Frontline’s “Sick Around the World” presented an informative view on the different approaches to healthcare in rich countries around the world. In a webcast discussing the different systems Uwe Reinhardt, professor of health economics at Princeton, emphasized the ethics involved. He said they fell into three categories.
- healthcare is available to everyone on an equal basis and financed by ability-to pay (the Taiwan-Canada approach).
- #1, however a small, wealthy elite is allowed to opt-out of the universal system and get their own coverage (the European approach.)
- healthcare is a private consumption good to be rationed on the basis of ability to pay (the United States.)
As to why Europeans have developed #2, a system in which wealthy elites can opt out, Reinhardt says
“some say it’s a design flaw, and in some regard it is, however it’s a safety valve. You want to get the malcontents out of the system. So they can have their own thing and for the 90% of the rest of us we can do our thing”.
I suspect that is exactly what will happen in America if we are ever to get universal coverage. The wealthy malcontents will have to be bought off.