Understanding the Health Care Debate: A Simple Chart

Submitted by Ken Watts on Mon, 08/24/2009 - 16:45

I'VE BEEN THINKING ABOUT the health care debate lately. It's complicated enough, even if you leave out the politics and stick to the truth.

I've done some research on my own—starting with actually reading the sections cited by people who claim it provides for "death panels," etc. (Spoiler alert: It doesn't, and the section in question was added by a Republican...)

Once you get past the political nonsense, and start trying to make sense of what our predicament is, as a country, and what choices we have to fix it, things get a little simpler.

There are basically three approaches to health care that get mentioned—Socialized Medicine, Single Payer, and Capitalism.

Although various countries use all kinds of combinations of these three, the fundamental options can be laid out on a line, moving from left to right as follows:

Socialized Medicine: Government Run

Mixed System: Socialized and Profit Based

Single Payer: Profit Based with Government Insurance

Mixed Insurance: Profit Based with Government and Private Insurance

Pure Capitalism: Profit Based Medicine with Profit-Based Insurance

I'll break those down a little further below, but the thing that strikes me about the list above is just how far to right the current Democratic plan sits.

No one in the United States has seriously suggested socialized medicine for the country as a whole, though the military has been quite successfully using it for years.
No one has even suggested a mixed system, though Congress, and veterans, have had that option for years—again, quite successfully. I guess what's good enough for Congress is too good for the rest of us.
A single-payer system has been suggested by a few brave souls—something like Medicare for everyone (which has also been working well for years).
By the time we get to the Democratic proposal, we're already one step away from the extreme right end of the list.
And yet, the Republicans in Congress and various right-wing propaganda organizations are still screaming "socialized medicine" as though we were even thinking about anything so extreme.

I did a bit of research, trying to put some order into the debate for myself, and came up with the following chart, which summarizes the various choices, with some examples from countries that use them.

As you read it, and draw your own conclusions, remember this: health care is too big an undertaking for there to be a perfect solution. There will always be anecdotal horror stories, no matter what system, or what nation, we are talking about.

The real question is how can we make our system better.

System	Example Country:	World Rating:	% of GNP ($ per person):
*Socialized Medicine* The government owns and operates the health care industry.
Pure Socialized Medicine: The government runs health care. All clinics, hospitals, etc. are owned and operated by the government, and all doctors, nurses, administrators, etc. are government employees.	Cuba (39th is the worst on this chart, but there are lots of poor third world countries that rank even lower.)	39th	7.1% ($363)
Socialized Medicine with a Private Capitalistic Option: The same as above, except that doctors are allowed to have private practices. Veterans have the equivalent of this system, since the V.A. provides a government run health system, but they are free to use a private system as well. Members of congress have a government-run system available, but also can choose private care. (They also have other options as well, which appear below.)	U.S.A. for veterans and members of Congress (Including Republicans)	NA*	NA*
	Spain	7th	8.1% ($2388)
	England**	18th	8.4% ($2784)
	Finland	31st	7.6% ($2472)
Single Payer Systems *The health care system* is private, and capitalistic, but health care insurance is government run. The government insures everyone and pays all medical bills. Medicare is a limited example of this general type of system which is available now to the elderly in the U.S.**
Single Payer with a Socialized Option: The same as above, except that the government also runs a socialized medicine system for those who prefer it.	Israel	28th	7.8% ($2263)
Single Payer with a Socialized Option and a Private Insurance Option: This is a mix of all three possibilities, leaving the most choice for the individual. If you are a veteran who qualifies for Medicare, or a member of Congress who qualifies for Medicare, this is pretty much what you have. You can access a socialized system (congressional or V.A.), a single-payer system (Medicare) or choose to pay for private insurance. Your Representatives in Congress (including Republicans) have the best package in the United States.	U.S.A. for veterans and members of Congress (including Republicans) on Medicare.	NA*	NA*
	France	1st	11.1% ($3554)
Single Payer with a Private Insurance Option: A single payer plan is available to all citizens, but they are allowed to choose from private insurance for at least some services as well. Any American who qualifies for Medicare is essentially in this kind of system.	U.S.A. Citizens who qualify for Medicare.	NA*	NA*
	Canada	30th	10% ($3672)
*A Hybrid Insurance System* Private, Capitalistic, Insurance and Private, Capitalistic, Medicine with a Public Insurance Option and some Minimal Regulation: This is the approach the Democrats are proposing. Put some restrictions on the private system, keeping private insurance from denying care because of pre-existing conditions, etc. Create a public insurance program like Medicare, so that people have a choice if their insurance companies are unreasonable. The system is essentially capitalistic and free-market. All the doctors, hospitals, etc. are private, and most of the insurance is private, as well. But, because there's a public insurance option available, people have a choice, and therefore they have some power. If the private companies become unreasonable, they'll lose customers to the public option. So they'll have an incentive to treat their customers well--an incentive based on competition, not endless regulation.	The Democratic Plan	NA	NA
*Pure Capitalism* Private Insurance and Private Medicine without any Public Option. This is the system we have now, except for veterans, the military, and members of congress (including Republicans). The rest of us are stuck with it for the moment. It's the system that Republicans, the drug industry, and the big health insurance companies would like to keep us stuck with. It allows corporations to make big profits, because people have to have health care, and have nowhere else to go. It leaves many uninsured because they can't afford insurance, because they have pre-existing conditions, or because their insurance simply denies them care. It does nothing to control costs, and is rapidly bankrupting our country, leaving less money for quality of life, education, supporting our military, fighting terrorism, or investing in infrastructure.	U.S.A.—the current system for the rest of us. (2 above Cuba, 36 below France)	37th	15.3% ($6714)

*Ratings are for whole countries, so the references to segments of the U.S. Population are not rated.
**Some figures cited for England are for the United Kingdom as a whole.

It's nice to know we come in ahead of Cuba.

My own view is that we should probably be considering some variation of the French system.

Why shouldn't the U.S. system be number one?

But of course, the big corporations and the Republicans in congress won't allow us to get even close to that.

So I'll go for the Democratic plan as a start.

Something has to be done quickly to keep the present system from bankrupting us, and it would be nice if no one had to worry about losing their health care, or about not being covered when they need it.

We can tweak it as we go along—that's what we did with Medicare.

At least, that's what I think today.