Colin,
I worked during my career in America as an executive of Medicare and Medicaid fiscal intermediaries, private insurance companies, and various provider organizations. In most ways, our system is better than the European system for those with coverage and to some degree Europe benefits from our health care system as our system helps single payer systems to keep down their costs and achieve better outcomes.
There are two primary kinds of “single payer” systems in the world. The first one is where the government employs the vast majority of the providers in a country like the NHS system in Great Britain. The other is where the government “funds” health care but does not “provide” health care. These systems work a lot like Medicare in the US. But no matter what form of health care funding exists in a country, health care is “rationed”.
The concern of being “underinsured” is not addressed by a “single payer” system. European systems have various mechanisms for managing utilization. So like in the US, a person can be faced with financial issues related to being underinsured. This explains why so people in France (over 80%) purchase private health insurance to supplement their “single payer” system to avoid being underinsured. Specific to this article’s subject matter, Medicare (a form of universal coverage, which many politicians are advocating as “our” single payer system) does not cover everything and so it is recommended people purchase private MediGap policies or alternatively switch to private Medicare Advantage plans to minimize (not eliminate) the risk of being “underinsured”.
Canadians come to the US and pay out of pocket for certain diagnostic testing because their country requires long waiting periods to get the test. It is not that their country does not pay for it in Canada, but it is because they cannot access care quick enough. The costs of these diagnostic tests can be high and so lack of access can translate into “uninsured” costs for people who believe they are getting universal health care on demand.
So universal health care coverage does not insure access or protect against being “underinsured”. What it does is provide “common” health care coverage for all. Everyone is equally “underinsured” and equally suffers from lack of access. Depending on the resources of a country, this can translate into everyone having equally bad health insurance or average health insurance. Rarely, does universal health insurance translate into “great health insurance” simply because nations are restricted from using the tools necessary to provide “great health care” coverage. Why is the subject for another response.
The world benefits from the US system? In many areas of health care, but especially in the area of pharma benefits, the US pays for the innovation and development of new drug therapies. These therapies are incredibly expensive to develop. Once developed, the world’s health care systems benefit because America’s health care system pays most of the freight.
It is fair to ask whether we should continue this or begin to implement price controls on health care products and services like other nations. Trump has proposed doing this and met with resistance by Congress. If we did, then the effect would be to lower US health care costs and increase them in other countries, which seems fair to me.
A Harvard study concluded that it was not single payer systems that made health care more affordable overseas, but rather health care prices. If our country implemented price caps on health care products and services, we would reap 70% of the cost benefits of “single payer” systems while preserving our greater level of “choice”. The second major reason between the cost differential of the US health care system and single payer systems around the world had to do with diseases related to obesity. Hard to blame our “health care system” for this.
On the other hand, “choice” is what makes America’s health system potentially the best. Choice can have powerful impacts on quality as well as service. “Choice” is a necessary component of “great health care” at the individual and societal level.
So the answer to being “underinsured” is not a “single payer” system. In and of itself, universal health care does little to address that problem. Historically and globally, the answer has been in “supplemental” insurance. Said another way, since no where in the world is government prepared to pay for all health care costs under any circumstances, it is left to individuals to determine how much more health insurance they want to pay for, knowing that in order to be affordable, there must be a high probability that they will never use it (the concept of insurance is to spread the high costs of one individual over a large group). This is why so many people choose to be “underinsured”, they simply believe the chance of something bad happening does not justify the cost. A great example is how few people purchase long term care policies when they are young enough to purchase them at an affordable cost.
As the US approaches spending 20% of its economy on heath care, it is unlikely that the US or any country can provide total health care coverage for any potential medical condition. Bottom line, every country has a way to “ration” care and when individuals step outside those rationing limits, they incur the full cost themselves unless they can find a group of people to “share the cost” through a supplemental insurance product.
It is fair to argue what those limits should be and how best to spend the limited dollars our economy devotes to health care, but it is foolish for anyone to presume that “universal health care” coverage addresses being “underinsured” for all potential health care conditions.
