Tuesday, November 19, 2013

The Birth Pangs of Obamacare



All the problems plaguing Obamacare reminds me of a difficult delivery. Is Obamacare facing the wrong way? Is it going to be a stillbirth? Any newborn that enters a world so hostile to its arrival would make an immediate about face and want to return to the womb. But I, for one, am confident that Obamacare is here to stay.

The one problem with Obamacare that cannot be ignored is that it is so bloody complicated. Under normal circumstances, I wouldn’t bother with such a boring subject as health care, but this is a historical moment in US history, and I owe it to myself to understand the delivery process.

Comparing International Health Care Systems is the first step to guiding me through the muck of misinformation, most of it willfully created by the Republican Party. Ironically, it is Americans who should have the least difficulty recognizing all four models, since they are all part of the US’ fragmented health care system.


The Beveridge model: In this model, healthcare is provided and financed by the government. It is a single-payer system (meaning that only one entity pays for health care costs). People don’t get a doctor’s bill. This system exists in Britain, Spain, Scandinavia and New Zealand.

The Bismarck model: This is the familiar Employer/Employee funded insurance system. Under this system, everybody is covered and the cost is controlled by government regulation. This system exists in many European countries like Germany, France and the Netherlands (since 2006).

The National Health Insurance model: Under this system care is provided by the private sector, but payment comes from the government that everybody pays into. This system exists in Canada, Taiwan and South Korea. It has a high negotiating power for lower prices.

The Out of pocket model: The majority of countries in the world go without mass medical care. The rule in those countries is that the rich get care and the poor get sick or die. This system exists in Africa, India, China and South America.

The VA follows the Beveridge model and Medicare is a National Health Insurance model. If you get insurance through your employer you follow the Bismarck model and the 15% of Americans without health insurance have the privilege of following the Out of pocket model. They might just as well live in Africa.


Why does the US spend so much more on health care than other industrialized countries? Is it because Americans are less healthy and need more health care? Or is it because there is too much testing and an overuse of unnecessary procedures to guard against lawsuits? Are Americans hypochondriacs that go to the doctor at a drop of a hat? According to Republicans like Paul Ryan, the problem is that consumers don’t pay enough out of pocket and that plans are too generous.

Source: What is Driving Health Care Costs?
The truth is that, except for obesity and diabetis, Americans are healthier than other industrialized countries, mostly due to its large immigrant population, which is healthier than average. Americans also go to the doctor less frequently. If you lived in Japan you would go to the doctor every month, here we go twice a year (this is an average, of course).

So, if we use less health care but it is more expensive than in other OECD countries, the only explanation is that it must be more expensive. If you rent a lawn mower once a week, but pay more for it than someone who rents one every day, you are basically being screwed. Wouldn’t you agree?

In countries with a single payer system or a variation thereof, people pay for health care through taxes, and the government pays the providers. This gives it huge negotiating power. In a fragmented system like ours, no single entity has enough clout to bargain for health care goods and services. It also causes an enormous amount of administrative waste, both for the hospitals, doctors and insurance companies. On top of it, doctors and nurses are paid more and the for-profit nature of our system demands that hospitals, insurance companies and manufacturers, make a nice profit for their shareholders.

This is what Obamacare ultimately is about, to make it less expensive overall. To make health care more AFFORDABLE. Granted, some Americans will pay more, including me, but that is the price you pay to insure 45 million uninsured Americans. That is what the individual mandate is all about. The young and healthy SHOULD pay for the sick. We already do, but if we make the system more efficient it will become less expensive.

It is commendable that in a country this big, this diverse and this ‘libertarian’, Obamacare has become the law. In many European countries, universal health care has a long, long history. Here, it is a shock to most people’s system. The fact that there is not more opposition to it, attests to America’s willingness to become more socially conscious. The baby is here to stay. leave comment here