Friday, March 13, 2020

What Might That Compromise On Health Care Between Biden And Bernie Look Like?

As discussed in an earlier post it looks like there is an as yet undetermined compromise between the ACA plus public option with some other items supported by Joe Biden that unfortunately lacks the crucial matter of universal health care coverage (although he professes to support such) with the single payer plan supported by Bernie Sanders, somewhat modeled on the system of Canada, although more generous and less open to private insurance than Canada's but definitely including universal coverage.  Obviously Biden's plan has the problem of lacking universal coverage while that of Bernie appears to call for the end of private insurance, which might save money but also seems to be unpopular and thus damages his potential electability.

It certainly looks like a possible compromise should be out there, and according to polls of Kaiser, such a compromise that has a mixed public/private system with universal coverage is well ahead of all other alternatives in the eyes of the US population.  And, indeed, the vast majority of other high income nations have just such a system.  They are the ones that are not the UK or Canada or US, pretty much all the others, although they have wide variations among them of their systems.  The Obama admin sort of tried to get there by imposing the individual mandate to ty to get everybody covered, but it was unpopular from the start and never seriusly enforced, before the Trump admin got rid of it.

So here is a bit of coverage of what is out there in nations that have mixed systems and universal coverage, noting that it is much easier for all of them to manage it compared to the US given their lower costs.  So some look like what ACA almost was, essentially an enforced individual mandate system although with varying patterns of subsidies and backups for the backup public health care system. Among the highly rated systems the Netherlands and Switzerland fit this pattern with Switzerland having more of a private system while the Netherlands has more of a public one.  Switizerland's reuqires higher co-payments, much like what came out of Obamacare/ACA, although Switzerland does have that universsal coverage.

Most of the other systems have larger public portions, although with private elements in various ways.  Let me note as simply one example the widely praised system of France.  The payment is upfront, labeled as an insurance premium but essentially a tax, and individual mandate if you will, but enforced.  With that one has a choice of vsrious systems.   Three are public, with the dominant one covering 84% of the ppulatoin while the other two cover another 12%. The remainder are covered by various non-profit private plans. People using one of the public plans can also get supplemtnal privare insurance from one of those non-profits, and the ultimate divide is 78% public and 22% private in terms of the provision of insurance. The whole thing costs 11.3% of GDP compared to the 17.1% in the US for health care.  And, of course, France does much better on botom line life expectancy and other health outcomes than the US, although apparently the system has been suffering in recent years from some doctor shortages and is probably not the top rated in the world as it once was.

But then, all systems are imperfect, even if so many of them seem to do better than that in the US.  Somehow it does not seem that it should be so difficult to get to one of these intermediate systems that are so pupular among Americans, but somehow for now no presidential candidate is proposing.

Barkley Rosser


Jerry Brown said...

There is sometimes made the argument that as a nation's wealth or income increases, the demand for health care will increase more as a percentage of total income. If this argument is true, and I'm not saying it isn't, the US must be far wealthier than all others since we spend so much more on health care.

I have also heard that despite our private health care insurance system covering around half our population, US government overall actually spends about as much per capita on health care as the other wealthy nations we generally compare ourselves to do in total (per capita again). Maybe that's because we are so wealthy?

I don't understand my fellow Americans very well I guess. said...


No, we are not by far the wealthiest nation per capita in the world, although pretty high up. It is not that big of a deal that with a bit over 50% of our health care costs covered publicly our government spends as much per capita as nations that have public sector paying around 75%, with those nations spending about 10-12% of GDP on health care while US spends about 17% of GDP so.

Jerry Brown said...

Barkley, if we aren't by far the wealthiest nation but actually are spending the most per capita on health care, wouldn't you consider that a bit of evidence that maybe we aren't doing things the best way? Especially if our outcomes are not the best in the world either. I would. said...

Of course I think that the evidence you mention is a sign we are not doing things the right way. I note that up until as recently as 30 years ago, certainly 40 years ago, spending per capita in the US was not that different from what was going on in other high income nations. The divergence has been since then and been very dramatic. It is also the case that there is no single clear source of this, with it coming from various parts of the US health care system, which is part of why it has been so hard to get at it, lots of interest groups out there benefiting from this and strongly resisting cutting any of this back with so much of it clearly wasteful and unnecessary. said...

BTW, just got off phone with two daughters (and three grandsons) iin Bay Area of CA, and one of them works at Kaiser Permanente. Apparently they have just started drive-through testing for Covid-19 at Kaiser out there. About time this got going.

Jerry Brown said...

I guess I didn't understand your first reply. Sorry. But it seems we agree for the most part.

That is good news about the testing. About time.