So, just because I decided we can't apply international principles to the US as their systems and histories and problems are different than ours, doesn't mean I can't look at the systems and make judgement calls about what I prefer on a pure philosophical level. I'll be looking at these systems from three major areas. First I'll be looking at the structure of the system and how preferable I find it to my ideology. Second I'll be looking at how much it costs. Third I'll look at effectiveness. Let's get to it.
These videos come from Healthcare Triage, a very good youtube channel that covers healthcare policy and the like.
9) Singapore
Singapore is the one system on this playlist I hate more than the US's. It's often used as a template of what a conservative utopia looks like. People put money away into health savings accounts. These are used to fund healthcare costs, and people are allowed to choose the kind of coverage they receive on a market. People who can't afford healthcare get coverage too, but it's very poor, and based on the video, sounds like third world standards. We're talking people sharing a sick bay with several other people level low. Yuck. People also are reported to put almost 20% of their salaries into these accounts. Spending overall on healthcare is low, but as the video points out its likely because of the market philosophy of when people have to spend their own money they're reluctant to. Yikes. Right wingers act like this is the gold standard for healthcare, but I find their system horrifying.
8) United States
We all know what the US system is. Expensive, with people often lacking coverage. We have huge issues in the US. Still, we do offer first class care to those who can afford it and some people do have excellent care if they're on medicare and the like. I think simply having first world standards makes it preferable to Singapore. Still, our system obviously sucks. Every other system here is arguably better than ours.
7) Switzerland
The next several systems are all about the same overall in my opinion, only the top few stand out to me. Switzerland is #7, and is close to what centrist liberals seem to want to turn us into. Switzerland relies on insurance mandates. All healthcare is private, and everyone is mandated to get insurance, similar to obamacare. People who are poorer get subsidies to afford it. This system has very good quality healthcare, but it is relatively expensive, second only to the US. And it also has high out of pocket spending. It's not preferable in my opinion.
6) Germany
Germany has a system that is a lot like Switzerland. It has a largely market based system, but it's nonprofit in nature. It also has an insurance mandate. However, I ranked it a bit higher because out of pocket costs seem lower.
5) Taiwan
I really want to like Taiwan's system. I mean, they implemented single payer. And it's very affordable to the end user. But at the same time, the quality is said to be lacking, with them suffering the notable drawbacks critics of single payer often criticize single payer systems for like not being good at handling certain diseases. I wish I could make this higher, but its quality is relatively low compared to the others. Even if I philosophically like it.
4) Australia
Australia is a largely publicly funded system based on its own medicare program. It seems quite solid in terms of outcomes, but costs are a bit high, as people are hit with relatively high out of pocket spending, comparable to Switzerland. Still, it gets good outcomes and is largely a public system.
3) France
France has several publicly funded funds for healthcare. Which one you get depends on who you are. However, everyone gets covered and even the unemployed get a good system of care here. It's relatively expensive, but seems to provide great coverage. It seems like a solid system.
2) Canada
The gold standard for single payer systems. However, it doesn't seem as impressive as it's often made out to be. Government spending only accounts for 70% of healthcare spending, and private insurance does cover a lot of things the single payer system doesn't. Still, its quality of care is a lot better than the right often claims it is, and their system works.
1) United Kingdom
The UK has a system that is not only completely government run, but it has good outcomes and is cheap. It angers me how little they spend (like 9% of GDP) while having a totally government run system with no up front costs and good outcomes. I mean, this is what the US should strive to do, but can't given how bloated its system is. If we had the UK's system I bet we could fund a full UBI and have a full universal system. But alas, we're not the UK.
What republicans want
Republicans often want to transition to a Singapore like system and I often hear conservatives go on about how great Singapore is for healthcare. That said they're the ones keeping us with a broken system at best, and their ideal solution for "universal" coverage would downgrade us to the one system I hate MORE than the US. Health savings accounts aint it. The amount of money people are spending on these things is higher than the "taxes" in most other countries. And if you run out of money, well, you get bargain basement care.
What democrats want
For as much as mainstream democrats mention wanting universal healthcare, they don't seem interested at all. They seem to want to go the Germany/Switzerland approach, which just...wouldn't...work here. I mean, we tried something similar to that with the ACA. Insurance mandates. What happened was that people were forced to buy expensive for profit insurance they couldn't afford, and it didn't solve anything. Medicaid was expanded, but the broken system relied on states accepting an expanded rollout, and doing it properly. Which even if they accepted it, they didn't do it well. For example in my state you basically need to sign up for welfare to get coverage. It's ridiculous. It's the most broken, passive aggressive way to accomplish healthcare. I'm sorry, but insurance mandates aren't it either. Not to mention they're in a tenuous constitutional position.
What Bernie wants
Bernie wants a single payer medicare for all system that would be a lot more aggressive than the other single payer type systems we have here. It would have no copays, no deductibles, and basically function like the UK's NHS, but without the state running the hospitals. While I have no doubt his plan would be the envy of the world if implemented, as we know, it's insanely expensive. Bernie would be taking on the costs of our bloated system all at once and while he would be cutting some spending and deflating costs a little bit, it still would require a massive expansion of spending. Again, this is why I keep saying these other countries systems can't work here. We can't implement insurance mandates and have them work as well as Germany or Switzerland do. We can't implement single payer and suddenly have a Canadian or British style system with Canadian or British style spending levels. Maybe if we did this 50 years ago, but not now.
What I would want
Honestly, the Medicare Extra for All system seems to function most like Australia or France. While it wouldn't be the best systems possible, it would be much cheaper. Basically we would have a combination of public and private insurance, with some level of cost sharing existing. Universal coverage would be achieved, and in the long term, it does provide the framework through which we can expand the system to a true universal system. But for now, it would greatly expand the system more than an insurance mandate would, but for far less of a cost than a true single payer system would. And it would give us a long term hope to get costs under control and over time and to expand us to a single payer system.
The fact is, I'm a believer in universal healthcare, and I love Bernie's proposals at heart, but I'm also being somewhat of a realist here. I believe republican and democratic responses to the healthcare crisis are awful, and both parties seem to be choosing among models that I deem to be comparably some of the worst discussed here on a relative level. Bernie wants to make us the envy of the world, but given our insane cost to GDP ratio, I can't justify that given my other policy preferences. So, I find this compromise with Medicare Extra to bring us close to the goal. Get us to a respectable, albeit imperfect system, at a reasonable price. Better than most democrats and their band aid fixes, but not as crazy as what Bernie wants to do. Boom, it would work.
Conclusion
People around the world have tackled the healthcare problem in different ways, and they seemed to have solved the problems to varying extents. However, those models are not necessarily applicable to the US. Insurance mandates would do little to stem the tide of rising costs and affordability issues, and are incompatible with my ideology. Single payer and NHS style systems seem philosophically most preferable to me, but to do them right here in the US would cost way too much. This exercise does make me jealous as fudge of the UK though, which seems to hit the trifecta of costless universal coverage, low government costs, and good outcomes. Realistically, we would need to settle for a middle ground between the two. I think such a system would provide good results, relative to its costs. I sure as heck want something better than an insurance mandate, but cheaper than a full universal system. I think medicare extra for all would get us there over time while transitioning us to rank 3-4 overnight if we really wanted it to.
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