We Want It Too The United States is known for being one of the most powerful and influential countries in the world. Why is it then that the health care system in the United States is one of the least effective amongst developed nations? I will be reviewing, comparing, and contrasting four of the most well-known and most well established single-payer health care systems around the world. This includes: The National Health Insurance from Taiwan, Medicare from Australia, Medicare from Canada, and the United Kingdom’s National Health Service.
Single-Payer
First off, what is a single-payer health care system? It is a term used to describe the type of financing system, which refers to one entity acting as the payer; hence the name single-payer. So what happens is that this entity collects all the fees, and then pays out the costs for any health care related issue. What is the benefit of having just a single entity taking in all the bills? Well just in the United States alone there are over ten thousand different health care organizations including HMOs and billing agencies. And of course all of these different organizations have different types of forms and regulations on how to be billed, so it doesn’t take a rocket scientist to think what would be better. One agency so everything is formal and regulated or just random chaos. As Uwe Reinhardt stated during a U.S Senate Finance Committee, “We have 900 billing clerks at Duke (medical system), a 900 bed hospital. I’m not sure we have a nurse per each bed, but we have a billing clerk per bed… it’s obscene.” Now that we have the basics of single-payer understood, let’s get to what people really care about. How does the payment and financing work? For the payment, hospitals would receive an annual lump-sum from the government to cover operating costs. A separate lump-sum payment would cover other costs, such as: the purchase of new technology, marketing and possible hospital expansion. Doctors would be able to choose from two different types of payment: a salaried position, or a fee-for-service. Fees for the fee-for-service would be negotiated between a representative for these doctors and a state payment board. It would be federally financed. There are many choices of how it would be federally financed. Either to fund it with a payroll tax of around 5%, or one of the better options would to be funding it with a combination of existing federal and state revenues for health care. Copayments, deductibles and premiums of all kind would be eliminated. All sounds pretty good so far right? According to a Harvard research done, there is an estimated 750 billion dollars in waste each year in health care in the United States. That’s a lot of money being wasted, but you may ask, just where is this money being wasted? In the same research done, it is reported that there is six major areas of waste: unnecessary services ($210 billion), administrative costs ($190 billion), inefficient delivery of care ($130 billion), inflated prices ($105 billion), fraud ($75 billion), and finally prevention failures ($55 billion). Now I’m not saying there would not be waste in a single-payer system, but it would not be anywhere near this level. All the saved money would be able to cover the uninsured and improve the coverage for those who are already insured. Now let’s take a look around the world, at other countries that have seen these facts and adopted them into their own single-payer health care systems. As I said earlier, we will be looking at Taiwan, The United Kingdom, Australia, and Canada—more specifically the province of Ontario.
Taiwan
The single-payer health care system in Taiwan is known as the National Health Insurance. In the 1980s Taiwan started their health care reform. While doing so, they looked at over ten countries as a guide to form their own system. The National Health Insurance was instituted in 1995, and by 2004 coverage was at 99% of the population of Taiwan. From a 2009