Health Care Options at a Glance

Type Socialized Single-Payer Nonprofit
Health Care
Britain (also, the Veterans Administration)
United States
How It Works Government hires doctors and runs hospitals. Doctors have private practices, hospitals may be owned by nonprofits or by government. Government pays the bills based on fee structures negotiated with health care providers. Medical practices and hospitals are private (nonprofit or for-profit). Nonprofit, regulated "sickness" funds collect payments and pay health care bills under the terms of a negotiated fee structure. Individuals or employers purchase coverage from mostly for-profit insurance companies. The elderly, disabled, veterans, some children, some low income people are covered through public programs.
Who Pays Government Government Payroll contributions (compulsory) from employers and employees. Funds cover 75% of medical bills. Remainder comes from government, patients, and supplemental insurance. Employers and individuals pay premiums. Most plans require co-pays and deductibles, and some costs are excluded. Government subsidizes employer plans through tax breaks and covers some families through publicly funded programs.
Who Chooses Doctor Patient Patient Patients Choice restricted by insurer; penalties may apply for seeing "out-of-network" provider. Some providers don't take Medicaid or Medicare.

Who Is Covered

Everyone Everyone (NOTE: This is the system proposed in Rep. John Conyers National Health Insurance Act, HR 676.) 99% of population Those with insurance, those covered by the Veterans Administration (which works like socialized medicine), Medicaid, and Medicare (which function like single-payer systems). Those with chronic illness or pre-existing conditions may not be able to find coverage at any price. About 50 million have no insurance, including nine million children.
Cost per capita: $2,389 $2,989. $2,902. $5,711
WHO rank* for Britain: 24 for Canada: 35 for France: 4 for U.S.: 72

*The World Health Organization (WHO) performance on level of health ranking measures how efficiently a system translates spending into overall health -- a "bang for the buck" rating.

Type Health Savings Accounts Individual Mandate Tax Credit Buy-in Option* *under consideration
Example U.S. as of 2004 Massachusetts as of 2006    
How It Works Individuals buy high-deductible insurance and they (or employers) contribute to tax-free savings accounts used to pay bills. All are required to carry insurance, through employers or by buying their own policy. Tax credits offset the cost of private insurance premiums. How it would work: Under a plan studied by the National Coalition on Healthcare, the uninsured could buy into Medicaid, Medicare, or SCHIP
Who Pays Individuals, employers, and government (through tax breaks). Individuals, employers, government (subsidizes premiums and offers Medicare for the low-income). Individuals and government (via tax breaks). Individuals pay on a sliding scale, with government subsidy sufficient to make it affordable.
Who Chooses Doctor Plans may restrict doctor choice. Insurance plan. Medicare recipients choose any doctor who accepts Medicare. Who chooses doctor: Restricted by insurance plan. Private plans determine choices. Publicly covered patients choose participating doctors.

Who Is Covered

Appeals to those with low medical expenses. Low-income people and those with accounts too low to cover deductibles are on their own. In theory, all. But barriers remain for low income families. Who is covered: Those who qualify for a tax credit and can afford to make premium payments. Some proposals call for restricting the credit to low-income people. Everyone
Costs Requires complex expense tracking. Incentive to postpone preventive care. Cost controls not addressed. Government subsidy makes coverage affordable to some low-income families, but there is no change to the main drivers of high costs. Tax breaks offset premium costs, but there is no provision for impoverished families. Individuals still pay co-pays, deductibles, etc. There is no change to the main drivers of high costs. NCHC says in the first decade health care savings would total $320.5 billion; businesses now providing health insurance would save $848 billion, and families who currently carry insurance would save $309 billion.
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