporate welfare without regulation, greases the wheels of this process, by increasing their operating capital.
Similar to US-based drug companies, they are pressuring other countries, which are struggling to "hold the line" on their systems. Little by little, a co-payment here, a deductible there etc, in recent years, allowing freer market access for private health insurance companies to open up offices under 'Free Trade Agreements' etc. In short, welcome to globalised Mc-BlueCross healthcare.