Thursday, May 22, 2014

There is more than one universal health care system and not all of them have the same name

I don't know why this drives me so crazy, but it does. Take this line from this article (and this quote is essentially the premise upon which much of the author's argument rests):
There is no better predictor of the course of a single-payer medical system in the United States than the VA system, because it is a single-payer system.
No it isn't.

Look, there are three basic ways to achieve a universal health care system:

(1) "socialized medicine" (also called the "Beveridge model")--where doctors are employed by the government and hospitals are publicly run.
(2) "single payer"--where doctors and medical providers are private, but health insurance is run by the government (the government being the "single payer", as opposed to the multiple payers in a competitive private health insurance market)
(3) Compulsory insurance (also called the "Bismark model")--where doctors, medical providers, and health insurance are all private, but individuals are legally required to buy private insurance to assure universal coverage.

All three have been used successfully by various other countries. The NHS in the UK is socialized medicine. The Canadian system is "single payer." The Netherlands has a compulsory insurance system. Like anything else, there are pluses and minuses with each. I actually think that the details of how each approach is carried out is just as important as the approach itself. But all three have proven to be viable alternatives for a universal health care system in various parts of the world. (Another explanation of these models is here).

Before 2010, there was a tendency to call all universal health care systems "single payer" or "socialized medicine", with opponents to universal health care preferring the "socialized medicine" label because it implicitly tarred the idea as "socialist," and proponents of universal health care preferring "single payer." But neither term should be accurately used to describe legally mandated universal health care in general. They just happen to be two of the three ways of getting there.

Since the Affordable Care Act went into effect, the U.S. health care system uses all three approaches. Veterans are under a socialized medicine system (the VA hospitals), the elderly, poor, and children of lower-middle income families are under a single payer system (medicare, medicaid, and S-CHIP), and everyone else is under a compulsory insurance system (the individual mandate for the uninsured).

Calling the VA or "ObamaCare" "single payer" is ignorant, those are the two components of the U.S. system that are not single payer. Likewise, the tendency of some progressives to call all universal systems used in other countries "single payer" is also ignorant. (I'm looking at you Corrente-critters!) The distinctions between government run health care, government run insurance, and government mandated private insurance should not be hard to grasp. I don't understand why so many people have such difficulty keeping them all straight.

(via Memeorandum)