Health Care a Basic Human Right: A Worldview of the Four Systems of Health Care

I am continuously saddened by the lack of quality health care offered in America. Barriers to receipt of health care are higher than ever. I have seen terrible things delivered in the name of “medicine” over my 15+ short years of practice. I want to see that terrible health care change.

Patients today are being denied benefits when they clearly need them.
Medicare recipients being given “bottom dollar” care because that is all that is “afforded” to them.
Therapists and physicians alike barely touch or speak with a patient and instead issue drugs, tests, or procedures with minimal long-term benefit, or worse, short-term gain but long-term loss.
Therapists and physicians alike also barely speak to another another, which poses the common risk of a patient missing critical care that they truly need. I see this happening over and over again in physical therapy. A new mother doesn’t receive the care she needs in the prenatal or postpartum period, which sets her up for a lifetime of aches and pains which could have been prevented if she had received physical therapy after childbirth. See my article on Why Every New Mom Needs PT .

Further, the US has an increasing gap between cost and efficiency.¹ Meaning the US is increasingly inefficient with the health care it delivers, meanwhile costs are soaring.^1,2

“In other words, the world’s richest country spends more of its money on health care while getting less than almost every other nation in return”.^1,2

I do want to be clear though. No one person is specifically is to blame. We inherited an enormous “machine” of a system that was already broken. Our generation is simply recognizing the great (and urgent) need for its repair.

Health care should be a basic human right.

Fortunately, we have helpful texts like T.R. Reid’s, “The Healing of America,” in which he describes the four types of health care models or systems, which clarify the motley crew of a system that currently possesses the American medical landscape.³ The four systems include³:

The Beveridge Model – Health care provided and financed by the government through tax payments.³
The Bismarck Model – Health care provided via insurers called “sickness funds” funded by employers and employees through payroll deductions.³
The National Health Insurance Model – A combination of Beveridge and Bismarck Models.³
The Out of Pocket Model – You can have health care only if you can afford it. Reid’s book states that the US is unlike any other country because it “maintains so many systems for many separate classes of people.” In this way, the US is “like rural India” for those 15% of uninsured Americans.³

It is a shame that America’s uninsured are in the same situation as the poor from third-world countries³ – starving, sick, and dying just because they lack basic access to quality health care. The American poor end up using hospital ER’s for their primary care because they lack the funds to pay for health care insurance. Many simply go untreated due to the “out-of-pocket” model.³In determining which model may be ideal, I decided to look up what citizens thought of their health care models and ended up landing on the Bismarck model as the most unobstrusive because it could allow for uninterrupted benefits to Americans, while affording all Americans coverage. It could also function to facilitate increased consumer responsibility for health, so long as accurate health beliefs and proper utilization of health care providers in front-line medicine could be established (i.e. PT’s as a primary care provider for back pain). I found two articles that spoke to the satisfaction(s) and frustration(s) of citizens in Germany and Switzerland.

Pros of Swiss system¹:

Universal coverage through insurance purchase by citizens
No cost past monthly premium and deductible – and may adjust the premium or deductible cost include less/more coverage and private rooms/private hospitals
Disability insurance for children and adults provides even more benefits
Insurance companies cannot make a profit under Swiss law
Most beneficiaries choose their own providers
99.5% of Swiss are insured.⁵

Cons of Swiss system⁶:

Everyone pays the same rates regardless of income, which could be a hardship for those making less income
Rising cost of subsidies provided by government

The investigative journalist interviewed German and German-American dual citizens, who said, “the health care system in America is the major reason why we have never moved there, and never will move there.”⁶ That is a strong indictment of the poor state of American health care.

Pros of German system⁶:

Most of funding from insurance system comes from premiums paid by workers and employers, not from taxes
Generous health benefits with “little to no wait” for surgery or diagnostic tests
House calls and direct access to speak with doctors via phone
Insurance companies will pay for household/keeping support when you are recovering from illness or are disabled
Premiums based on salary
Low co-pays and low premiums, even including orthodontics
Insurance company cannot raise rates on an individual if they get sick or increase premiums as they age. Insurers also must control costs.
No one is uninsured in the 125 year-old history of the system.

Cons of German system^6:

The self-employed can opt out of system and pay to have better coverage (go to the front of the line, receive private rooms, chooses who he wants to see, etc.).
There is an 8% tax on gross income to a nonprofit insurance company called “sickness fund.” (However, that isn’t really a “con.”)
German employers pay 8% of premiums, whereas US employers pay around 18% (but Americans have more expensive healthcare with less overall good health and outcomes), again not really a con.

This post is not an endorsement of any one health care system, as the problem of health care in this country is complex and deeply broken. This article does serve as just one more indictment of the shameful state of our current health care system. It also serves to inform and encourage the “citizen-as-health-care-consumer” (rather than citizen as helpless or passive patient with no voice) to stand up and ask for the health care that by birth, you deserve.

References

Davidson, KA. The Most Efficient Health Care Systems in the World. (Infographic). The Huffington Post. http://www.huffingtonpost.com/2013/08/29/most-efficient-healthcare_n_3825477.html. Last accessed November 5, 2013.
World Development Indicators database, World Bank, 23 September 2013. Gross Domestic Product 2012. http://databank.worldbank.org/data/download/GDP.pdf. Last accessed November 5, 2013.
Reid T.R. An Excerpt from The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care. Penguin Press 2009. http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries/models.html
Rovner, J. In Switzerland, A Health Care Model for America? http://www.npr.org/templates/story/story.php?storyId=92106731 Last accessed November 5, 2013.
Roy, Avik. Why Switzerland Has the World’s Best Health Care System. http://www.forbes.com/sites/theapothecary/2011/04/29/why-switzerland-has-the-worlds-best-health-care-system/. Last accessed November 5, 2013.
Knox, R. Most Patients Happy with German Health Care. http://www.npr.org/templates/story/story.php?storyId=92106731. Last accessed November 5, 2013.