If an alien came to America today and asked you to describe our health care system, could you?
I certainly doubt you would be able to fit it into one sentence. It’s a smorgasbord of private insurance, government programs (Medicare and Medicaid), non-profits and a lot of things in between. Lucky for some other countries, they don’t have this problem. And two in particular, Germany and Britain, are seen by experts as two of the best models for health care.
The Bismarck Model
For 130 years the Germans have been using this model of health care. Adopted by the French and many other countries, including the U.S. to some extent, this system uses insurance or “sickness funds” to pay for medical care. Employers and employees contribute to the funds through payroll and the government sets budgets and prices. This model works really well for a lot of countries despite the doctors who often exercise their right to strike and protest for higher wages.
The Beveridge Model
This is the epitome of the single-payer system. The government, through taxes, is the sole payer of medical care in Britain and other countries such as Spain and Cuba who’ve adopted the model. The government keeps costs low and patients never see a bill.
The Obamacare Model?
The other week I had the privilege of seeing Wes Moore speak (author of The Other Wes Moore, a true story about two boys from Baltimore with the same name who grew up to have very different lives — a must read). He said one of the smartest things I’ve heard in a while. His definition of a good politician was someone who sees what’s already working and helps to make it work bigger and better. To me, I think that is what the Obama administration tried to do when it came to health care reform.
For example — and Obama has said this many times — they looked at Mayo Clinic and Kaiser Permeante for inspiration on the Accountable Care Organizations that have been popping up in Medicaid. In these organizations, multi-disciplinary groups of health care providers are accountable for the quality and cost of care to the patient. This could be a shift from the old fee-for-service model of payment and is one of the few cost-control initiatives in the affordable care act.
On a less popular note, what had been working (or more like had created a market so big that it couldn’t be shut down, cough, cough Blue Cross Blue Shield) were private insurance and employer-based insurance. Since the turn of the 20th century this is what has been “working” and is most popular in the country, for better or for worse.
In this way and many others, Obamacare tried to improve on our current mash-up health care system. But will Obamacare be known as a model for health care? It certainly is the first reform and health care system that advocates for the market-based approach. Even though the Affordable Care Act itself isn’t popular, most of the provisions on their own are.
