National health care rare and ineffective
The Aug. 31 column by David Collins − "Why are Connecticut Democrats running from paid Medicare for all?" − along with the comments and the follow-up article on Saturday concerning a hearing held by Sen. Chris Murphy in New London, frighten me because of the astounding level of ignorance exhibited by so many people.
The only country in the world that has national single payer is Great Britain and it is recognized as the worst government system in Europe. Parliament is continually cutting back on services to keep health care from bankrupting the government. This is for a country of 65 million people, about twice the size of California. Imagine this system in the United States with 330 million people. The bureaucracy would be horrendous, politicians would buy votes by adding goodies all the time, and everyone would be motivated to get as much out of the system as possible. Driven by greed at all levels, such a system would destroy this country.
The Netherlands, Germany and Switzerland all have compulsory medical insurance programs where individuals are required to have health insurance. In Germany, a country of 81 million, employees and employers share the insurance cost 50/50 and rates are set regionally, not nationally. This system is supplemented by private health insurance covering about 15 percent of individuals.
In Switzerland, a country of only 8 million, there are no free state-provided health services, but private health insurance is compulsory for all persons. There is a basic policy for which the insurance company is not allowed to make a profit. For this policy, individuals are required to pay 8 percent of their salary plus co-pay on all medical services. Additional coverages are available on a for profit basis.
The Netherlands, with a small population of 18 million, has the most highly regarded medical system in the world. It benefits greatly by being a physically small country that places 99.8 percent of the population within 45 minutes of an acute care facility. Health insurance by private companies is again mandatory for everyone over the age of 18. Insurance companies must charge the same rate for everyone, regardless of age or health. Employers pay 50 percent of the premium, employees 45 percent and the government 5 percent. Health care for children 18 and under is paid by the government.
The single-payer systems in Scandinavia are not national, but municipal. Everyone in a single-payer district pays for all the health care of the residents in the district.
In Sweden, a population of only 8.9 million is equal to the combined population of Connecticut and Massachusetts. Responsibility for financing and providing health care is decentralized to the 21 county councils. The smallest single-payer district has 10,000 people and the largest has 100,000 people. Each county council pays all the health care costs for its residents through income taxes.
Finland with a population of 5.5 million is smaller than Massachusetts. Health care is financed at the municipal level based on taxes and is used to provide primary health care services. This is supplemented by user fees for all services.
Denmark at 5.7 million is also smaller than Massachusetts. Health care is provided by five regions, financed by regional income taxes. The central government has very little control of health care.
So there is a summary of seven very different systems in Europe, none of which is close to the "National Single Payer" promoted by Collins, Sens. Sanders and Warren, et al. In fact, the number one lesson we should take from Europe is to scrap the Affordable Care Act and send medical insurance systems back to the states. At the state level, it should be further kicked downstairs to the counties. Then finance it by a 50/50 employer/employee tax, or at 100 percent through an income tax like the Scandinavian countries.
Stewart Walton lives in Mystic.
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