FL: In the book, you describe four different healthcare models used around the world. What are those models?

TRR: In the "Beveridge Model" [used in Great Britain], which I think is closest to what Americans most think of when we think of healthcare overseas, government owns the hospitals, government employs many—but not all—of the doctors, government runs the lab and government pays all the bills. Government is pretty much the provider and the payer of healthcare. To me, that is pretty close to what I'd call socialized medicine.

But if you go across the English Channel to the continent, a lot of those countries are "Bismarck" countries. They get universal coverage with private docs, private hospitals and private insurance companies. It's the opposite of the Beveridge model. It's private; it's not socialized. There are many—Switzerland, the Netherlands—they don't have a Medicare for elderly people. They don't have a government plan for elderly people. They stay with private insurance. I argue in the book that this is less socialized than the U.S.

And there is another model [called the "National Health Insurance Model"] that is kind of a combination of the two. Private doctors, private hospitals, but a public payment scheme—government insurance. The Canadians invented that model and they gave it the name, they call it Medicare. It's also used in Australia, South Korea, Taiwan, etc. And of course that's the model Lyndon Johnson copied when he created our Medicare system to serve American seniors—private docs, public payment scheme. The only difference is the other countries in the model—Australia, Canada, etc.—apply it to everybody and we only apply it to people 65 and up.

And then the fourth model, which you find in third world countries, is the "Out of Pocket Model." If you've got money to see a doctor, you get treated. And if you don't have any money or if the doctor won't accept potatoes or corn or whatever you've got to offer, you stay sick or you die. That's it.


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