There's been a lot of traffic about health care on dkos recently. Just thought I'd show you all how it works elsewhere in the world.
I'm not claiming that alternative systems are perfect, but that's not the point. The point is whether they're workable, sustainable, and able to provide for disadvantaged folks.
If you want to see a system which achieves all of the above, keep reading...
UPDATE: If you're an International Kossack, why don't you post something which describes the health-care system in your country? It strikes me that this is one of those issues where the average joe has difficulty thinking of useful alternatives to the system they know and, uh, love, and an international perspective which shows various systems succeeding or failing could be a worthy contribution to the debate.
Australia's
Medicare system was implemented with much fanfare by the Labor government in the 1980's. The aim is to provide health coverage to every citizen of Australia.
Here's how it works.
Every Australian who earns more than $6000 pays 1.5% of their income as a Medicare Levy. The levy is usually deducted by employers when they set aside your income tax contribution.
The funds accumulated by that levy provide every Australian citizen with health services. Hospitals, prescription drugs, visits to the family doctor, ER services, you name it. An Australian never needs to worry about the cost of a heart transplant or chemotherapy. It's "cradle to the grave" system: Aussie families don't have to think too hard about the cost of treating their sick kids either.
The two most expensive parts of the system are hospitals and prescription drugs, and they consequently deserve special mention.
When allocating hospital costs, the Government divides hospital work into "elective" and "non-elective" treatments.
Non-elective treatments are things like chemotherapy, heart transplants, brain surgery following strokes, appendix removals, ER, the basic pair of glasses you'd need to be able to function usefully in society if you have eye problems, emergency dental work, etc -- All the things which aren't discretionary items chosen by patients. Non-elective treatments are the funding priority: Government-run hospitals are directly funded by the system to pay for them, and privately owned hospitals receive subsidies from Medicare equivalent to 100% of the cost of the non-elective treatments they provide. As a private citizen you never see a bill for a non-elective treatment (although you may get one for hospital accommodation separate to the treatment itself if you've opted to have your non-elective treatment delivered by a private hospital)
Elective treatments are things like joint replacements, followup treatment after ER has helped you out after you've broken an limb, removal of non-malignant tumors, most dental work, most optical treatments, etc. Generally stuff that isn't life-threatening, which is chosen by the patient. Hospitals receive funding for elective treatments from Medicare, but the elective ones take priority so there'll probably be a queue for the non-elective ones in Government hospitals. If you're wealthy you can pay a private hospital directly to effectively jump the queue, or pay them indirectly through a private health insurance policy (more on that below).
So the end effect for hospital treatment is this: Australians can choose to pay for it, and receive a better level of service if they do; But those who are unable to pay for it have free hospital treatment in Government-run hospitals. Life-saving treatments are provided instantly, discretionary treatments will probably involve waiting anywhere from a few weeks to a year, but the treatment will be provided, and the patient won't ever see the bill.
Prescription drugs are covered by the Pharmaceutical Benefits Scheme. The Government consults an independent panel of medical experts to judge the efficacy and utility of drugs; If they meet certain standards, the Government will subsidizes the retail cost of the drug to whatever extent is necessary to make it reasonably affordable.
There's a lot of wiggle room in the scheme, and the level of subsidy will vary from drug to drug, and some drugs won't be covered at all. But Doctors know which drugs are covered, and where there are multiple alternative treatments they'll tend to prefer the ones which are on the PBS list. And the PBS list encourages generic drugs, which substantially cuts costs as you'd expect.
Senior Citizens have a higher level of subsidy, and most medications can be dispensed for $2.50 per prescription. After a certain annual spending level subsequent prescriptions are free.
The PBS costs the Australian Government a couple of billion dollars per year. It's an expensive line-item on the Federal Budget for a country that only has 20 million people; But as a trade-off between that and paying full retail costs for life-changing medication, it's an acceptable compromise. It's immensely popular and very politically sensitive: There's a huge electoral backlash waiting for any political party who tries to restrict the PBS.
There's still room in the Medicare system for private health insurance. Medicare is intended to provide a basic safety net, to ensure that all Australians get the health care they need. But you might want higher levels of service -- For instance, you might want to be covered for drugs which aren't on the PBS list, or you might want to be covered for privately operated hospitals so that you can avoid the queues at Government hospitals. Or perhaps you want entire classes of therapy which Medicare doesn't offer at all (e.g., traditional asian treatments, to name one example)
So that's what you'd use private health insurance for. It's effectively a "top-up" overlaid on Medicare, filling-in the gaps that Medicare doesn't cover.
Originally the emergence of Medicare resulted in health insurance companies losing most of their customers (why would you need private health cover when Medicare provides almost everything to every Australian citizen?). They have some political clout, though, and a few years ago they successfully lobbied the Government to create some "encouragements" to go on private health insurance: If you earn over a certain threshold and you don't have private insurance, your Medicare Levy percentage increases a bit each year. On the other hand, if you do have it the Medicare levy remains at 1.5% and the Government pays 30% of your private health insurance premiums (you get to choose whether you want the Government to pay the health insurance company or to give you an annual cash payment).
For instance, I have a health insurance policy which costs about $100 per month (plus the Government 30% subsidy) which covers me for optical, dental, private hospital and a bunch of other stuff. Medicare continues to cover things like non-elective surgery, visits to my doctor, any prescriptions I happen to require, and so on.
So how does it work in practice?
Well, let me give you a case study.
I needed some surgery last year after a visit to my doctor revealed a lump in my neck, and subsequent pathology tests failed to identify it. My doctor referred me to a lymphatic system specialist who examined me and recommended surgery to have it removed, so that it could be examined under a pathologist's microscope to ensure that it wasn't a lymphoma. I checked myself in for day surgery, received a general anaesthetic, and the aforementioned specialist removed a lymph node, which was sent off to a pathologist, who determined that it was all much ado about nothing and that I didn't have anything to worry about.
So what did that little foray into my country's health system cost me?
Well, my various visits to my family doctor cost me between $0 and $25 per visit. My doctor "bulk bills," which effectively means that his business submits my Medicare claim paperwork to the Govt on my behalf and receives payment directly, instead of making me submit the paperwork, wait for a check from Medicare, and get around to paying his bill. So he gets efficient payment, and I don't see a bill. Medicare has schedules of standard consultancy fees for doctors, and if my consultancy fits into one of them Medicare pays all of the bill. If it doesn't, there'll probably be a gap between the Medicare payment and the doctor's bill, which is where the $25 I mentioned above (which is called a "gap payment") comes from.
Pre- and post-operative pathology: 100% covered by Medicare. My doctor would have received the bill from the pathologist, and would have included it in his bulk-billing claim and received payment from the Government.
My two pre-operative visits to the lymphatic specialist: $0. He bulk-bills too, and his consultations were a perfect match for the standards covered by Medicare.
The surgery itself? Well, the specialist I saw only performs surgery at a private hospital (if I'd told my doctor I didn't have private insurance, he'd have sent me to a different one). The surgery itself was covered by Medicare as elective surgery, so I didn't have to pay for anaesthetic, nor did I need to pay the surgeon. But the hospital accommodation wasn't covered by Medicare (only Government hospital accommodation is). But my private health insurance picks up the bill for that one, and my out-of-pocket expenses were $0.
My total out-of-pocket expenses for the whole saga were about $50, consisting of a few of the "gap payments" I described above from my doctor.
If I didn't have private health insurance the bill would have been the same, but I'd have waited for 3 months to have the surgery, and it'd be done in a 1970's-era Government hospital instead of a gleaming, expensive-looking ultra-modern private one.
Overall the system works pretty well. There are grumblings and political controversies from time to time, but I think every nation gets them regardless of the kind of health care system they have. The Australian electorate is very sensitive to political interference in Medicare: When it was first created it was greeted with suspicion, on the expectation that it'd turn into a massively inefficient and expensive bureaucracy, but in the 20 years or so that it's been in service those fears have been mostly shown to be unfounded.
The one thing which it has done spectacularly well (and the main reason why the electorate is so sensitive about it) is to provide a "safety net" to disadvantaged people. Absolutely everyone, from the richest media baron down to the lowest street bum is covered by it. If you're a homeless person living out of the back of your 1976 Toyota you can still visit your doctor to find out that that horrible ache in your chest is lung cancer, and once it's discovered you can still receive the heart-lung transplant that'll save your life.
To the vested interests who claim that a Government-operated insurance scheme cannot possibly work: Medicare is nearly 20 years old, and it works. You're wrong. Cope.