by Alison Hayward, MD
SDN Staff Writer
In this election season, healthcare has been an increasingly pressing issue for American voters.
In an August 2008 TNS Healthcare survey, nearly 60% of voters age 18-29, and 75% of voters over the age of 65 agreed that healthcare issues would play a major role in their presidential election choice.
The feeling that our current system is a “failure” predominates, and thus healthcare reform is seen by many as a mandate for the new president.
Healthcare professionals must understand the issues involved in the politics of health in order to move towards reform – and that brings us to one of the most contentious issues, that of single payer healthcare.
A single payer system would clearly be a radical change. In the current system, private insurance companies independently negotiate payments with healthcare providers, which are different than the payments made by government programs like Medicare and Medicaid. These, in turn, are different than the payments that a patient would make out of pocket if uninsured. This system has made the costs of healthcare services seem mysterious and fluid in nature, numbers drawn out of a hat.
Those from the left side of the political spectrum tend to advocate single payer systems as a curative solution for this bureaucratic nightmare, pointing out that eliminating complex billing and administrative procedures from healthcare offices and centers would be a huge cost-saver and tool for simplification. Those who approach the issue from the right tend to advocate transparency in billing as a free market approach to the problem, reasoning that if patients were able to act as customers of a healthcare business, they could then shop around for lower cost services and understand far more clearly the actual cost versus benefit equation for proposed therapies.
There are major challenges to both these views. For example, though a single payer system might be able to greatly reduce healthcare costs through elimination of complex billing procedures, many suspect that it could just as easily reduce healthcare costs through reducing payments to physicians and other providers. Medical professionals, already angered by the inability of Medicare to cover the costs of patient care, are understandably fearful of the idea of governmental disbursement of all patient care costs.
Though Medicare is efficient in terms of administration and billing, it is often accused of reducing access to healthcare. Many doctors already have stopped taking Medicare patients in their practices, and more are poised to do the same. In fact, the AMA has estimated that 60% of physicians would limit their Medicare patients if the payment cuts continued. The current political situation is that there will be a meager 1.1% raise in payments in January 2009, which seems unlikely to keep pace with inflation. Since the underlying formula that directs payment increases and cuts has not been corrected, a 20% cut is pending for 2010. The Medicare and Medicaid programs already cover a third of Americans, and with costs on the rise, they already consume 40% of our federal budget. Single payer is often referred to as “Medicare for all” – clearly not a thrilling prospect considering the challenges the program has faced.
To look critically at the conservative viewpoint, it is difficult to see how a free market philosophy could be easily applied to the healthcare industry. After all, sick patients are often not in a position to shop for the cheapest care. A patient often is geographically limited in terms of the healthcare facilities that are available. And a patient who chooses to “save” by shunning preventative healthcare or by avoiding purchasing health insurance can drive up costs for others by then incurring an avalanche of unpaid costs when disaster strikes. Thus the idea that we can exist as independent healthcare consumers is a bit misleading, since in fact we may have an interest in keeping our neighbors healthy.
So what is single payer, specifically? Conservatives who disapprove of increased government intervention into healthcare often refer to single payer as socialist. As Michael Moore pointed out in the documentary “Sicko,” common public institutions such as police departments and libraries are more truly socialist than a single payer healthcare system because they are not only government financed, they are also government run. But they don’t generate the same amount of controversy. Some countries, such as Cuba, have a socialist healthcare system run by the government. Single payer specifically refers to a system that is paid for by one entity, generally understood to be the government, but does not specify how the healthcare system is run. A proposal in the United States for the government to run all hospitals and medical offices seems unlikely to meet with success.
Even single payer itself seems less than mainstream. Democratic presidential candidate Barack Obama does not have it as part of his platform (he has stated, though, that he would support single payer for building a healthcare system “from scratch”). But if single payer healthcare becomes a reality, strict accountability and quality measures will be crucial to track how taxpayer money is being spent.
Single payer is gaining popularity as a concept. A 2003 Pew poll found that 72 percent of Americans favored government-guaranteed health insurance for all. Whether it could realistically be successful in the United States, where employer-based, private health insurance is an entrenched concept, is another question. Look for increasing debate on the pros and cons of single payer as healthcare reform looms as a legislative priority.
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Great article, its nice to have a seemingly unbiased news feed point out the pros and cons of our current and future health care possibilities. I think for right now its safe to say there is not a win win answer to please everyone. It will be interesting to see how this election unfolds and what changes might be implemented in our health care system. If the single payer system, which is currently gaining popularity, is indeed eventually initiated, what changes will that hold for future health care providers regarding both salary, and schedule?…
Although the economy has pretty much single-handedly pushed Obama over the top, guaranteeing his election, it is fortunate that the downturn will also shrink the government’s tax revenues. Obama will be less able to push for socialized healthcare when the budget is tight, and financially squeezed households will be more averse to tax increases to pay for such entitlements.
End the beaurocratic nightmare…? – This is the govt we are talking about.
Medicare is efficient….? – Are you kidding me?
You can’t be serious.
That all depends on who you are talking about when you say “Americans”, because Obama clearly is not proposing to raise EVERYONE’S taxes. Per capita, we should see the cost of healthcare drop dramatically, although the rich will pay more than they do now covering themselves to cover others. Looking at Obama’s plan, I see no reason an across-the-board tax increase would be required.
I like to look at this like the education issue. The family making $30,000 a year does not pay enough in taxes to cover putting their child (or, children) through school. However we, as a society, have decided it is beneficial and fair to educate all children. This is done on the backs of those who make more money through progressive taxation and property taxes. For instance, someone making $1 million per year may pay enough taxes to put 10 children through public education.
Now, we probably all agree that it would be detrimental to society to just allow the free market to work in education. If the family can’t afford the $10,000 per year (completely unsubsidized, since we’re removing the government), then their child simply cannot go to school. I don’t think (most) Americans would accept a scenario like this, so why should we treat healthcare differently?
considering that there is a shortage of physicians as it is forcing physicians to only take one form of payment unless they are in plastics is going to make it even more difficult for people to see doctors because there will be even less of them! Not only that, look at Canada; it can take up to three months for someone to get in to get films taken. So, lets add an even worse shortage of physicians since less people will want to go into medicine if they’re going to get the same treatment that medicare gives PLUS, people thinking that every bump and scratch deserves a visit to the doctor since they’re paying for it anyways. We should just stop having a medical system in the U.S. and just start letting people “fight it out”.
A “single payer system” is grossly unfair and is bound to almost be a complete disaster if implemented by our government. The fact that medicare is a part of social security and that both have been on the verge of collapse for several years should be a very good indicator of the governments inability to manage this issue.
Furthermore, how are we going to make sure that illegal immigrants (all 12 million+) are not taking advantage of this situations. There are cities across this country that are giving these people valid IDs and other privilages. Why should a hardworking american taxpayer pay for people who have no respect for our laws?
Speaking from personal experience, the government can and WILL have total control over reimbursement and quality of care. The military medical system is the closest model of a government controlled system. We have already seen the recent reports of how wonderfully wartime veterans’ medical issues are being treated by the governments. There is also the mandated guidelines for kidney care (epo & dialysis). The bottom line is, THE GOVERNMENT DOES NOT NEGOTIATE IT DICTATES!!
The quality of care in this country will go down with a single payer system. The way out of this crisis is a total overhaul and a consumer based system similar (but modified to fit our government structure) to the one in switzerland.
In response to the 2nd comment, people are already “paying for it anyways”. Everyone with a job in this country has a percentage of their paycheck going to Medicare. And I don’t think people will just seek care for every bump and scratch because, frankly, nobody likes waiting in the doctor’s office/ER for 3+ hours. What a single payer system will prevent is people waiting until their condition is so bad that a ridiculously expensive amount of medicine/procedures must be used to just slightly prolong their life, whereas if they could have been covered to seek medical care earlier, screening methods aka “preventive medicine” could have been used to detect and treat their condition earlier. Overall this results in better health for everybody, and lowers the cost of health care because less expensive procedures have to be performed.
“Obama will be less able to push for socialized healthcare when the budget is tight, and financially squeezed households will be more averse to tax increases to pay for such entitlements.”
Good thing he is only raising taxes on those who can afford to pay it. A 3% increase on income greater than $250,000 (which is back to where it was before President Bush) isn’t going to affect financially squeezed households.
Solving the healthcare problems are EASY. Passing the laws are HARD due to lobbies, stupid people, rhetoric etc.
1) No single payer. Private insurance becomes portable, no exemptions for pre-existing conditions.
2) Some form of insurance is mandatory, gov sets the minimum standard and everyone is insured at a baseline level through payroll tax (you get preventative and acute hospitalizations but NOT million dollar workups or therapies).
3) Government runs a SINGLE computer billing and EMR system that EVERYONE uses. While ppl may not like this, it cuts down on massive duplication and also you get sharing of EMR between hospitals and clinics.
4) Doctors are essentially un-suable, like in the military. In exchange, a robust peer-review system is setup that takes away licences for gross negligence.
5) Doctors are incentivized NOT to practice defensive medicine by limiting expensive studies. They are also incentivized by getting paid more if their patients rate them highly through a central survey database.
America will never be told “No.” We’ll always vote for the candidate who will promise us more. US citizens would rather believe a lie than be told no. At some point the handouts stop, and by my guess, it’ll be because there will be nothing left to take, not because anyone will ever actually try reform it. But what do you expect from the US. We live beyond our means. Credit cards, mortgages to people who can’t afford them, and most of all, a government that spends more than it’s income. Spend less? Nah. Let’s just tax more, borrow more, “fix” more. Where exactly do you think all this money is coming from? I wish I was selling ink and paper to the Treasury. Better yet to be China, buying up all our government and consumer debt.
No more entitlement programs. End of story. At some point our debts will be called in, and future generations will have to pay up, which they won’t even be able to do without having over half their income taxed (let alone taxing the rich more). There’s no money to pay for the level of health care we already are handing out, let alone what politicians plan to give out. The comptroller general has been warning us about this for years.
Anyone who’s worked in a hospital for 10 minutes can see how little we value our elderly. Even with Medicare and more policies, it won’t change the underlying attitude of the growing majority of Americans. We don’t value life. To our generation, the elderly are a problem to be solved, not a revered member of our family. And since we’ll still be too busy trying to buy our way to happiness, we’ll continue to overlook them. By the time I retire, I expect euthanasia will be a legitimate option for care of the elderly.
You guys can keep dreaming that money grows on trees. If you’re wise you’ll start saving for retirement now, make a budget, live within your means, pay off debt early, and live as healthy as possible, because these programs won’t be there for us.
I like the article since it’s balanced unlike anything I here from either Dems or Pubs. I also like some of the ideas already proposed. The main issue is our compensation suffering whether people want to say it or not. So as long as we have a set wage/hour and maximum set number of hours while everything above that would be “free market”, I think most of us would have no problem. And every time a patient complains about why I can’t get this or that, just say you voted for it. Ah…Democracy!!
Anyone who uses Michael Moore as a REFERENCE (mush less refers to his crap as a “documentary”) has lost my attention.
Among the physicians I have personally polled, none of them would agree that the Medicare system of billing and reimbursement is “efficient.” Based on the evidence, I would doubt that a single-payer billing system would be efficient either. If you want proof, just look at our tax system that is run by one entity–the IRS–and the complicated tax code that has resulted. I suspect a new specialty area in law will be created under this system because of its complexity just like has happened with the tax system.
I am sick of individuals who are supposed to be some of the brightest people in society (doctors) not looking at these issues more critically. In addition to the single-payer system that (make no mistake about it) a democrat-run government would push, we are also facing higher taxes. How many of you future-doctors plan to make at least $250,000/year? Do you not realize that the higher taxes PROMISED by the left will affect you and your ability to sustain a private practice? Now add to that a history of decreasing reimbursement like we have seen with Medicare and state-run insurance. The bottom-line is the possible end of the private practice.
I hope everyone will think about these things between now and election day.
It is very reassuring knowing that there are others out there who oppose the single-payer system. The most socialized form of medicine in the U.S. is Medicare, and most would agree that it is a complete and utter failure. I think the figure – 70 trillion need in a savings account right to cover all the people who are dependent on it right now or have paid into it.
Allowing competition in medicine is truly what seems to be lowering prices and pushing advancements – look at laser eye surgery and plastics. Competition isn’t something that a single-payer system can emulate. It is for all intents and purposely a monopoly run by the government. Though you could argue that voting would prevent this concentration of power, in reality it is very different than a free market response in three main ways 1)there will be a delay in change 2)voting tend to be all or nothing rather than proportional – things that a minority of the population support (e.g. hollistic medicine) may be eliminated all together 3)corruption exists politics
My hope is that despite Obama and despite the popularity of handouts (legal plunder), that healthcare will progress in a direction of freedom. I will certainty fight for it.
The majority of physicians DO NOT make over $250,000/year. Those that do should have no problem in continuing to sustain their private practice, given that the internists who make roughly $140,000 are able to do so. The reason Medicare continuously decreases its reimbursement is because it’s broke… but where do you think the increased taxes on those that make over $250,000 are going to go? Hopefully back into the system, thereby preventing Medicare’s need to decrease its reimbursements. I think we need to look at the big picture here and realize that what’s better for the “little guy” may actually be good for us physicians too in the long run.
Obama first says 250k…then 200k in his infomercial…now Joe Biden says 150k…
The following salaries represent the 50th percentile for the respective specialties:
Anesthesiologists: 309,600; Family Practice: 162,000; Internal Medicine: 169,500; ED: 228,000; General Surgery: 368,200
Please keep in mind that these figures represent what is “taken home,” not what is earned by the practice. Small businesses, including private practices, stand to suffer from these proposed taxing policies (that seem to change with each speech).
Finally, Medicare and state programs are broke because of the abuses – period. Loose inclusion criteria enacted for political gain allow individuals who should not be covered to be covered. Anyone who participates in DIRECT patient care should know this after their first shift.
You all should read “Health Care Guaranteed”, by Ezekiel Emanuel, MD, for a sketch of how a non-governmental, non-single payer universal coverage system might work–and save taxpayers millions.
It is especially imperative to read this book, given that the author’s brother, Rahm Emanuel, is being named as a likely Obama White House Chief of Staff!
Come on student doc, you reveal your bias by only publishing articles on health care that have liberal viewpoints. You promised to show both views of the health care reform and you have yet to present articles of a conservative viewpoint. Also, anyone who cites Michael Moore’s “Sicko” as evidence in an argument looses all credibility in my view. Health care is expensive and will be. We can choose to pay for health care through taxes and have the government manage our care or we can embrace a free market system that will encourage competition–driving prices down and increasing efficiency. Who do you trust? The government or yourself? As for me, I trust myself and the free market principles that have led to America’s greatness. Like the vast majority of liberal ideas, health care for all sounds great, but fails every time its tried. Just ask Hawaii (socialized medicine for children failed), Canada, or Europe. I don’t want their problems and the inefficiencies associated with government run health care.
I like the AMA talking point above (The Swiss system). People concerned that people will just go crazy cause it is free must not have ever had a colonoscopy. If we make it a free market system, no one would ever get screened (think of it like your car, do you get regular tune ups once it has passed warrenty, or do you keep driving it even when the light comes on), whatever state has the least regulations will become the haven that all insurance companies set up shop in (look at small companies and how many are based out of Delaware). The Canadian system is underfunded, the British system is true socialized medicine and has its issues, but ours is pretty bad for those that can’t get into it. I don’t know what the solution is, but its not a free market
Hey PHNP– “ours is pretty bad for those that can’t get into it” ???? Are you trying to say that America’s system is bad because some can’t get treatment? Everyone in america can go to an emergency room at anytime and receive treatment. Everyone “can get into” our health care system. Maybe you are confusing uninsured with unable to receive treatment. We always hear that 47 million or so people in america don’t have insurance. This doesn’t mean they don’t have health care. I still don’t know what your argument is against a free market system.
Have you ever worked in an ED? Thats all I need to say right there…
The following 9 steps will simply suggest how, without the inefficiencies and burden to productivity of private insurance corporations, we can deliver efficient and effective comprehensive health care with great savings and no sacrifice of jobs. In fact, we may be able to decrease morbidity and mortality in this Country with one coordinated system which cares for all Americans, and concurrently analyzes optimal diagnoses and treatment modalities through its integrated computerized billing system. The savings incurred insuring all Americans through the more efficient Medicare system will benefit all citizens of our Country.
9 Steps to Comprehensive Quality Health Care in America
1) Shut down the private health insurance corporations.
2) Enroll all Americans (including Veterans) and the 40 million uninsured citizens into the Medicare Health Insurance Corporation. Since the current functioning Medicare Insurance Company is already accepted by almost all physicians, Hospitals and clinics in the Country, hardly any infrastructure investments on the health care delivery end will be necessary. Have all private businesses pay a Medicare premium for their employees instead of private health insurance premiums. Let employees as well as businesses contribute a fixed premium amount based on their age up until 65 for their Medicare services and drugs. Freeze current premiums for all Americans over 65 and adjust in the future according to the cost of living index. These premiums paid by businesses to Medicare for their employees should be less than that paid to current private insurance companies because of the lower overhead costs of the Medicare Corporation and improved risk distribution.
3) Hire the now unemployed former private health insurance corporate bureaucrats to actually deliver and not inhibit health care by working in hospitals, doctors’ offices, clinics and nursing homes around our Country. Demographically, the percentage of elderly Americans is rapidly increasing. With every American now insured through Universal Medicare Insurance, real health care workers will be in desperate need. For the first time in the brief but bloody history of managed care, these former private insurance corporation employees will actually touch and improve care for patients by working in physical therapy, nursing, home health care and other ancillary patient care capacities.
4) Obtain by eminent domain (for the public good) the best of the intellectual property protected computer codes which the closed private insurance businesses previously used to monitor patient care and doctors utilization and performance. Private health insurance companies have used these computer programs exclusively for the purpose of strong-arming their contracted health care providers into doing less for their patients and increasing the premium costs for sicker patients in order to achieve higher corporate profits. Medicare on the other hand can use these same computer programs for the common good; to monitor, collect data and eventually improve the efficacy of diagnoses and the treatment of diseases and medical outcomes every time a doctor submits a bill. For example, wouldn’t it be nice to know as a medical consumer (patient) which oncology groups in Boston, New York or Houston have the highest cure rates for stage III breast cancer or Stage II prostate cancer? All those numbers currently exist in cancer registries nation wide and just need to be collected and honestly disseminated. Currently, instead of solid medical data which delineates morbidity and mortality and performance, the medical consumer when choosing an oncologist must rely on word of mouth, physician referrals or advertisements in the local papers which show photographs of smiling doctors in white coats who claim to be the ‘best’ doctors in town. In addition to garnering invaluable instantaneous epidemiologic data on diagnoses and treatment of diseases based on severity and other variables, a strong Medicare based utilization review computer code would also allow Medicare to monitor doctors and hospitals who abuse a fee-for-service billing system. Any physician, institution or service found to abuse the Medicare fee for service billing system after proper review and appeal should be dealt with severely through stiff penalties and loss of their Universal Medicare provider contract.
5) Freeze Medicare physician, hospital and ancillary services reimbursements at current 2007-2008 levels. Adjust reimbursements for future services yearly by Cost of Living increases, or in the event of a deflationary economy a decreases in doctor and hospital payments. Ask any physician and they’ll tell you they would accept current reimbursement rates with COLA over the current mysterious illogical fee adjustment system of Medicare, or the physician population density reimbursement formula used by most private insurance corporations. Two tiered medical systems separating the “haves and have not’s” of society have and will always exist. Therefore, we must allow physicians to practice medicine without enrolling in or accepting the Universal Medicare reimbursement. With private medical insurance no longer available, and no performance based evidence for improved morbidity and mortality among their private for-pay patients, these extraordinarily expensive private ‘VIP’ practices will be limited.
6) Allow Medicare, much like the current Veterans Administration System and every private health insurance company and government health care system around the world, to bid on medications from pharmaceutical corporations for its Medicare drug formulary. Every physician recognizes that we don’t need a choice of a dozen redundant drugs in each pharmaceutical category. For example, we need only 2-3 statins for cholesterol, a handful of antibiotics for infections, 2 beta blockers for hypertension, and a few pain killers. Once the Government bids on pharmaceuticals for the Medicare Corporation formulary, macro economics will force prices to massively decrease to levels identical to that which all the other people of the world outside of America are paying for the same medicines. Since it has not effectively decreased morbidity or mortality in this Country, and only wastes money, we should also prohibit pharmaceutical companies and their workers from contributing to political campaigns or buying commercials on the public airways. We need to also prohibit the current practice whereby your local pharmacy and pharmacist sells your private medical diagnoses and your doctors private prescribing drug information to pharmaceutical companies so the pharmaceutical companies in-turn can directly pressure-market physicians. Prohibit pharmaceutical companies from contributing to organized medicine societies, colleges or associations because the doctors can’t rely on soft bribes or free lunches to prescribe what’s best for their patients. Prevent pharmaceutical representatives from visiting doctors’ offices or hospital pharmacies directly. Allow delivery of Medicare formulary approved sample medications for patients to physicians’ offices via post office mail only. Allow pharmaceutical companies to market products to physicians only via peer reviewed publications delivered by email or snail mail.
7) With the savings incurred from closing the private insurance corporations and paying less for drugs, have the American government fully fund the National Institutes of Health (NIH) and the National Cancer Institute (NCI) and Small Business Innovative Research (SBIR) programs. Emphasis should be placed on basic bench research carried out at not-for-profit American Institutions which employ or utilize a majority of American Citizens in their laboratories and clinics. Too often American Universities rely on free overseas labor to conduct bench research. Clinical trials should emphasize new drugs and devices which have promise to significantly decrease morbidity and mortality for any disease, including orphan diseases. Since a large percentage of private funding for drug and device studies will originate in the expanding financial liquidity and innovations and patients of the emerging developing world, we should allow the FDA to utilize research data obtained by reproduced laboratory and clinical studies performed overseas as well as in this Country.
Corruption of honest academics should be curtailed. Force all investigators to release reproduced publicly funded scientific data for all scientists to review on the internet via the Freedom of Information act (The Senator Shelby Amendment). Prohibit rights of first refusal on scientific data for private companies performing research in non-for profit institutions which receive public funding. Any rights to profits obtained from intellectual property and patents invented with combined funding from government and private sources should be split fairly among the contributing government institutions and any other private corporations funding the research, as well as with the individual inventor. Prevent organized medicine societies, associations or colleges from contributing to political campaigns since campaign donations have no relevance for physician performance or patient morbidity or mortality.
9) The quality of current medical records software lags two decades behind business software. Therefore, we need to fund and challenge America’s best software corporations to finally develop standardized electronic medical records software for use in doctors’ offices and hospitals in order to increase the efficiency and productivity of physician charting, billing and prescribing. We should use the integrated medical records system to instantaneously and confidentially gather important epidemiologic data on physicians’ performance, patient diseases, and treatments. With new potent viruses and unsophisticated biomedical and nuclear warfare on the horizon, this system will be absolutely necessary for rapid National Security responses. Protect patient confidentiality at all costs to prevent the commercialization and abuse of patient data like that which the pharmacies trade today.
Lastly, some argue that Universal Government run health care in America will result in delays in diagnosis and treatment similar to those experienced in Britain and Canada. One can not simply compare the massive extremely functional Medicare insurance corporation based infrastructure which seamlessly delivers health care to tens of millions of people yearly in the USA to the government run westernized health care systems of Canada and Britain, France, Switzerland, Netherlands, Scandinavia, and Israel. America, for the last 40 years, thanks to the government run health insurance corporation-Medicare, has built an incredibly dense and fluid public insurance system involving almost all doctors’ offices, hospitals, clinics and ancillary services. The Medicare system dwarfs in breadth and actual practitioners and efficacy the lesser insurance systems established in all other countries. The billing and reimbursement bureaucracy for health care providers contracted with Medicare Insurance is already relatively streamlined and efficiently centralized in America thanks to 40 years of physician, hospitals and government cooperation.
We all know that the medically bankrupt private health insurance corporations and medical malpractice lawsuit threats have caused many disheartened physicians to quit practicing or downsize their practices in America. A continuation and technological upgrading of our most fair Universal Medicare based health insurance Corporation based on the concepts outlined above would undoubtedly motivate those disenfranchised physicians to return to the profession and bright younger physicians to invigorate the field. If patients, physicians and the Medicare Corporation continue to work together, without the deleterious interference of private for-profit health insurance corporations, malpractice threats and overt pharmaceutical marketing, the future for American health care will be healthy indeed.. A continuation of the status-quo mixture of a government subsidized private health maintenance insurance industry operating parallel to and within Medicare is wasteful, and will continue to provide no potential future health improvements for America.
You are a fool if you think there can exist a government financed health care system that is not ultimately government run.
Ask yourselves this. How many VA, tricare, medicaid or medicare doctors are happy? Why would another government financed program be any different?
What’s often missing from the health care debate — and what frustrates me to no end — is the absence of discussion on a third type of health care payment model: universal multi-payer.
Switzerland, the Netherlands, Germany, France, and Belgium all deliver universal health care through a combination of public and (carefully-regulated) private insurance programs. These systems provide the best of both worlds: everyone is guaranteed coverage, but those who want to customize their health care packages have the option of doing so.
The health care debate is often falsely presented as a dichotomy between single-payer models on the one hand and “American-style” models on the other, when in reality there are many models out there that successfully provide the best of both worlds.