This question seems to come up a lot, especially in light of the ongoing debate about the future of the ACA and single-payer proposals. Most recently, a congressional candidate who is genuinely interested in the subject and finding an optimal solution posed it to us. So, what do the data tell us? Turns out there are actually a number of non-fully socialized systems that do well:
The first article, from the New York Times, set up a “playoff” of randomly assigned health systems. The authors asked a group of experts to pick the winners of each “game.” Note that UK’s National Health System (a single-payer system) did not fair very well in this assignment. And a different type of system with universal coverage “won out” – Switzerland, a system with private insurance and private delivery.
And here is an article that refers to rankings of the European systems. Note that they conclude that the Netherlands is best. Again, a system like Switzerland, that has universal coverage through private insurance and private delivery. They also conclude that, when looking at patient outcomes in particular, the government-run systems do not do well unless the country is small.
And even the Commonwealth Fund, which continues to rank the UK as the best system among those analyzed, says that they are disappointed that when it comes to patient outcomes, the UK does very poorly: “The U.K. stands out as a top performer in most categories except for health care outcomes, where it ranks with the U.S. near the bottom.”
As patients ourselves, we have always felt that what a health system is trying to provide, first and foremost, is excellent patient outcomes.
Interestingly enough, the US already has models for “fully-socialized” (VA/Military = UK), national health insurance (traditional, fee-for-service Medicare = Canada) and market-based (Federal Employees Health Benefit Plan /Tricare/employer-based = Netherlands/Switzerland) coverage schemes. Instead of re-inventing the wheel, why not chose the option that seems to promote high-value care (better outcomes at lower costs) and expand it to all? And on that note, Medicaid, the subject of another blog, is not the answer.
So, if we were asked, here are some key principles to keep in mind as we re-structure the current insurance system:
- People should have choice – this is the USA after all (conservative notion).
- Everyone should be insured birth to death in the SAME SCHEME (liberal notion).
- This would include the same set of insurance options, that everyone can chose for themselves and change as they see fit (conservative notion).
- The insurance options should be market based (conservative notion).
- The government role should be to provide means-tested premium support (liberal notion).
- The government should regulate the market with a utility mindset (liberal notion).
- People should have the options to buy up if they so desire (conservative notion).
These principles already exist in the insurance program for our federal employees and politicians – the Federal Employees Health Benefit Plan. Why not for the rest of us?