Glad you asked this question, sugarandspice.
I have lived under every kind of healtcare regime--in Australia (like the Canadian system), in Japan (national health, but scary), the USA (flat out fucked up), and Germany (bureaucratic, but it works).
When I lived in NYC (2004-2007). I had cushy health care, generously subsidised by an elite employer. I was successful in getting only about half of my claims paid. The only thing that was easy seemed to be drugs. I wonder why?
Further, I had that stupid health savings plan, administered by the company health insurer. You know, the one where you can save up to five grand pre-tax and use it for health expenses.
I tried to claim a couple of pairs of glasses. Impossible. They wouldn't approve it unless it was on the correct form. They wouldn't provide me or my optometrist with such a form, saying that the doc should have it already. The doc sent in the usual form she used with my insurance company, and it was bounced twice. I gave up.
But who, I asked, keeps the money if I don't or can't use it? The government? The HR people at my company didn't know, but they thought it might be the insurance company administering the account.
Most opponents of national health schemes base their objections on an article of faith. Private enterprise will always be cheaper than government enterprise.
Problem is, private enterprise simply doesn't work with health care. If you're a normal provider of goods or services want to grow your business, you have a number of options. All of them work in the consumer's favour.
1. Cut the price so people will buy more, or buy more often.
2. Gain share from other providers so that you can enjoy economies of scale.
3. Raise the quality of your goods or services, so you can charge more for them.
None of these apply to health care.
1. People (mostly) use healthcare when they're sick. This is not a discretionary purchase. I'm not going to have three appendectomies just because they're cheap.
2. It's unrealistic to expect people to shop around for doctors. If I have an accident, I don't expect three ambulance companies to arrive on the scene and bid for my business.
3. All healthcare should be of the highest quality, period. Nobody should be asked to compromise. "No thanks, I'll take the cheaper bypass, you know, the one where I don't get brain damage but still stay too weak to climb stairs. My house is a ranch, anyway. I don't need to be in the peak of health, and I can use the savings for a new set of golf clubs..."
Under these circumstances, there are four ways for a private health care company to increase its return:
1. Cut corners
2. Cheat on your obligations
3. Only insure people who will never need your services.
4. Conspire with competitors to keep prices higher than they need be.
But this has never happened in the United States, has it?
Better simply to say to all: you're sick, you get fixed.
Yes, taxes are higher in some countries to pay for universal health care. But look at it this way. If I take the tax burden I paid in New York, and add my health costs, then it works out to be a much higher %age in NYC than it did in Australia. That's just in tax plus premiums (and I had supplementary health insurance in Australia). It doesn't count my extra costs in NYC because I had to pay for so much out of pocket.
Now, the Australian system has running into trouble, simply because they've tried to partially privatise it to save the government some money. The newly-elected Australian government has scrapped that idea--it simply didn't work.
In moving out of the USA, I voted with my feet. Health care was an important factor.
