Tuesday, October 16, 2012

Healing Healthcare

Liberals like to pretend that you can, with impunity, spend unlimited money and that tax dollars are a blank check. This fosters an environment that culminates with using tax dollars to pay for the sex change operation of inmates. Conservatives tend to avoid admitting that society has any obligation to provide healthcare for its members. This leads to an unsavory 'let him die' attitude.

In order to provide a discussion for answers instead of simply pointing out problems, I have included the basic models of healthcare that are sustainable, but which also have varying levels of government interference, regulation, and use of tax dollars.

The Bismarck Model operates solely in the private market. The providers (doctors, clinics, and hospitals) as well as the payers (insurance plans) are all private entities. The payers are nonprofit, tax exempt entities that are required to dump a certain percentage of premium dollars into actual healthcare costs. There are over 200 competing insurance companies and there is a governmental individual mandate. The countries operating in this manner are Germany, France, Belgium, and Japan.

The Beveridge Model is a bit different. All healthcare services are provided by the government much like the fire and police departments. Hospitals are all owned by the government and doctors are either government employees or private practitioners that contract with the government. Patients get no bills and this model is seen in Britain, Italy, Spain, Sweden, and Cuba.

The National Health Insurance Model is the classic single payer system seen in Canada, Taiwan, and South Korea. The government collects taxes, pays a set amount for services provided, and providers are private entities that bill the government.

The Out of Pocket Model is the one probably most familiar to everyone. There is no insurance and providers are private entities that bill the patients who are directly responsible for the costs.

For most working people under 65 we operate in the Bismarck Model where employers and employees share the premium and the insurance pays most of the tab to private providers. For Native Americans, military personnel, and veterans we operate in the Beveridge Model where the providers are government employees working in government-owned clinics and hospitals and the patients never get a bill. For those over 65 we operate in the National Health Insurance Model where Medicare is the single payer, costs are paid by collecting and dispersing taxes to private providers. Those who are uninsured, either through choice or extreme indigence, operate by paying out of pocket for any medical expenses.

I find the least to dislike about the Bismarck Model because it has the least amount of government regulation, it fosters competition among providers, and one person subsidizing another is minimized.. In order to make it the most palatable for the greatest number, the individual mandate would be necessary as well as government assistance with the premiums for those near the poverty line. However, helping to pay for the premiums of health insurance is a small price to pay for doing away with government funded operations, pharmaceuticals, medical equipment, hospital stays, labors and deliveries, and health maintenance of 130 million people: 3 million federal, 20 million state, and local government employees not counting their dependents or contractors, 2 million inmates, 104 million people on Medicare and Medicaid, and the miscellaneous Native Americans and Alaskan Natives.

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