Universal Health Care, American Style

Timing is everything. Presidential hopeful Hillary Clinton wants to have universal health care implemented by the end of her second term. If she wins the leadership post in November 2008, then all Americans would be covered by a health plan by late 2015. According to my watch, that’s about 5 years into the first phase of Baby Boomer retirements.

Universal health care (UHC) is a general term. Don’t confuse it with single-payer, which is but one form of UHC. Most developed countries in the world offer some version of universal health care. The flavor of a nation’s UHC plan varies based on that country’s particular social, economic and political structure as well as the unique history of the place. If you’ve seen one single-payer plan…you’ve seen one.

Single-payer systems are a form of UHC, but not all UHC plans are single-payer. These plans provide health care for everyone through payment from one organization – usually, the government. When the government funds a single-payer system, monies come from taxes paid by citizens and business. A government bureaucracy then disburses (reimburses) payments to health care providers. Thus, the government becomes the “single payer.” Canada, Denmark and Sweden are single-payer systems.

But universal health care can be implemented without a government paying for all of it. There are hybrid UHC systems that combine private and public funding, particularly in Europe – in Germany and France – and in Japan. The new Dutch health plan, another hybrid style system, is gaining attention among U.S. health policy analysts.

It’s America’s free-market tradition that finds us with the fragmented health system we have. But I cannot imagine this next round of health reform will turn its back on a market-based system. I can, however, see a hybrid model where public finance supports uninsured people with a guarantee of a minimum benefit plan, while other insured people will have the option of trading up. After all, we “trade up” for other consumer goods: automobiles (from Toyota to Lexus), shoes (Pay-Less or Jimmy Choo?), and face cream (Jergen’s to La Prairie).

A universal plan of some flavor is in the cards for this next President. Of course we should cover the uninsured; it's the right thing to do. American business cannot exploit any competitibve advantage globally if we do not address health care (see my oost -- Steel, Coffee Beans, and Health Care -- on the UAW-GM negotiations). Furthermore, as the first wave of the 79 million baby boomers begins retiring during the first term of the next president, our health system will be even more hamstrung with access and capacity challenges. A plan is required to deal with these challenges. And that plan will be uniquely American in its details.

Health Populi’s Hot Points: We’ve entered the next wave of health reform discussions in the U.S. The phrase, "Universal Health Care," will be a centerpiece of the debate. Be part of the conversation with your providers, payers, neighbors, communities. Be open to new ideas. Love Thy Neighbor. Play out your future scenarios with respect to health care coverage, your employier, and your own plans for retirement. Finally, save more money, because whatever form health care takes by 2010, it’s inevitably going to cost you more.

Note: the following countries have some form of universal health care; Argentina, Australia, Austria, Belgium, Brazil, Canada, Cuba, Denmark, Finland, France, Germany, Greece, Ireland, Israel, Italy, Japan, The Netherlands, New Zealand, Norway,, Poland, Portugal, Russia, Saudi Arabia, Seychelles, South Korea Spain, Sri Lanka, Sweden, The Republic of China (Taiwan), and the United Kingdom

Sources: Expensive and divisive: how America is losing patience with a failing system, The Guardian (UK), http://www.guardian.co.uk/usa/story/0,,2167865,00.html; Would Dutch Health-Care Plan Work Here? Wall Street Journal, http://online.wsj.com/article/SB118980738116728025.html?mod=googlenews_wsj