Clinton neo-liberals and Republicans have used the term universal care in these corporate health reform policies pretending they are being progressive especially towards the poor. The poor lost all access to hospitals with the ACA and the defunding of the Federal agency that subsidized US citizens who could not pay for health care. The insurance mandate was never about using that money to subsidize health care for the poor----CLINTON/OBAMA NEO-LIBERALS WERE LYING AGAIN.
Let's look at the difference between single-payer and the social democratic Expanded and Improved Medicare for All. Remember, it is Republicans who use the term 'single-payer'-----and they see that as a gutted of funding Medicaid for All......preventative care for all.
Below you see a stat that shows we are moving to this 90% of people accessing only preventative care and in Maryland---
ALL MARYLAND ASSEMBLY AND BALTIMORE CITY HALL POLS ARE CLINTON NEO-LIBERALS AND BUSH NEO-CONS PUSHING THIS MESS.
Thank Cardin, Sarbanes, Cummings, Mikulski, Edwards, Van Hollen et al for doing to health care what they did for Wall Street----ending thousands of years of medicine that does no harm and with human rights.
The U.S. just significantly boosted military aid to Israel by 50% to $4.5 billion/year only days after a report found 238,000 veterans have died waiting for VA healthcare. Share if you think this is disgusting!
It is the health insurance mandate that will end up making this a single-payer system of gutted of funding Medicaid for All. As corporations no longer offer health plans that are not currently preventative care-----you see where all health coverage that Americans will be able to afford falls into that preventative care window. Preventative care is wellness and monitoring for communicable disease to prevent epidemics.
THIS IS EXACTLY WHAT HEALTH CARE IN THE DEVELOPING WORLD LOOKS LIKE!
'But the Republicans are not the only ones to flip on the individual mandate. Even President Obama opposed the idea while he was running for president against Hillary Clinton and up until six months into his first term'.
'If you have access to Medicaid, you can reject employer-based coverage to go on Medicaid, and your employer will not have to pay the fee. The fee only pertains to Marketplace coverage. Thus, you may be eligible for free or low-cost family coverage even if employer-based coverage is unaffordable for you, but due to Medicaid expansion, not technically considered unaffordable'.
'What is the Impact of the ObamaCare Employer Mandate
The ObamaCare employer mandate has already caused many companies to cut hours from full-time workers to ensure that they are given part-time status'.
ObamaCare Employer Mandate
The Employer Mandate / Employer Penalty Delayed Until 2015 / 2016
The ObamaCare Employer Mandate / Employer Penalty, originally set to begin in 2014, was delayed until 2015 / 2016. ObamaCare’s “employer mandate” is a requirement that all businesses with 50 or more full-time equivalent employees (FTE) provide health insurance to at least 95% of their full-time employees and dependents up to age 26, or pay a fee by 2016. Below we clarify how each aspect of the mandate affects employees and employers.
The employer mandate is officially part of the Employer Shared Responsibility Provision. Under the Affordable Care Act, the federal government, state governments, insurers, employers, and individuals are given shared responsibility to reform and improve the availability, quality, and affordability of Health Insurance Coverage in the United States.
If you have access to Medicaid, you can reject employer-based coverage to go on Medicaid, and your employer will not have to pay the fee. The fee only pertains to Marketplace coverage. Thus, you may be eligible for free or low-cost family coverage even if employer-based coverage is unaffordable for you, but due to Medicaid expansion, not technically considered unaffordable.
ObamaCare Employer Mandate image from Robert Wood Johnson Foundation
What is Minimum Value?
Minimum value means that a plan provides the minimum essential coverage and cost sharing in line with a Bronze plan on the marketplace and has a minimum average cost sharing amount (actuarial value) of 60%. All marketplace coverage is minimum essential coverage. We suggest using the Small Business Health Options Program (SHOP) to cover employees. This helps ensure that your plan complies with the law. More information on minimum value can be found below.
More on FTE’s and the Employer Mandate.
How Many Hours is Full-time Under ObamaCare?
Under the ACA, for the purposes of providing an employee with health benefits, full-time is defined as working an average of 30 hours a week or more or 130 hours a month. To be considered full-time, the employee must work more than 120 days in a year. Learn more from the IRS.
How Many Hours is Part-time Under ObamaCare?
Under the ACA, for the purposes of providing an employee with health benefits, part-time is defined as working an average of less than 30 hours a week or less than 130 hours a month. To be considered part-time, the employee must work more than 120 days in a year.
Since only full-time workers need to be provided with benefits under the law, some companies have chosen to employ more part-time workers to avoid providing benefits. See more on ObamaCare and jobs.
Measurement Periods and Lookback Periods
To find out if an employer has to comply with the mandate the government looks at initial measurement periods for new hires to determine full-time status. To find out if an existing employee is full-time they use look-back periods. Employers also use measuring periods of 3 – 12 months when looking at full-time equivalent employees to see if they have to offer full-time employees coverage for the purposes of the mandate.
Look-back periods and initial measurement periods can be between 3 and 12 months, and are chosen by the employer. These periods can start on the 1st of the calendar month or at the start of payroll (with new-hires that is on the first on the month or on the first payroll period after their start date).
Understanding measurement periods can get a little complicated, and employers who are subject to the mandate should seek professional legal advice.
Sec. 1558. Protection for employees. Amends the Fair Labor Standards Act to ensure that no employer shall discharge or discriminate in any manner against any employee with respect to his or her compensation, terms, conditions, or other privileges of employment because the employee has received a premium tax credit or for other reasons.
- In general the fee is only “triggered” if at least one employee shops on the marketplace and is eligible for a federal premium subsidy. So, failing to provide benefits to workers who make too much for cost assistance won’t count toward the fee.
ObamaCare Individual Mandate
Both the Individual Mandate and Employer Mandate are part of the same Shared Responsibility Provision. See our Individual Shared Responsibility page more information on the ObamaCare individual mandate.
What is the Impact of the ObamaCare Employer Mandate
The ObamaCare employer mandate has already caused many companies to cut hours from full-time workers to ensure that they are given part-time status. Although less than a fraction of a percent of firms in the US have over 50 full-time equivalent employees and don’t provide health insurance, many Americans are finding their hours cut. See our page on the Affordable Care Act and jobs for a detailed discussion on how the mandate has affected employment.
Clinton neo-liberals are setting a record with the percentage of US workers unemployed and/or part time. Almost all of the job recovery that occurred for US workers was part time and poverty. So, when Obama and neo-liberals wrote the ACA with this Republican mandate clause pretending corporations would share the costs-----they deliberately placed this loophole knowing American workers were going to move en masse to part time or unemployment.
Avoiding the Mandate by Moving Employees from Full-time to Part-time
To avoid the employer mandate, some employers who have to comply with the mandate are moving employees to a work week of about 27 hours a week. The law originally lowered part-time status to 30 hours a week for the purposes of health benefits to get more employers to comply.
Look below to see where RomneyCare took Mass---the first thing the mandate did was close public hospitals and ended the free care for the poor. They will try to tout stats that now everyone has insurance while hiding the fact that health access has declined as has health outcomes. The mandate has always been about making health care like the auto industry insurance and where are we today with auto insurance? Paying rates so high for ten years could buy a new car---and if you or someone else has an accident involving your car----up goes the rates. People today are forced to consider not making a claim to avoid cost. this is exactly what will happen with health care and Clinton neo-liberals/Republicans think that is good cost reduction.
THIS HEALTH INSURANCE MANDATE WILL REALLY COME BACK TO PREY ON PEOPLE'S ABILITY TO ACCUMULATE WEALTH.
MARYLAND IS ALREADY HAVING ONE OF THE MOST EXPENSIVE BASIC PACKAGES---PEOPLE BEING FORCED TO GUTTED OF FUNDING MEDICAID FOR ALL.
'Before MHC came to Massachusetts medical services were provided to the poor who had no health insurance, free of charge'.
United States. Mandatory Health Care leaves 31 million people without medical treatment
By Les Blough. Axis of Logic
WSWS. Axis of Logic
Saturday, Oct 5, 2013
The concept and enactment of "Mandatory Health Care (MHC)," the centerpiece of "Obama Care" or the "Affordable Care Act (ACA)" was first executed in Massachusetts in 2006 by Mitt Romney who was governor at the time. It was a windfall for the health insurance corporations, hospital adminstrations and medical doctors.
The MHC concept was patterned after mandatory car insurance and was sold with similar cynicism to the public. Those with health insurance were told that they were being robbed - that those without health care should not be allowed to receive free treatment in hospitals and other public institutions, funded by their tax dollars. The car insurance lobby got mandatory car insurance passed - playing on the fear of having a car accident with an uninsured motorist. It forced everyone, regardless of their income to purchase car insurance, relieved the insurer of having to pay for the accident unless they received premiums from everyone involved and guaranteed more revenue and profits for $billion(s) dollar car insurance companies like Liberty Mutual.
Before MHC came to Massachusetts medical services were provided to the poor who had no health insurance, free of charge. For example, Boston City Hospital had been a public institution that was required to provide full health care for the 500,000 poor who were uninsured. But in 1996 Boston City Hospital was sold to Boston University, a private university, as a precursor to Romney's MHC and all residents of Massachussets are now legally required to pay for their own medical insurance and many people simply cannot afford it.
In 2007, the state government began penalizing people who filed personal income tax (required by law of course) but could not afford to enroll in the MHC program. The penalty took their $219 personal income tax exemption; in other words, they were forced to pay for it through the tax system. In 1998 the penalty, through the state income tax system was raised to 50% of the lowest monthly insurance premium available. As a result, many people are forced to pay for health insurance before paying rent and buying food, clothing, heating oil, electricity and other daily needs for their families.
According to the Kaiser Foundation, in 2010 Massachusetts had the highest health insurance in the US with individual policies costing over $400 per person per month.
For those who are still employed across the United States today, with the employer picking up part of the cost of health insurance, about $380 a month is taken out of their paychecks. The Kaiser Foundation reports:
"Annual premiums for employer-sponsored family health coverage reached $16,351 this year, up 4 percent from last year, with workers on average paying $4,565 toward the cost of their coverage" - October 1, 2013.
Mitt Romney's Mandatory Health Care system became a model for "Obamacare," the much touted "Affordable" Care Act - for the entire nation, leaving 31 million people in the United States without medical treatment. What do people do without the health care once provided by public institutions like Boston City Hospital? They go without it and the resulting suffering and death is immeasurable.
According to Forbes, in 2013 (so far) the value of the health insurance index has gained 43%. CIGNA shares are up 63%, Wellpoint 47% and United Health Care corporation up 28%. Obamacare has allowed public companies to raise their premiums, multiply their profits and increase the value of their common stocks by 200%-300%.
Insurance giant CIGNA sells health and life insurance. Reuters reports that their revenue rose from $7.42 billion to $7.98 billion and their net profits rose to $505 million from $380 million a year earlier. They took in $5.69 billion in premiums and fees in their global health care division and they plan to drop about 3 percent of it's 440,000 members because of the government's cuts to Medicare Advantage funding in 2014. CIGNA is also planning to sell insurance on the stock exchanges in five states - a move which is part of U.S. President Barack Obama's "Affordable" Care Act (ACA).
If the Federal Reserve, a private corporation, can print US dollars as they want to bail out Wall Street, the private investment banks and failing capitalist corporations, they can print dollars to pay for quality health care for all people living in the United States. Health care like clean air and water, decent housing, food and quality education is a Human Right - not a thing to be bought and sold for corporate profits.
A true national health care system has been systematically blocked in the United States using another fear bandied by the insurance lobbies and corporate media - the trumped up fear of socialism.
In Venezuela's New Socialism of the 21st Century, the people's own natural resources, most prominently PDVSA, the national petroleum industry pay for health care and other human rights for all people whether citizens of the country or not. The only reason the government of the richest country in the world is not taking care of its own people is because of corruption, corporate graft and robbing of the US National Treasury.
The people of the United States must finally rise up and rebel against this economic fascism by taking to the streets. March on Washington and shut the city and government down for a week, just to get their attention if nothing more. Better to do it now and face police batons than to wait until it's too late and die a slow death with the corporations sucking off everything we hold dear. The power is in the hands of the people and in their numbers.
When we read media giving us all these stats on ObamaCare we are never told the data set------how many people are making that 60% of citizens? Below you see 8 million Americans enrolled in health insurance with 60% of those heading to Bronze in 2014 and then in 2015 you see prices soaring.
The reality is most Americans are being pushed to gutted of funding Medicaid whether Wall Street plays with the rates---deductibles---co-pays or plays the regional low rate game.....
RAISE YOUR HAND IF YOU KNEW-----IF GIVEN A CHOICE----REPUBLICAN STATES WOULD NOT WANT EXPANDED MEDICAID. EVERYONE.
Obama and Clinton neo-liberals took what was a uniform coverage of Federal Medicare and Medicaid where all states had to give the same level of care------and deliberately made it state-optional knowing that large numbers of states would opt-out of Medicaid.
Now, Medicaid is one big block grant for the most part-----defunded and offering no oversight and accountability. The perks of glasses, dental care are simply preventative care that has nothing to do with hospitals while Bronze and Medicaid are not allowing access to ordinary hospital treatments.
May 1, 2014 Health Insurance Insurance News NetSilver Plans By Far The Most Popular ACA OptionAlmost two-thirds of the 8 million Americans who enrolled in health insurance through the Affordable Care Act picked “silver” plans, according to new data on sign-ups released by the Department of Health and Human Services…
Bronze Plan Could Be Most Popular Exchange PlanBy Amy De Vore+ Medicoverage Health News
The new Healthcare Exchange “metal” plans debut January 2014. These plans were based off the Massachusetts Health Exchange Plans which were called: Bronze, Silver, and Gold. ObamaCare has added one more plan called Platinum, making four options all together. According to a collaborative study from BU and U of Penn, the most popular plan of the MA Exchange was the Bronze plan with over 60% of all enrolled people. This behavioral study found that most people selected this plan because it cost the least per month. If this behavior holds true on a national level then the ObamaCare Bronze plan will be the most popular because it has the lowest monthly premium.
Why Bronze Plan is Most Popular
The “Heuristics and Heterogeneity in Health Insurance Exchanges: Evidence from the Massachusetts Connector” authors Keith Marzilli Ericson and Amanda Starc explain the data, “Plans that are the cheapest in their area receive a substantial increase in enrollment.” Basically they found that most people just looked for which plan cost the cheapest each month and selected it without considering other strengths and weakness of the plan.
Should People Select the ObamaCare Bronze Plan Because it Cost the Least?Comparing the Massachusetts’ model and the ObamaCare model is not straightforward. Besides having four plans available under ObamaCare, we have discovered a few unique differences that could ultimately make the new Healthcare Exchange Bronze plan not necessarily the least expensive or the best choice.
- With the ObamaCare Bronze plan you have to meet your $5000 deductible before most services are met. If you are injured on a Bronze plan, you will spend a lot more out of pocket than those on the Silver or better plans.
- Only the ObamaCare Silver Plan offers federal cost-sharing subsidies to help offset the costs of deductibles, coinsurance, and copayments. These cost-sharing initiatives will make the new Silver plans much more competitive in price.
The new Bronze plan only includes 3 doctor’s visits before the $5,000 deductible must be met. Whereas the Silver plan offers Rx, specialists, lab tests, and X-rays all before the deductible is met. It’s important to look at what benefits the plans have to offer, not just monthly cost.
“Selecting the cheapest health care plan is a lot like selecting the cheapest car at a use car lot, ” states Medicoverage co-founder Chris Mihm. ” You might pay less now but end up paying a fortune in repair bills. When selecting a health plan in the exchange, you will want to select the plan that has the “lowest total cost of ownership” ...meaning pick a plan that will save you money should you need medical services.”
Prices for popular Obamacare health plans rising sharplyBy Paul Demko
10/30/15 07:13 PM EDT
Updated 10/31/15 10:25 AM EDT
Premiums for some of the most popular insurance plans in the Obamacare exchanges will have double-digit rate hikes in 2016, at a time when both advocates and critics of the law have been voicing concern about health care affordability for American families.
Rates released by the Obama administration Friday and analyzed by consulting firm Avalere Health found that the lowest cost “silver” plan – the most popular option in the law's insurance marketplaces – will rise 13 percent, about four times the increase for plans this past year.
More than 80 percent of exchange customers qualify for subsidies, so they don’t bear the full cost of the premium increases. Still, surveys have found that some people don’t know about the subsidies – a gap that HHS plans to address in its next wave of enrollment outreach – and some families find health insurance unaffordable even with the federal financial assistance.
The steep increases are certain to rekindle criticism from Republicans that the Obamacare marketplaces aren’t working as promised. In recent weeks, they’ve also seized on the collapse of 10 nonprofit startup insurers established with tens of millions of dollars’ worth of Obamacare loans as evidence of the law’s deep flaws.
Joe Antos, a health care finance expert at the conservative American Enterprise Institute, argues that the double-digit increases show that insurers set rates too low during the first two years of open enrollment.
“What’s basically happening is the insurance companies finally have gotten a little bit of cost experience,” Antos said. “This is getting closer to a realistic set of premiums."
The administration and insurance experts are pushing the 9 million-plus Obamacare customers to shop around for a better deal when the three-month enrollment window re-opens this Sunday.
"Most consumers will need to return to the exchange to shop and may need to select a new plan to avoid higher premiums," said Caroline Pearson, senior vice president at Avalere.
The new data represents health plans sold only on HealthCare.gov, the federal enrollment portal that served 37 states this year. State-run marketplaces have released rates separately.
Roughly two thirds of all HealthCare.gov customers are enrolled in the mid-level silver plans, which cover 70 percent of medical costs. Those plans will see varying cost swings across the country -- the cheapest silver plan in Oklahoma will spike by 44 percent next year, while exchange shoppers in Indiana will an average decrease of 14 percent.
Premiums for bronze plans, which cover 60 percent of costs and offer cheaper premiums than silver plans, are also rising sharply this year. The cheapest bronze option will increase by 16 percent on average across the country, according to Avalere’s analysis.
One caveat on Avalere's analysis: it's not weighted by enrollment in each plan because HHS has not released that data. That likely skews the numbers higher since plans with more enrollees have typically seen lower rate hikes.
The administration announced earlier this week that premiums will rise more slowly for a key benchmark plan, which helps determine size of federal subsidies. The benchmark plan, which is the second-cheapest silver plan offered on the exchange, will increase by 7.5 percent on average in 2016.
On Friday, Department of Health and Human Services officials also announced that HealthCare.gov shoppers would have an average of 50 plans from five insurers to choose from. That level of competition is almost identical to 2015.
“The marketplace is stable,” said Richard Frank, assistant secretary for planning and evaluation at HHS, on a call with reporters. “Consumers will continue to have affordable choices in 2016.”
Maryland citizens need to stop and think-----WHO SUPPORTED THE AFFORDABLE CARE ACT without ever mentioning all of the dismantling of a thousand years of public protections in medicine? The national labor and justice organization leaders knew-----all of Maryland's pols knew-----Maryland Health Care for All knew. This is when we can see how global pols are posing progressive and the corporate non-profits created to hide these truths. We the people must become the voice of social democratic policy----we cannot sit and allow these posing progressive organizations take our voice.
Maryland has spent decades juking the health data to justify being exempt from Medicare----now they are going to go from using pooled funds to expand Hopkins and MedStar nationally and globally----they are now ready to super-size profit.
Remember, the major US health insurers are all on their way to being global health systems and they could care less about getting state markets----and this will leave citizens with those most predatory. Across the nation and especially in Maryland-----most people connecting to these health exchanges are going for Medicaid.
Price to jump for most popular health plan on Maryland insurance exchange
By Amy Goldstein September 4
'The price of the most popular health plans sold through Maryland’s insurance exchange will jump, on average, by about one quarter next year, fueling questions about whether coverage under the Affordable Care Act will remain affordable in Maryland
Price to jump for most popular health plan on Maryland insurance exchange
The Mary’s Center health clinic helps enroll people eligible for coverage though Affordable Care Act health plans. (Frank Johnston/The Washington Post)
By Amy Goldstein September 4 The price of the most popular health plans sold through Maryland’s insurance exchange will jump, on average, by about one quarter next year, fueling questions about whether coverage under the Affordable Care Act will remain affordable in the state and elsewhere.
The 26 percent average increase in monthly premiums are for CareFirst plans, which cover three-fourths of the state residents who have bought insurance under the federal health-care law. The price jump, scheduled for January, is among rate changes that the state’s insurance regulators have approved for plans sold to individual families and small businesses.
The increases were announced Friday by state Insurance Commissioner Alfred W. Redmer Jr.
Maryland is the latest state to disclose premiums for 2016 in time for the third annual open enrollment period for buying plans on the exchanges created by the ACA.
Open enrollment begins Nov. 1.
Before the exchanges opened two years ago, the Obama administration, health policy experts and consumer advocates worried whether enough insurance companies would agree to sell health plans through the marketplaces and what prices they would charge. The initial results were promising, but questions lingered as to whether some insurers set their rates artificially low at first to attract customers.
[Maryland approves smaller rate hikes for CareFirst for 2015]
The rates for 2016 are of keen interest to supporters and detractors of the law. For the past two rounds, insurers were partly guessing about how much to charge, since they had not yet had an entire year to gauge how much medical care their new customers in the exchanges would actually use. Around the country, the rates that insurers proposed for next year are the first grounded in concrete knowledge of their costs.
Although the ACA is a federal law, each state has a separate set of insurers in its marketplace and sets its own rates. Some states have more leverage than others to raise or lower the premium prices proposed by insurers. Among the several states that already have announced their final rates for next year, the price patterns vary.
Florida’s insurance regulators announced last week an average 9.5 percent increase in insurance premiums for its exchange’s plans. California’s marketplace has said the average increase there will be 4 percent. In other states, such as Illinois and Texas, insurers are hoping for much greater increases, but it is not yet clear what their final rates will be.
Across the Washington area, the District has not finished setting its rates. Virginia has final rates, but it does not compute averages or publicize rates in a form that makes it easy to discern the range of prices.
In Maryland, nearly 125,000 people had received coverage through the Maryland Health Connection as of midsummer, according to that exchange’s most recent figures. Nearly 96,000 of them have one of a variety of plans sold by CareFirst. Maryland’s exchange, like ones around the country, is intended for people who cannot get health coverage through a job.
Under the rates announced Friday, prices by the various insurers will rise, on average, more sharply for individual policies than for small-business ones. But not all insurers are raising their rates in the individual market as much as CareFirst, and a few small carriers are reducing them. For a typical 40-year-old in Maryland’s Washington suburbs buying a CareFirst “silver” health plan, the most common level of coverage, the monthly premium next year will be $329 — a $75 increase.
During the past two years, CareFirst has asked for big rate increases, but the insurance commission has pared them. In an interview, Redmer said that CareFirst deserves to be able to charge more for 2016 because it has lost $100 million this year on individual insurance policies. That loss, he said, is partly because 7,800 small businesses around the state have decided to stop offering insurance to their workers, sending them into the exchange, where premiums were less expensive.
Michael P. Sullivan, a spokesman for CareFirst, said that, once the company had a full year of experience with the exchange, it turned out that “people who are in that pool in Maryland are, in fact, older and sicker than we expected them to be.” He said that he hoped that the rate increase would “go a long way” toward making the prices adequate and, as a result, more stable in the future.
Benjamin Wakana, a spokesman for the federal Department of Health and Human Services, said that, in Maryland as elsewhere, the health-care law now makes it easier for consumers to compare the prices and benefits of plans in the exchanges — and to switch plans. He also pointed out that more than eight in 10 people insured through the exchanges get federal subsidies to help pay for their coverage.
“Discussing rates without discussing financial assistance does not reflect reality,” he said.
But Maria Gomez, president of Mary’s Center, a health clinic with branches in Maryland and the District, said, “If the subsidy doesn’t move somewhere along the same rate, then forget it.”
Mary’s Center helps patients enroll in exchange plans, and Gomez said that “it took quite a bit to convince” some patients that insurance was worth paying for.
“If the increase is that high for people that just barely were able to scrape together enough dollars to get the insurance,” she said, “this 26 percent will put them over the edge.”
WE THE PEOPLE CAN REVERSE THIS AND MAKE HEALTH CARE REFORM ABOUT EXPANDED AND IMPROVED MEDICARE FOR ALL.
Below you see from where social democrats were coming in 2009 during this health reform debate. The three models showing social health systems are all in the developed Western nations----and then there is the developing third world nations with what will become in the US---gutted of funding Medicaid for All. Clinton/Obama Wall Street global corporate pols think the US has no right to all the health care it gets and needs to come on par with the developing world.....the mandate will take 90% of Americans to this third world level of access. A social model for universal care would not need a MANDATE----as everyone is in----no one is out. The mandate is only needed when people cannot afford the insurance and opts out.
'For the 15 percent of the population who have no health insurance, the United States is Cambodia or Burkina Faso or rural India, with access to a doctor available if you can pay the bill out-of-pocket at the time of treatment or if you're sick enough to be admitted to the emergency ward at the public hospital'.
An excerpt from correspondent T.R. Reid's upcoming book
The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care,
to be published by Penguin Press in the summer of 2009.
- Related Reading
- Q&A With T.R. Reid
But we don't have to study 200 different systems to get a picture of how other countries manage health care. For all the local variations, health care systems tend to follow general patterns. There are four basic systems:
The Beveridge ModelNamed after William Beveridge, the daring social reformer who designed Britain's National Health Service. In this system, health care is provided and financed by the government through tax payments, just like the police force or the public library.
Many, but not all, hospitals and clinics are owned by the government; some doctors are government employees, but there are also private doctors who collect their fees from the government. In Britain, you never get a doctor bill. These systems tend to have low costs per capita, because the government, as the sole payer, controls what doctors can do and what they can charge.
Countries using the Beveridge plan or variations on it include its birthplace Great Britain, Spain, most of Scandinavia and New Zealand. Hong Kong still has its own Beveridge-style health care, because the populace simply refused to give it up when the Chinese took over that former British colony in 1997. Cuba represents the extreme application of the Beveridge approach; it is probably the world's purest example of total government control.
The Bismarck ModelNamed for the Prussian Chancellor Otto von Bismarck, who invented the welfare state as part of the unification of Germany in the 19th century. Despite its European heritage, this system of providing health care would look fairly familiar to Americans. It uses an insurance system -- the insurers are called "sickness funds" -- usually financed jointly by employers and employees through payroll deduction.
Unlike the U.S. insurance industry, though, Bismarck-type health insurance plans have to cover everybody, and they don't make a profit. Doctors and hospitals tend to be private in Bismarck countries; Japan has more private hospitals than the U.S. Although this is a multi-payer model -- Germany has about 240 different funds -- tight regulation gives government much of the cost-control clout that the single-payer Beveridge Model provides.
The Bismarck model is found in Germany, of course, and France, Belgium, the Netherlands, Japan, Switzerland, and, to a degree, in Latin America.
The National Health Insurance ModelThis system has elements of both Beveridge and Bismarck. It uses private-sector providers, but payment comes from a government-run insurance program that every citizen pays into. Since there's no need for marketing, no financial motive to deny claims and no profit, these universal insurance programs tend to be cheaper and much simpler administratively than American-style for-profit insurance.
The single payer tends to have considerable market power to negotiate for lower prices; Canada's system, for example, has negotiated such low prices from pharmaceutical companies that Americans have spurned their own drug stores to buy pills north of the border. National Health Insurance plans also control costs by limiting the medical services they will pay for, or by making patients wait to be treated.
The classic NHI system is found in Canada, but some newly industrialized countries -- Taiwan and South Korea, for example -- have also adopted the NHI model.
The Out-of-Pocket ModelOnly the developed, industrialized countries -- perhaps 40 of the world's 200 countries -- have established health care systems. Most of the nations on the planet are too poor and too disorganized to provide any kind of mass medical care. The basic rule in such countries is that the rich get medical care; the poor stay sick or die.
In rural regions of Africa, India, China and South America, hundreds of millions of people go their whole lives without ever seeing a doctor. They may have access, though, to a village healer using home-brewed remedies that may or not be effective against disease.
In the poor world, patients can sometimes scratch together enough money to pay a doctor bill; otherwise, they pay in potatoes or goat's milk or child care or whatever else they may have to give. If they have nothing, they don't get medical care.
These four models should be fairly easy for Americans to understand because we have elements of all of them in our fragmented national health care apparatus. When it comes to treating veterans, we're Britain or Cuba. For Americans over the age of 65 on Medicare, we're Canada. For working Americans who get insurance on the job, we're Germany.
For the 15 percent of the population who have no health insurance, the United States is Cambodia or Burkina Faso or rural India, with access to a doctor available if you can pay the bill out-of-pocket at the time of treatment or if you're sick enough to be admitted to the emergency ward at the public hospital.
The United States is unlike every other country because it maintains so many separate systems for separate classes of people. All the other countries have settled on one model for everybody. This is much simpler than the U.S. system; it's fairer and cheaper, too.