Every California legislator should read The Healing of America by T.R. Reid. An informative and entertaining world tour, Reid describes how health care models generally fall into four categories:
- THE BISMARCK MODEL: Found in Germany, Japan, Belgium, Switzerland, and parts of Latin America, providers and payers in this multi-payer model are private but payers are non-profit.
- THE NATIONAL HEALTH INSURANCE MODEL (NHI): Found in Canada and Australia and to some extent Taiwan and South Korea, providers are private but government is the only (single) payer.
- THE BEVERIDGE MODEL: Found in Great Britain, Italy, Spain, most of Scandinavia and Cuba, government provides both care and financing.
- THE OUT-OF-POCKET MODEL: In nations too poor to provide mass medical care, most medical care is paid out of pocket.
California’s health care system is a combination of all four:
- Native Americans, military personnel and veterans are in Beveridge systems.
- Californians over sixty-five or with end-stage renal disease are in a single-payer NHI system (Medicare).
- Californians with incomes less than 138 percent of the poverty level are in a single-payer NHI system (Medi-Cal).
- Employed Californians under 65 or with incomes greater than 138 percent of the poverty level are in a Bismarck system but with for-profit insurance companies.
- Uninsured Californians are in an Out-Of-Pocket system.