Landmark health care legislation that would provide health insurance for all Americans is under intense scrutiny -- in particular, the "public option," which creates a government health insurance program that would compete with private insurers. Critics lambast the public option as "socialized medicine," warning that bureaucracy and government-mandated rationing would lead to interminable waits and dangerously substandard care.
Americans are without health insurance, an anomaly when compared to their European and Asian counterparts. President Barack Obama had wanted a comprehensive bill on a new domestic health care system on his desk for signing by October, but acknowledging the fractious environment, extended his deadline to the end of the year. What the White House and Democrats are proposing does not resemble the health care systems in other countries -- seven of which are depicted in the slideshow below.
Slideshow sources: NPR, The New York Times, Health Canada, WHO, National Policy Analysis, The Boston Globe
Everyone in France has health insurance and like the United States, people rely on both private insurance and government insurance. The French system is particularly generous to cancer patients, guaranteeing that every cancer patient can get any drug, including the most expensive and even experimental ones. In France, the sicker you are, the more coverage you get. For people with one of 30 long-term and expensive illnesses — such as diabetes, mental illness and cancer — the government picks up 100% of their healthcare costs, including surgeries, therapies and drugs. France has been rated the best among industrialized nations at preventing avoidable deaths. The national insurance program is funded mostly by payroll and income taxes.
Switzerland requires that all of its citizens have health insurance (it's the law). Health insurance premiums are the same price for everyone, regardless of income. The government provides generous subsidies for those who cannot afford it. Under Swiss law, insurers do not earn a profit on the basic, comprehensive plan. Individuals, however, can adjust their premium up or down by choosing a larger or smaller annual deductible, or by joining an HMO-type plan that requires them to choose a doctor in a network.
The Canadian healthcare system is known as "medicare" and it offers universal, comprehensive coverage for hospital and physician services. Private insurance companies have practically no role in the system. The state or regional governments fund healthcare services with assistance from the federal government. All medical services are free of charge for the 33 million people living in Canada. Canadians acknowledge their healthcare system has flaws -- there are shortages of doctors in some places and some elective procedures may entail long lines -- but Canadians emphasize that all those who need medical assistance receive it.
The Taiwanese government created a national healthcare system in 2005 that guarantees coverage for all citizens. Regardless if you're rich or poor, the Taiwanese people have equal access to doctors and government coverage includes drug benefits, vision care, in/outpatient care and traditional Chinese medicine. No approvals are needed from general practitioners for an appointment with a specialist. Everybody in the country has a smart card to go to the doctor. The doctor puts the card in a reader and the patient's history and medications all show up on the screen. The bill goes directly to the government insurance office and is paid automatically.
Healthcare is considered an inalienable right in Cuba and therefore given top priority. Cuba's health policy emphasizes prevention, primary care, services in the community and the active participation of citizens. Life expectancy in Cuba is higher than that of the U.S. (72.5 years of age vs. 71.9). Health workers have eliminated polio, tuberculosis, typhoid fever, and diphtheria. Critics charge that Cubans are forced to wait long hours at government hospitals and access to such rudimentary medicines as antibiotics and Aspirin can be limited.
The Netherland's health insurance is run by private insurance companies, but insurers are obligated to accept every resident in their area of activity. The federal government is heavily involved in regulating prices and setting national budgets. The Dutch have longstanding relationships with their doctors, and experience little hassle or delay when making appointments. Sixty percent of Dutch patients get same day service in contrast to just 26% of Americans.
Aside from France, Germany is considered to have one of the best healthcare systems in the world. Only 0.2% of Germans do not have health insurance compared to 18% of Americans. German health benefits are very generous and there's usually little or no wait to get elective surgery or diagnostic tests, such as MRIs. It is compulsory for Germans to contribute to the system. The more money you make, the higher the premium you pay for services. All German workers pay about 8% of their gross income to a nonprofit insurance company called a sickness fund. Their employers pay about the same amount. Workers can choose among 240 sickness funds.
45 million Americans are currently uninsured, including 9 million children, and estimates put the number of early deaths due to lack of health care at 18,000 a year. Despite the fact that Americans spend over twice as much per capita on health care as most other industrialized nations, the US falls behind those nations when it comes to preventable mortality. Yet, in an attempt to sway public opinion away from universal coverage, opponents point to worst-case scenarios in countries with government-run health care.
In a Wall Street Journal op-ed, Karl Rove framed the public option as the first step down a slippery slope to socialism: "If Democrats enact a public-option health-insurance program, America is on the way to becoming a European-style welfare state." In an ad sponsored by the conservative group Conservatives for Patients' Rights, citizens of Canada and the UK tell horror stories of nationalized health care. According to the Washington Post, the group, led by former hospital CEO and multimillionaire Richard Scott, works with CRC Public Relations, the same PR firm that designed the "Swift Boat" smear campaign against Senator John Kerry in 2004.
In the Conservatives for Patients' Rights spots, Scott asks "Before congress rushes to overhaul health care, listen to those who already have government-run health care." We asked readers the same question, and received dozens of responses from Canada, the UK, Israel, France, Germany, Italy, Sweden, South Africa, Spain, Japan, and Singapore -- the US, after all, is the only industrialized country in the world without universal health insurance.
HuffPost reader Alison Victoria now lives in Rome, Italy. Her easy access to health care in Italy shocked her after working in the US health care industry:
For 15 years, I was the financial manager for a large organ transplant program in Texas. A kind of "gate-keeper." It was a heart-wrenching job. I saw firsthand what the abstract economic expression "market-driven health care" means in human terms. We reviewed each patient's insurance -- or lack thereof -- to determine who could have a transplant and who could not, based on finances. This "wallet biopsy" is not limited to transplant procedures -- almost any hospital procedure must be pre-authorized by the insurance company or patients will be asked to pay at the door.
My staff and I did everything possible to push the gate open as widely as possible. We battled with insurance companies when procedures were unfairly denied, and we were often successful. We also tried hard to find resources for the uninsured, but those resources are few and far between. Too often we had heart-breaking meetings with patients and their families to explain, knowing that a transplant was their only chance, that the operation would not be possible -- because of the money. This conversation happens every day all across America. In my office, I heard the same words over and over: "I worked all my life until I got sick. Isn't there some protection for me now?" "Am I just supposed to die because I don't have the money?" Heart-wrenching doesn't begin to describe it.
I left my job, sold my house and moved to Italy 9 years ago. I teach English here. I have had only two episodes with the health care system here in Rome. The first was after a car accident. Nothing serious, just wanted to be sure I was okay. I was examined and no one asked for money or insurance. The second was more serious. I had suddenly become extremely dizzy and could not stop vomiting. I had neurological symptoms as well. I was scared to death! A friend picked me up and rushed me to the ER. I was then admitted and seen by a doctor immediately. They examined me and eventually did an MRI. Fortunately, it was nothing serious in the end. But after my experience in the U.S., it was incredible to me that at no time did anyone ask me for any money or insurance. I never received a bill.
Carl Aspler, from Toronto, Canada, recounts his mother's surgery in 2007:
My mother, living in Canada, had to undergo a knee replacement operation, at the age of 86. She waited about 6 weeks, saw three specialists, all of her choosing, spent several days at the hospital (Jewish General Hospital) after the operation, and 3 weeks at a convalescent hospital (Julius Richardson Rehab Center). She required ongoing physio, painkillers, needed a walker and other home care devices for taking baths, etc. She never paid a nickel, and the care she received throughout was fabulous.
Emily W. moved to Lerum, Sweden nine years ago. For her, the occasional waits are worth the quality and affordability of the Swedish health care system:
In Sweden, the costs are very low. Going down to the health clinic is about $15 for a visit, a specialist is twice that. There are some kind of caps on how much you pay in a year, but I've never been close to it. I had a laparoscopic gall bladder removal with a one night stay, it cost $20. I had to wait 6 months for my turn, but I just needed to avoid fatty foods to avoid the pains. Medicines are not expensive either. The price tends to be indirectly proportional to how necessary they are for your survival.
The system is far from perfect, but people here decided that health care IS a human right. For the most part, those that need the care get it. Sweden has one of the highest standards of living and highest longevity, so something is obviously working. It isn't free having the health care system they do, but people feel they actually get something for their taxes.
Mike Collins now lives in Tucson, AZ, but spent eight years living in Germany while he worked for a German company in the 90's. "During that time I fell under the German health care system and was totally impressed with every aspect of it":
I got my insurance/health care card and whenever I needed to go to the doctor for a routine checkup, the hospital for my acute appendicitis, the dentist or to the pharmacy to fill a prescription I received nothing but the best care and treatment.
The waiting times were in no way excessive and if there were any fees at all... they were minuscule. As an example, I was rushed to the hospital a couple of hours before my appendix was about to burst. They arthroscopically removed it and I stayed in the hospital for seven days. When I checked out, my total bill came to around 35 Euro.... I thought there was surely a mistake, but they assured me that they only billed me for 21 meals. I was shocked.
Eight years later and back in the USA, I am lucky to have an employer that provides insurance coverage (mandatory in Germany). Suffice it to say that I am not impressed whatsoever. It seems that every January we get told that because of 'higher than anticipated usage' the premiums are going UP slightly and the coverage is going to be slightly modified to compensate.
Keith Watson moved to South Africa with his longtime partner when they were both around 50 years old, partly because of the problems they had with health care in the US:
South Africa has a public health system, which we did not use because it is low cost but overcrowded. For less than $150/month, we bought affordable coverage from a private insurer, which by law could NOT discriminate against people with HIV/AIDS. (South Africa has one of the highest rates of HIV/AIDS in the world.) My partner received excellent medical treatment, including affordable HIV/AIDS medications, until his death in 2008 not of HIV/AIDS but the same disease that killed his father at about the same age in his life: prostate cancer.
I returned to the United States, my native country, and enrolled as a part-time student at a university. Why? So I could be eligible for student health insurance, thereby avoiding the required "audition" before a private insurance underwriter in the United States. Excluding coverage based on "pre-existing conditions" is inhumane and cruel. Most developed countries understand this.