The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care

by T.R. Reid

THESE FOUR MODELS SHOULD be fairly easy for Americans to understand, because we have elements of all of them in our convoluted national health care apparatus: • For most working people under sixty-five, we’re Germany or Japan. In standard Bismarck Model fashion, the worker and the employer share the premiums for a health insurance policy. The insurer picks up most of the tab for treatment, with the patient either making a co-payment or paying a percentage. • For Native Americans, military personnel, and veterans, we’re Britain, or Cuba. The VA and much of the Pentagon’s Tri-Star system involve doctors who are government employees working in government-owned clinics and hospitals. Following the Beveridge Model, Americans in these systems never get a medical bill. The Indian Health Service also provides free care in government clinics. • For those over sixty-five, we’re Canada. U.S. Medicare is essentially a National Health Insurance scheme, with the near-universal participation and the low administrative costs that characterize such systems. Americans with end-stage renal disease, regardless of age, are also covered by Medicare; this group had enough political clout to get what it wanted from Congress, and the “dialysis community” opted for coverage under the government-run NHI system. • For the 45 million uninsured Americans, we’re Cambodia, or Burkina Faso, or rural India. These people have access to medical care if they can pay the bill out of pocket at the time of treat...