Every wealthy country other than the United States guarantees essential
care to all its citizens. There are, however, wide variations in the specifics,
with three main approaches taken.
In Britain, the government itself runs the hospitals and employs
the doctors. We’ve all heard scare stories about how that works in practice;
these stories are false. Like every system, the National Health Service has
problems, but over all it appears to provide quite good care while spending only
about 40 percent as much per person as we do. By the way, our own Veterans
Health Administration, which is run somewhat like the British health service,
also manages to combine quality care with low costs.
The second route to universal coverage leaves the actual delivery of
health care in private hands, but the government pays most of the bills. That’s
how Canada and, in a more complex fashion, France do it. It’s also a system
familiar to most Americans, since even those of us not yet on Medicare have
parents and relatives who are.
Again, you hear a lot of horror stories about such systems, most of
them false. French health care is excellent. Canadians with chronic conditions
are more satisfied with their system than their U.S. counterparts. And Medicare
is highly popular, as evidenced by the tendency of town-hall protesters to
demand that the government keep its hands off the program.
Finally, the third route to universal coverage relies on private
insurance companies, using a combination of regulation and subsidies to ensure
that everyone is covered. Switzerland offers the clearest example: everyone is
required to buy insurance, insurers can’t discriminate based on medical history
or pre-existing conditions, and lower-income citizens get government help in
paying for their policies.
So what should we do?
So where does Obamacare fit into all this? Basically, it’s a plan to
Swissify America, using regulation and subsidies to ensure universal
If we were starting from scratch we probably wouldn’t have chosen this
route. True “socialized medicine” would undoubtedly cost less, and a
straightforward extension of Medicare-type coverage to all Americans would
probably be cheaper than a Swiss-style system. That’s why I and others believe
that a true public option competing with private insurers is extremely
important: otherwise, rising costs could all too easily undermine the whole
But a Swiss-style system of universal coverage would be a vast
improvement on what we have now. And we already know that such systems work.
So we can do this. At this point, all that stands in the way of
universal health care in America are the greed of the medical-industrial
complex, the lies of the right-wing propaganda machine, and the gullibility of
voters who believe those lies.