Sen. Bernie Sanders often points out that the U.S. is the only advanced nation that doesn’t offer universal health coverage for its citizens. Worse, Americans also spend nearly 50 percent more on medical care, notes the Vermont senator, who on Wednesday joined 15 other lawmakers in introducing a plan,” that would expand a system that covers about 55 million people to the entire country.
But a so-called single-payer approach to providing health care isn’t the only way to achieve universal coverage, although such systems often achieve better care for lower cost than others. And while it would save billions for the country as a whole, decisions over who would win and lose under a new system will almost certainly derail it.
How other countries provide health coverage
Developed economies achieve universal health care coverage in a number of ways, often by combining financial incentives and penalties. In many of these, the actual delivery of medical care — from doctors, hospitals and facilities — remains private, and private insurance still exists. But this is often lost on Americans first learning about single-payer.
“The real issue is when people hear ‘single-payer,’ they hear ‘single-provider.’ Sanders is not proposing single-provider,” said Laurence Kotlikoff, an economics professor at Boston University.
This single-provider approach is the system that exists in the U.K., where the National Health Service employs doctors, runs the hospitals and purchases drugs.
Other countries with single-payer health systems, like Canada, fund care publicly but deliver it privately. Canada’s system is paid for by taxes and administered by regional governments. Medical care is delivered by doctors, most of whom work in private practice.
Switzerland achieves that goal with a system that’s strikingly similar to the Affordable Care Act. All citizens are required to have health insurance, which they buy privately. The central government approves premiums, defines the benefits that must be offered and subsidizes premiums for low-income people. Insurers, all of which are nonprofits, aren’t allowed to charge sicker people more and…