When T.R. Reid was bureau chief in Japan for The Washington Post, he wondered why healthcare prices were a tenth of what he paid in the U.S. “Japan has the oldest population and the healthiest. Those two shouldn’t go together.”
The author of the bestseller The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care, producer of PBS documentaries on the same topic and crusader for universal healthcare in his home state of Colorado described four models of healthcare for a City Club audience.
Great Britain’s Beveridge Model is named after Lord William Beveridge, born to fabulous wealth and title who dedicated his life to serving the poor. In 1943, Beveridge proposed treating healthcare as a social service like paved roads and libraries – service without ever seeing a bill.
Today, 62 million citizens and 15 million resident aliens in Great Britain are covered, and the country “spends 44 percent as much as we do and are somewhat healthier than we are,” Reid said. Spain, Scandinavia, New Zealand and Cuba also use this model.
Germany’s Bismark Model is named after a tough, hawkish Prussian general who wanted to unify German-speaking people into a nation through a central government that bestowed benefits such as old-age pensions. In 1883, it required everyone to buy insurance to get healthcare at private hospitals.
But unlike the U.S. “trillion-dollar industry” in which Reid said a thousand companies make a billion a year in in healthcare profits, in Germany no company is allowed to make a profit. “Earning a profit directly conflicts with paying doctor bills. Other countries don’t allow it.”
The 220 insurers in Germany use the same forms and are in the same system because it’s simpler, cheaper and fairer. “Everybody has access to the same care at the same price,” Reid said.
Today 83 million German citizens and 20 million alien workers are covered. Germany has “great health results, and spends 62 percent as much as we do,” Reid said. France, Japan, Switzerland, The Netherlands also use this system.
A marriage of the Beveridge and Bismark models started in Saskatchewan, spread to other Canadian provinces and eventually to all of Canada by 1961. Everybody pays into a government-run health program and receives services at private hospitals and other facilities. Called “Medicare,” the U.S. copied the model down to the name in 1965 for those over age 65. Today, Australia, Taiwan, Brazil and U.S. seniors use the Canadian model.
The fourth model, in poor countries, requires people to make out-of-pocket payments without any financial assistance.
All these systems are in use in the U.S., Reid said. “The design of any country’s healthcare reflects its moral values. Our country could provide high-quality care for less because other countries do it. If France can do it, the United States can do it.”
Jan can be reached at [email protected]
