Universal health care

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Universal health care is a state in which all residents of a geographic or political entity have access to health care.^[1]

Universal health care is not tied to any particular health care system, though it is the motivation for the socialized medicine practiced in countries such as Italy^[2] , the United Kingdom and most, not all services paid for by the government, and most all services provided by the private sector. Some theorists claim universal health care could be accomplished via private enterprise, without government regulation of the health care industry, but no completely private system currently exists.

Contents 1 Types of universal health care 1.1 Single-payer health care 1.2 Hybrid health care 1.3 Private universal health care 2 Economics of medical insurance 3 Funding of universal health care systems 4 Countries with universal health care 5 Health Care in the United States 6 Universal health care politics 7 Support for universal health care 8 Opposition to universal health care 9 References 10 See also 10.1 Examples 10.2 Related topics 11 External links 11.1 Supporting universal health care 11.2 Opposing universal health care 11.3 Neutral

[edit] Types of universal health care

Universal health care is a broad concept and has been implemented in several ways. The common denominator for them all is that every resident of a geographic area — such as a country — is mandated to have health insurance. In market-based systems, a.k.a., "capitalistic" systems, as used in part by the USA, the mandate is coupled with a private insurance market. In government monopoly systems, a.k.a., "socialistic" systems, the mandate is coupled with a government agency that pays for a wide range of health benefits. The government monopoly is paid for with taxes, most commonly on payroll, a year end tax income tax calculation, or from general government revenues.

The variety of ways that a country can fund health care can be highlighted by the example of Canada. Prior to the Universal health care system, individuals paid out of pocket. Later the Canadian government imposed monthly or yearly insurance type fees per family or individual. Recently the government eliminated the fee structure in favor of a strictly tax based funding system. Today Canada has re-introduced and implemented added health insurance tax through annual income tax system form.

There are no universal health care systems that cover all thinkable health services. The Health Care System in Canada is a case in point. It is socialized in the relevant aspect of funding. This makes the Canadian system a single payer system. Most health services are provided by private enterprises which act as contractors, billing the government for patient care.^[3]

[edit] Single-payer health care

Main article: single-payer health care

Single-payer health care is a system whereby one party, usually the government, pays for the health care of everyone. In practice this means that the government collects taxes from the public, businesses, etc., creates an entity to administer the supply of health care and then pays health care professionals. While this replaces competing health insurance companies, some claim that it tends to create a large government bureaucracy.^{[citation needed]}

[edit] Hybrid health care

Universal health care can be implemented without having the government pay for it in full, as in single-payer health care. Hybrid health care models emerged from efforts to reconcile the drive for expanded access and the drive against rising health care prices. This model is geared towards getting past the dichotomies that have stymied universal health care efforts, such as whether the state or federal governments should take the lead, whether the primary jurisdiction for negotiating health care should be at the market or government level and whether health care is more of an individual or societal responsibility. There are no examples of single payer systems that have successfully converted into a hybrid model, although there are examples of countries that have moved from private insurance to a hybrid model, one example is Germany.

[edit] Private universal health care

No such system currently exists, although the reform bill in Massachusetts has characteristics of a private universal model. Advocates of the free market define a private universal health care system as one in which health care would be affordable to all, and anyone who wanted to buy health care could do so in the free market. Some of these free-market health care systems would provide vouchers to those who couldn't afford to pay. Others would not involve any wealth redistribution.

If a government subsidizes health care, the free market will never be able to develop a private universal health care system, advocates argue, claiming this is why no such system has ever existed.

Bill Frist argued in the New England Journal of Medicine^{[citation needed]} that the free market will keep costs down, because individuals who have to pay for their own health care will make wiser decisions and not spend money on unneeded or inefficient care. A deregulated free market, Frist argues, will also encourage efficiency and innovation.

[edit] Economics of medical insurance

Medical (health) insurance is subject to the well-known economic problem of adverse selection which may also be referred to as a market failure. Adverse selection in insurance markets occurs because those providing insurance have limited information with which to estimate the risks their clients wish to insure against. In simple terms, those with poor health will apply for insurance, raising the cost of providing insurance; those with good health will find the cost of insurance too expensive, raising costs further. In practical terms, adverse selection means that private insurers are economically incentivized to spend substantial sums on 'weeding out' bad risks in advance by providing medical insurance only to the most healthy.

Among the potential solutions posited by economists are forms of universal health insurance, such as requiring all citizens to purchase insurance, limiting the ability of insurance companies to deny insurance to individuals or vary price between individuals. Compulsory universal health insurance is a common thread, although there is no requirement that the insurance or medical services be provided by government.^[4] , ^[5]

[edit] Funding of universal health care systems

Most European systems are financed through a mix of public and private contributions.^[6] The majority of universal health care systems are funded primarily by tax revenue (e.g. Portugal^[6]). Some nations, such as Germany, France^[7] and Japan^[8] employ a multi-payer system in which health care is funded by private and public contributions.

"Single-payer" describes a type of financing system in which a single entity, typically a government-run organization, acts as the administrator (or "payer") to collect all health care fees, and pay out all health care costs.^[9] Some advocates of universal health care assert that single-payer systems save money that could be used directly towards health care by reducing administrative waste.^[9] For instance, according to the Drum Major Institute, a public policy, non-profit organization founded by Harry Wachtel, lawyer and advisor to Martin Luther King Jr., the estimated amount the U.S. would save each year on paperwork if it adopted single-payer health care is $161 billion. Denmark, Sweden, and Canada are some of the countries that currently employ single-payer financing of health care.^[8]

A distinction is also made between municipal and national healthcare funding. For example, one model is that the bulk of the healthcare is funded by the municipality, speciality healthcare is provided and possibly funded by a larger entity, such as a municipal co-operation board or the state, and the medications are paid by a state agency.

[edit] Countries with universal health care

Argentina,^[10] Australia,^[7][10] Austria,^[7] Belgium,^[7] Brazil,^[7] Canada,^[7] Cuba,^[7] Denmark,^[7] Finland,^[7] France,^[7][10] Germany,^[7] Greece,^[10][11] Ireland,^[12] Israel,^[13] Italy,^[10][14] Japan,^[7] The Netherlands,^[7] New Zealand,^[7] Norway,^[7], Poland, Portugal,^[6] Russia,^[10] Saudi Arabia,^[10] Seychelles,^[15] South Korea^[10] Spain,^[7] Sri Lanka,^[16] Sweden,^[7] The Republic of China (Taiwan),^[7] and the United Kingdom^[7][10] are among many countries that have various types of universal health care systems.

Mexico,^[10] South Africa,^[7][10] and Thailand^[17] are among those nations attempting to implement universal health care systems.

[edit] Health Care in the United States

In the United States, certain publicly funded health care programs help to provide for the elderly, disabled, military service families and veterans, and the poor^[18] and federal law ensures public access to emergency services regardless of ability to pay;^[19] however, a system of universal health care has not been implemented. The Commonwealth of Massachusetts is attempting to implement a near-universal health care system by mandating that residents purchase health insurance by July 1, 2007.^[20] California, Maine, Pennsylvania, and Vermont also are attempting universal systems.^[21]

If a government has a public health care system, it is usually illegal for private institutions to provide healthcare insurance by offering lower prices. That is, it is an enforced government monopoly.^{[citation needed]} Until recently, private health insurance was illegal in all of Canada.^{[citation needed]} All insurance was supplied by the government. Recently, the Supreme Court of Quebec ruled, in Chaoulli v. Quebec that private business must be allowed to offer health insurance and compete with the public program.[4]

However, those who are proponents of implementing a universal healthcare system in the United States point out the fact that there are many flaws in the reasoning used against having such a system. Among these flaws, the one that stands out is the fact that the USA has a lower life expectancy than virtually all other countries in a similar economic class, including those with national healthcare systems, such as Australia, the United Kingdom, Canada, and Sweden.^[22] Also, infant mortality rates remain higher in the United States as well, despite declines in recent decades, and are in fact higher than the average of the European Union; however, this fails to take into effect that premature births are not counted as live births in most EU nations, potentially resulting in this disparity. -see table^[23]

Current estimates put US healthcare spending at approximately 15% of GDP, which is the highest in the world.^[24] Despite this, only an estimated 85% of citizens have some form of health insurance coverage, either through their employer or purchased individually.^{[25] [26]}

Employers that do provide insurance, on average, spend between 4.6 and 8.7% of their payroll in health insurance premiums. This, while expensive, is a lower percentage than France, where employers must pay a sum of 14% of their payroll for health insurance.

[edit] Universal health care politics

Main article: Health care politics

There are many common arguments for and against universal health care. Those in favor of universal health care often point out that it would provide health care to the people who currently do not have it. Opponents of universal health care often argue that universal healthcare will require higher taxes and a great likelihood of poorly performing healthcare facilities and physicians. ^[27] These opponents also claim that the absence of a market mechanism may slow innovation in treatment and research, and leads to rationing of care through waiting lists.^[28] Both sides of the political spectrum have also looked to more philosophical arguments, debating whether or not people have a fundamental right to have health care provided to them by their government.^{[citation needed]}

Other objections come from physicians, since universal health care almost always lowers wages leading to a shortage of doctors. A statistical comparison shows that it is not universal health care that leads to a doctor shortage, but the payment system to doctors that causes a doctors shortage. In Italy,^[29] doctors are paid a fee per patient per year, a per capita salary, and Italy does not have a doctor shortage but has one of the highest doctor per patient ration, 5.8 doctors per 1,000 patients. In Italy though, it should be noted that most physicians subsequently have very limited hours; many only maintaining patient hours 2 days per week. Canada, whose universal health care system pays its doctors a "fee per visit", creates a real market condition, where doctors' salaries are protected, and even increased, by decreasing the supply of doctors. Canada has a low doctor per patient ration of 2.1 doctors per 1,000 patients. A comparative analysis shows that a salaried doctor system, while not perfect, results in more doctors; however, they work substantially fewer hours, while the fee per visit system creates economic pressures to reduce the number of doctors, who subsequently work more hours.

The issue of quality control is an important aspect of any system, and in Canada, the self regulation of the health industry by the doctors union, the Canadian Medical Association, and its self regulatory wing, College of Physicians and Surgeons of Ontario shows that most complaints are swept under the rug, (Toronto Star reports) ^[30] and very few complaints sent to quality control for study.

[edit] Support for universal health care

Common arguments waged from supporters of universal health care systems are:

• Health care is a right^[31][32] or entitlement.^[33]
• Ensuring the health of all citizens benefits a nation economically.^[34]
• Provides coverage to all citizens regardless of ability to pay.^[35]
• Health care is increasingly unaffordable for businesses and individuals.^[35]
• Universal health care would provide for uninsured adults who may forego treatment needed for chronic health conditions.^[36]
• Providing access to medical treatment to those who cannot afford it themselves reduces the severity of epidemics by reducing the number of disease carriers.
• Reduces wastefulness and inefficiencies in the delivery of health care.^[35]
• Aligns incentives for investment in long term health-care productivity, preventive care, and better management of chronic conditions.^[37]
• Encourages patients to seek preventive care enabling problems to be detected and treated earlier.^[35]
• A centralized national database makes diagnosis and treatment easier for doctors.^[35]
• Medical professionals can concentrate on treating patients rather than on administrative duties.^[35]
• Profit-driven care leads to more deaths^[38] and is more expensive.^[39]
• Universal health care can act as a subsidy to business, at no cost to the business. The Big Three of U.S. car manufacturers cite health-care provision as a reason for their ongoing financial travails. The cost of health insurance to U.S. car manufacturers adds between USD 900 and USD 1,400 to each car made in the U.S.A.^[40]
• The profit motive adversely affects the cost and quality of health care.^[41]

[edit] Opposition to universal health care

Common arguments waged from opponents of universal health care systems are:

• Health care is not a right.^[42][43][44]

• Providing health care is not the responsibility of government.^[45]
• Increased waiting times, which can result in unnecessary deaths.^[42][46]
• Poorer quality of care.^[42][35]
• Unequal access and health disparities still exist in universal health care systems.^[42]
• Government agencies are less efficient due to bureaucracy.^[35][42] Administrative duties, by doctors, are the result of medical centralization and over-regulation, and are not natural to the profession. In fact, before heavy regulation of the health care and insurance industries, doctor visits to the elderly, and free care, or low cost care to impoverished patients was common; governments regulated this form of charity out of existence.^[47] Universal health care plans will add more inefficiency to the medical system because of more bureaucratic oversight and more paperwork, which will lead to less doctor patient visits.^[48]
• Profit motives, competition, and individual ingenuity lead to greater cost control and effectiveness.^[35]
• Uninsured citizens can sometimes still receive emergency care from alternative sources such as nonprofits and government-run hospitals.^[35]
• Government-mandated procedures reduce doctor flexibility.^[35]
• Healthy people who take care of themselves have to pay for the burden of those who smoke, are obese, etc. ^[35]
• Loss of private practice options and possible reduced pay dissuades many would-be doctors from pursuing the profession.^[35]
• Causes loss of insurance industry jobs and other business closures in the private sector.^[35]
• Eliminates a right to privacy between doctors and patients as governments demand power to oversee health of citizens.^[49]
• Empirical evidence on single payer insurance programs demonstrates that the cost exceeds the expectations of advocates.^[50]
• Governments, such as Canada, have outlawed medical care if the service is paid for by private individual funds. This results as governments attempt to control costs by gaining or enforcing monopsony power.^[51]

[edit] References

[edit] See also

[edit] Examples

• Medicare (Australia)
• Medicare (Canada)
• National Health Service (United Kingdom)
• Journal of Health Care for the Poor and Underserved
• Medicare in Italy Ranked in the top three in the world.
• Medicare in France Ranked in the top three in the world.

[edit] Related topics

• Health savings account
• Medical savings account
• Medicare (United States)
• Two-tier health care
• Massachusetts 2006 Health Reform Statute

[edit] External links

[edit] Supporting universal health care

• American Medical Student Association (AMSA)
• Connecticut Coalition for Universal Health Care
• Physicians for a National Health Program (PNHP)
• Universal Health Care Action Network (UHCAN)
• Universal Health Care / National Health Insurance

[edit] Opposing universal health care

• Capitalism Magazine
• The Problems with Socialized Health Care from Mark Valenti's Liberty Page
• British, Canadian Experience Shows Folly of Socialized Medicine, Analyst Says. Press release, Heritage Foundation. Sept. 29, 2000.

[edit] Neutral

• BalancedPolitics.org - "Should the Government Provide Free Universal Health Care for All Americans?"

• Hidden costs, value lost: uninsurance in America. Institute of Medicine Committee on the Consequences of Uninsurance. Washington, DC: National Academies Press, 2003.