PBS reporter T.R. Reid gave a very interesting and informative keynote at a Dec. 2 conference in New York about the global healthcare landscape and how the U.S. should consider a one-size-fits all system to remedy its fragmented coverage.
During his presentation, Reid laid out the four main healthcare system models he’s seen traveling and reporting around the world. The first he explained was the “Beveridge Model,” named after English social reformer Lord William Beveridge, who died 1963. In this model, which is found in the U.K., Scandinavia, and Cuba, the government owns all hospitals and labs, and employs specialists, nurses, lab techs. General practitioners are private but bill the government, who is the single payer in this system. Patients have no premiums, no copays, and no doctor bills.
The second model Reid explained was the “Bismarck Model,” named after the Germany’s first chancellor, Otto von Bismarck, who invented the concept of social security. This model employs private doctors, private hospitals, and private insurance, whose cost is split between the individual and their employer. This model is found in countries like Germany, Japan, Switzerland, France, and Belgium.
Canada and Australia exemplify the third model described, called the “National Health Insurance” or the “Douglas Model.” This healthcare model has private doctors, private or charity hospitals, and public payment. Everyone pays into the public health system every month, a premium that is withheld from the individual’s paycheck, in case of Canada.
The fourth model which comprises about 150 of the world’s 200 countries, Reid says, is the “Out of Pocket Model,” where all healthcare costs rest on the individual. This model is found in developing countries like Africa and India. And many times if a patient doesn’t have money, they pay what they have or barter for medical services.
America’s Patchwork Quilt
Reid illustrated that the U.S. is the only country that has all four models of healthcare: Native Americans and veterans operating on the “Beveridge Model,” senior citizens (Medicare) on the “National Health Model,” employees of companies with health plans on the “Bismarck Model,” and uninsured individuals on the “Out of Pocket Model.” Reid made many quips about maintaining his objectivity of a reporter, but had a clear viewpoint that the current healthcare system in the U.S. had many faults. He admitted that America has never wholly favored a one-size-fits all system, as many equate universal coverage as “socialized medicine.”
Reid made a salient point when he said that the design of a country’s healthcare system reflects its morals and values, and that many countries around the world think it’s fairer to have one healthcare system. He said if a country doesn’t make the moral commitment to cover everyone, a gulf emerges, as in the U.S., where some get the finest healthcare and others aren’t covered at all. “If we can find the will, the other countries can show us the way,” he said.
When asked which U.S. healthcare model he’d get rid of first, Reid said he’d get eliminate the VA Health Care, pointing out the U.S. is the only country that has a separate healthcare system for veterans. He also suggested that the U.S. could move toward a one-model healthcare system by experimenting on a state level, and if successful then neighboring states could adopt the model.
Reid overtly appeared to favor the French healthcare system, praising its Carte Vitale and citing a McKinsey & Co. study that found a savings of $6 billion a year if the U.S. employed the French system of healthcare. “If France can do it, then America can do it,” Reid added.
Reid said America could provide universal coverage for a reasonable cost like many European democracies do, instead of causing many Americans to face fiscal ruin because of unpaid medical bills. A study published in 2009 by The American Journal of Medicine showed that medical costs contributed to more bankruptcies in the U.S. than any other factor, with 62.1 percent of all bankruptcies in 2007 stemming from medical bills. Ninety-two percent of these medical debtors had medical debts of more than $5,000.
Beyond unifying the disparate healthcare models in the U.S., how do we implement and use health IT to provide the same quality of healthcare for each American? The ARRA/HITECH Act is one step in that direction, but how do we move beyond vendors’ proprietary boundaries, so systems can communicate with each other? HIEs and the Nationwide Health Information Exchange are the next step, but will it get the U.S. toward a more unified healthcare system?