Yves here. Michael Olenick is correct to point out how one of the many bad features of US exceptionalism is that we refuse to learn from the experience of other countries, particularly with health care. And that’s before you get to the fact that big swathes of the public have been propagandized to view foreign “socialized” medicine programs as failures and thus regard like Medicare for All and other single-payer initiatives with suspicion.
Having said that, there would be transition issues with the adoption of any Medicare for All type program in the US. However, what isn’t sufficiently well recognized is that US doctors are already being “transitioned” to corporatized medicine, where they are employees of large health care organizations and have little autonomy.
By Michael Olenick, a research fellow at INSEAD who writes regularly at Olen on Economics
Sitting here in France and watching the Medicare for All debate. Good idea? Bad idea? How would it work? How would costs be controlled? I think everybody, for and against and in the middle, miss an enormous point: there are lots and lots of national healthcare systems to copy. There’s no need for the US to create a new one from scratch. Nothing happens in the US — besides the current cesspool called healthcare — that’s any different than the UK, France, Spain, Germany, or countless other developed countries that have healthcare systems.
My wife was just saying this morning “I should probably see the doctor but don’t want to waste the €35.” “All but €1.50 is put back into our account within a few days,” I answered. She’s used to the US system. Even the idea that seeing the doctor is a waste is foreign here; people are encouraged to go for the most minor things, which can turn out to be nothing, because they can also turn out to be something that’s much easier to treat earlier than later. Even chronic hypochondriacs have something wrong with them — a mental issue — that needs to be treated. The French run off to the doctor for virtually anything, and that’s the way the system is supposed to work, and it costs much, much less.
As for the socialized thing that’s not even true. Like everybody else here legally for more than three months we’re enrolled in the government system. That pays 2/3rds of less serious things, an amount that increases with seriousness. Regular doctor visits are reimbursed 2/3rds of the government rate of €25. Our mutuelle, private supplemental insurance provided by employers or that the self-employed buy at a reasonable price (or that’s free for poor people) pays most of the rest. But, you might have noted, you said your doctor charges €35 – is that a typo? No, it isn’t. Our doctor speaks fluent English and is close-by. Like all doctors, he sets his own rate schedule; he doesn’t have to charge the government price. In our case, our supplemental insurance pays all but €1.50 of the difference. If we had a doctor that charged €25 — and there are many, many that do (and most speak English – we just like ours) — it’d be reimbursed at 100%.
So there is still a private system, doctors in private practices — which most doctors are — set their own rates. And the public/private insurance companies reimburse at those rates. Pharmacies outside hospitals are all privately run and seem to have lots of customers but the prescriptions are paid for by insurance; the ones we’ve had are reimbursed at 100%. Hospitals are typically run by the government (I’ve been told all are, but the American Hospital in Paris is private, so that can’t be accurate). Clinics, that often look a lot like hospitals, are all private. In any event, they’re all affordable.
This public/private combination is common. Government healthcare systems do not eliminate the private market. In many ways, the system here has more elements of a genuine marketplace than the US, where insurance companies often dictate more terms than governments do. I can’t think of any US insurers that allow people to choose more expensive than baseline doctors then cover the vast majority of the cost. Usually, they pay a set fee and if people want something above it the patient pays the difference. There is no gaming prescriptions like we see in the US; pharmacies fill what a doctor prescribes and insurance (the public/private combination) pays. I don’t know the numbers but overhead has to be much, much less than in the US.
Americans tend to be creative, which is usually a fine attribute, but not in this case. Stop overthinking – take a system and copy it. And maybe come to the realization the complexity is not in the implementation, it’s in the political will to stop bickering and break away from a broken system that literally kills people for profit.
As Lambert added:
“Stop overthinking – take a system and copy it.”
Canada. Same continent, continental scale, multicultural/multilingual population, Federal structure, “mixed economy,” common law, Anglosphere, etc. They are absolutely the political economy closest to our own (and so there’s no need to look for some locale that’s wildly exotic by US standards, like the UK or France).
All the jerks at Vox yammering on about Germany or whatever are just trying to muddy the waters. It’s exactly what the same crowd did in 2009-2010; muddy the waters to keep the health insurance industry alive for another couple election cycles. Like Iraq, where the people who caused the debacle 15 years ago (rounding) are still in charge and still authorities, the people who caused the ACA debacle 10 years go are still in charge and still authorities. They’re not overthinking. They’re obfuscating.