A Primer on Health Care Systems Across Countries

Discussions with the US about the American health care system often counterpose the well-known issues of the US health care system (high costs, lack of health insurance, unequal access to care, lower health outcomes than many other high-income countries) with a nebulous alternative often called “national health insurance, like all the other countries in the world” or sometimes “Medicare for all.” I refer to the alternatives as “nebulous” because the suggestion seems to be that these alternative plans offer all the health care demanded, with all or the vast majority of costs covered by someone else. But more than half the recipients of Medicare, for example, now have their benefits managed by a “Medicare Advantage” or Part C plan, in which the government makes a risk-adjusted payment to a private health insurance company to provide care. The traditional Medicare plan, in which the federal government makes direct payments to providers, also includes insurance premiums, co-pays and…