Sorry, this will be long. But I feel I'm coming at this from a very different (and hopefully useful) perspective.
There are some good health systems in various countries out there as well as health systems with problems. You could say that ALL health care systems have something wrong with them. Here in Australia we've had some form or other of nationalised heath care, since the early 1970s. I remember the system we had before this, too. So I've lived through a range of systems. Frankly, all of them were as good as, and mostly better than, what you have in the US. I really want to see your country have a GOOD health care system that will make it affordable and within reach of ABSOLUTELY EVERYBODY, as it is for us. Nobody in Australia is outside the health care system, not even the homeless bum sleeping on a cardboard box or in a clothing bin.
What we had when I was a kid - we had the option of private health insurance (at various levels) or the public system, which meant that if you were desperate, you would be treated in hospital as a public patient. However, there were long waiting lists for hospital treatment and ANY aservices remotely private, you got billed for it. If you had private health insurance you immediately got a better level of hospital care but it cost. The health fund paid for most if not all. Most of the time when I was a kid, my mother diagnosed all our childhood illnesses and we were not taken to the doctor unless it was really bad, or unless it was necessary for our childhood immunisations. So I had measles, mumps, chickenpox, rubella, bursitis, dislocated kneecap, various sprains etc, all without being seen by a doctor.
We had private health insurance if we took it out ourselves, paid for it ourselves. It was not part of any employment package.
Then in the 1970s we got Medibank. It was health cover for all. Instead of paying the doctor and then claiming it back from the health fund (or being out of pocket, if you didn't have private health insurance), we simply showed our Medibank card (one provided to every citizen regardless of age). The doctor filled the number in on a large green and white form then sent it in. He would then be paid according to how many numbers he filled in.
Private insurance was still recommended because it meant you had choice of doctor if you went to hospital, plus it covered a lot of frills such as glasses, dental, private rooms etc. Around this time I became independent of my parents and immediately took out my own private health insurance. An important point here - when the public health system (government-funded) pays for GP visits, then private health insurance doesn't have to fork out so much and as a result, premiums are lower and more affordable.
But Medibank was very open to abuse. All a doctor had to do was fill in the numbers. A lot of doctors claimed for services not rendered and the country's health budget blew out to ridiculous levels. Finally someone investigated and found that a lot of doctors were listing so many patients that there was no way they could have provided any sort of service at all, to such a number. "Medibank fraud" became a well-known phrase.
Then we had a change in government and a watering-down of the system. We still had public health cover for the GP and for specialists, but only 85% of it was covered. We had to pay the gap. The idea was to discourage people from over-using the health services. There was a lot of tweaking of the system at this point, all determined to weed out fraud by doctors. The biggest problem we have always had with our health care system, is the blowout in the national budget.
Further down the track we come to the first incarnation of our current system - Medicare. Long ago, Medibank was turned into a private health scheme. Now with Medicare, it became part of our taxation system. We could have simply paid X amount per head, but they decided to means test it. So we pay a Medicare levy. It used to be 1% of your income, but now it's 1.5%. It's sorted out at tax time, on the same paperwork as your tax return.
But there are a couple of other wrinkles.
First, if your income is below a certain level (I think it's about A$20,000) you don't pay any Medicare levy. And if your income is above a certain level and you don't also have private health insurance, you pay an extra 1% - that's 2.5% of your income.
Now, this seems not too bad - 1%. If you earn $20,000 that means you're paying $300 pa for your public health cover. If you earn $100,000 you're paying $1,500 pa. But you can afford it better.
What we get for our levy - we get public hospital cover but no choice of doctor. In most cases this doesn't matter. it's only if we're having a baby and want OUR obstetrician (or similar scenario) that private insurance is of value. There are other issues - if you need a hip replacement and your orthopedic surgeon is someone you really trust, you still often have to wait for a place in public hospital (because there are a lot of people who don't have private health insurance and who need the same operation) and still can't be certain you get YOUR surgeon. Instead, you get the specialist who happens to be on duty when you're admitted.
But for most purposes, Medicare covers it. Need to see the GP - Medicare. It still only pays te doctor 85% of schedule fee, but a lot of doctors are OK with this because they get more patients if they bulk-bill. If doctors don't bulk-bill then the patient pays up-front the full amount then take the receipt to a Medicare office and claim back what they can (up to 85%). Most specialists do NOT bulk-bill, we get back about two thirds because most specialists charge over the schedule fee. Because they can get away with it (not so much competition).
However, people on Health Care card (the elderly, the disabled, the low income earners) get bulk-billed by most specialists.
Private health insurance - it's still an individual choice and an individual responsibility. Again, not connected to employment perks as a rule. It covers choice of doctor in hospital, a better choice of room in hospital - in fact there are a lot of variations on private health insurance packages.
Problems - we still have a very expensive health care system. But we can choose who we see as GP (unlike the British system). So if we have a problem with Dr A, we can go elsewhere. A good thing because you could have a personality clash with a doctor, or you could find someone totally incompetent but be unable to get anything done about the idiot (been there done that). We've also had the local medical practice go through a laerge number of doctors in a short time, some of them total idiots and some of them brilliant. Some patients chose to follow the good doctors to wherever they went next. We chose to find a practice that wasn't changing doctors every five days.
There are other aspecgts to this sytem, a lot of fine detail, but that is it in a nutshell.
Good things about our system -
1) EVERYBODY has their own Medicare number, which opens doors for medical treatment. The lowliest hobo is entitled to the same level of health care as the richest billionaire.
2) You don't get caught out by medical bills likely to bankrupt you. Need a heart transplant? You can get it done free, if you need it.
3) Our medications come into this as well, with subsidised prescriptions. What is more, once you spend more than a certain amount per family per calender year, the cost per prescription drops to about $5 each. And if you begin with a Health Care Card, you get your prescriptions already at that low price and once you reach your annual limit further scripts are free.
Problems -
1) Our national budget still blows out with health care costs. But it's much more manageable now.
2) The biggest disadvantage from a US point of view, is Big Brother. It takes a HUGE amount of red tape to administer this system. Our health bureaucracy has evolved over 40 years. There is a connectedness to it all that is likely to have your civil libertarians screaming blue murder. With some justification, at least. But you can't make an omelette without breaking eggs and it needs to be considered - what is best? Freedom but poor health, or some level of "Big Brother is watching you"?
A lot of Aussies have accepted the Big Brother stuff on the premise that if you're not doing anything wrong, there is no problem. And generally that is the case.
How it's administered - I said each citizen has their own Medicare number. Each kid when it's born, is at first treated under the mother's medicare number. But once the birth is registered, new cards are issued to the family which include the baby. You can opt to have separate cards for each person in the family, or one card which has all family members on it. You can have multiple copies of the card but only ever one Medicare number that is current.
For example, Medibank was in when we began to have kids. husband & I got a card each, but the same stuff was printed on it - his name, my name and easy child's name. There was one big number at the top, then our names underneath with a prefix number. I'm No 1 on our cards (because I saw the doctor the most, back then). husband No 2, easy child No 3. As each kidcame along they were added. When difficult child 3 arrived, we needed a second card to cover all the family because each card only has room for five names and there were six of us.
Then our older kids grew up and became independent. They applied for their own cards, which came with their own unique numbers.
Now they're getting married. Currently, each kid has their own card, their spouse has their own different card (and number). If they choose, they can combine themselves under one number and a different number will be allocated to them for this. The previous number will be deleted.
For us, it's like a social security number. Medicare works for ID as well. When we get our medications at the pharmacy, we have to give our Meeicare number. Once its registered at a pharmacy that is it, we don't need to keep showing it.
How the Big Brother side of it works - it's all administered by the Health Insurance Commission. Their computers are programmed to watch for anomalies. A doctor who apparently sees more patients than he has time for in the day - it gets flagged as needing to be investigated. A doctor who orders more pathology than average - flagged. Patients whose medication pattern and usage is excessive - flagged (as is the prescribing doctor).
Anything flagged gets checked out, usually beginning with the doctor.
A lot of cross-checking goes on, increasingly so. Because Medicare is paid for at taxation time, our tax file numbers are now linked to our Medicare numbers, so the government can make sure we're paying our fair share. And because Medicare numbers are used for ID in so many areas, if you earn money 'under the table' and get paid by cheque or there are any receipts anywhere, you can be sure that at some stage you WILL get caught out.
There has been some talk about microchipping our Medicare cards to carry a copy of our medical history with it. These days when we see a doctor, it all goes on computer. The idea is that the microchip will carry a history of what has been prescribed and when and perhaps what has been diagnosed, when and by whom. So if we go see another doctor (for example, if we're on holidays) it doesn't matter if we can't remember all our medications, or what our doctor last told us. it will be on the chip. It would be useful in my case, for example, with my history of allergies.
The problem would be if a doctor writes something badly wrong or nasty. But if all that is written is what was precribed (or similar) then it shouldn't be a problem. Besides, a doctor using the system to be vindictive ("this patient has only one funcitoning neurone, and even it is nnot synapsing properly") would find another doctor could easily blow the whistle on him and the patient could sue the first doctor.
So there it is, as simply as I can sketch it.
WE can live with this even though it's not perfect, because it is still the best we've had, in my lifetime.
But could YOU live with it? And if not, can you see where your government could improve on it, to give you a health system for your country that is workable, affordable and tolerable?
Marg