On 23/03/15 08:45, Martijn Lievaart wrote:
> On Sun, 22 Mar 2015 11:06:17 +0100, David Brown wrote:
>
>> The same applies to most of Europe. Healthcare, public or private, is
>> never perfect, but in most European countries you get solid public
>> health care without having to have private health insurance - it is all
>> covered by your standard taxes.
>
> Well, not in the Netherlands, and I think actually not that many other
> countries.
>
> What we have is a mandated basic health insurance. This basic health
> insurance provides the same basis at every insurance company. You can
> choose the insurance company, you can choose extra health insurance
> programs, you can choose your but you cannot choose not to be insured.
>
The mandated health insurance (which is a common model in Europe) is a
tax by a different name. You pay a certain amount, either a fixed sum
per person or a percentage of your income (or a combination), to a state
body. It is not dependent on your state of health, and does not come
with different options. It's a tax. Most European countries have a
similar thing that covers unemployment benefits, etc. In the UK, it's
called "National Insurance". But since it is handled like a tax, and
collected like a tax, it's easier just to refer to it as a tax.
In addition, you can also choose to arrange for a third-party private
health insurance - but that is in addition to the state mandated "tax".
This is a normal private commercial insurance system - companies charge
what the market will pay, they make a profit from it, and the insured
person can use it for private medical care beyond the public health
service (such as to get a nicer room, better food, quicker treatment,
etc.). European countries are capitalist economies - there are people
happy to pay for additional health care, and therefore companies happy
to provide that service.
But it is all on top of the full coverage public health system paid for
by taxes (even if the tax is called "health insurance"). And although
no health care system is perfect, European governments strive to give as
good public health care as possible at a reasonable public cost, and
they usually do quite well.
> Sounds to me just like Obamacare, but I don't know enough about Obamacare
> to say if they are actually alike.
I believe Obama wanted to make such a system, but the forces against it
in the USA are too strong. Too many people there would rather that
/their/ money went to paying for /their/ health care, and not spread
around amongst everyone. The people with power and money, who can
currently afford world-class health care in the USA, fear that that
quality will be reduced if there is a move to public health care. And
there is a vast industry in the USA involving health care insurance and
payments - there are armies of insurance salesmen, accountants, lawyers,
administrators, bankers, who all depend on the flow of health care money
for their jobs. Of course, they are part of the reason why the US
spends more than twice as much per capita on health care than other
developed countries, yet is rated so low in the average quality of the
health care. (There are /many/ reasons for this - the extraordinary
inefficiency of the health insurance system is just one part.) There is
also the idea that public health care is socialist, and therefore
practically communist, and goes against the "American spirit" of working
for your own reward.
The inevitable result is that Obamacare /added/ to this system, as yet
another health insurance option, rather than revolutionising it, and I
believe most statistics show that the total health care costs in the USA
have gone up. I don't know whether or not it has led to better average
health care - I think it's too early to tell.
>
> By the way, there is a very good reason why it is set up like this. If
> you provide free health care (pay by tax is very indirect), people will
> not use it as the precious resource it is. By making them pay every month
> (and raising that yearly, or not) people are more aware of the cost and
> will (in general) be more conscious.
>
There may be psychological reasons for calling the financing "public
health insurance" rather than "tax", but I suspect it is more about
keeping budgets somewhat separate to ensure that the public health
service gets fairly consistent financing despite variations on the main
state finances.