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EspañolUNIVERSAL HEALTH CARE
'Universal health care' is a state in which all residents of a geographic or political region have access to most types of health care.
Universal health care is provided in most developed countries, and many developing countries across the globe. In the 1880s, most Germans became covered under the mandatory health care system championed by Bismarck. The National Health Service in the United Kingdom was the world's first universal health care system provided by government. It was established in 1948. The most comprehensive today is in France, and the second most is in Italy. Other examples are Medicare in Australia, established in the 1970s, and by the same name Medicare in Canada, established between 1966 and 1984. Universal health care contrasts to the systems like health care in the United States or South Africa, though South Africa is one of the many countries attempting health care reform.[1]
Some government health care systems allow private practitioners to provide services, and some do not. In the U.K., doctors are allowed to provide services outside the government system; in Canada, some services are permitted and some are not.
Main articles: Health care systems
Universal health care is a broad concept and has been implemented in several ways. The common denominator for them all is that every resident of a geographic area — such as a country — is mandated to have guaranteed health care access at reasonable cost.
Most countries implement universal health care through legislation and taxation. Legislation directs what care must be provided, to whom, and on what basis. Usually some costs are borne by the patient but are heavily subsidised by direct taxation and compensated to the patient to some extent either directly by the government or by some form of compulsory insurance.[2]
All of Europe has publicly sponsored and regulated health care. Countries include Austria, Belgium, Bosnia, Bulgaria, Croatia, Czech Reublic, Denmark, Finland, Estonia, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, the Netherlands, Norway, Lichtenstein, Luxembourg, Poland, Portugal,[3] Romania, Russia, Slovakia, Slovenia, Spain, Sweden, Switzerland and the United Kingdom.[4]
Main articles: National Health Service
The NHS is the world's largest centralised health service, and the world's third largest employer after the Chinese army and the Indian railways. It provides a very wide range of health services to virtually the entire population. Unlike most health systems, it does not bill its services to either its patients, an insurance fund or to the government. Even in-patient medicines, hospital supplies such as bandages and hip joints, as well hospital supplied meals and refreshments all are free to in-patients, and even outpatients receive free loans of medical aids such as crutches. This is a factor which reduces administration costs considerably over insurance based systems. It is entirely funded from general taxation. It was created in the aftermath of World War II, by Clement Attlee's Labour government, based on the proposals of the Beveridge Report, prepared in 1942.[5] The structure of the NHS in England and Wales was established by the National Health Service Act 1946 (1946 Act). Governments since 1997 have spent more money on the NHS and UK spending on health is now closer to (but still below) the European average. The new money has reduced waiting times and modernised the infrastructure, and has improved the salaries of medical staff. The outsourcing of medical services and support to the private sector is a recent innovation. Hospitals may have both medical services (such as "surgicentres"),[6] and non-medical services (such as catering) provided under long-term contracts by the private sector. Capital projects such as new hospitals have been privatised through the Private Finance Initiative, enabling the public sector borrowing requirement to be reduced.
Argentina, Brazil, Costa Rica, Canada, Chile, Cuba and Uruguay all have public health care provided. Mexico is planning to launch its own universal health care network.[7]
Main articles: Health care in Canada, Medicare (Canada)
The federal government of Lester B. Pearson, pressured by the New Democratic Party (NDP) who held the balance of power, introduced the Medical Care Act in 1966 that extended the HIDS Act cost-sharing to allow each province to establish a universal health care plan. It also set up the Medicare system. In 1984, the Canada Health Act was passed, which prohibited user fees and extra billing by doctors. In 1999, the prime minister and most premiers reaffirmed in the Social Union Framework Agreement that they are committed to health care that has "comprehensiveness, universality, portability, public administration and accessibility."[8]
The Canadian system is for the most part publicly funded, yet most of the services are provided by private enterprises or private corporations. Most doctors do not receive an annual salary, but receive a fee per visit or service. About 30% of Canadians' health care is paid for by the private sector or individuals. This mostly goes towards services not covered or only partially covered by Medicare such as prescription drugs, dentistry and optometry. Many Canadians have private health insurance, often through their employers, that cover these expenses.
The Supreme Court of Quebec ruled, in Chaoulli v. Quebec, that private services must be allowed to compete with the public program.[9]
India, Australia, Israel [10] Japan, New Zealand, Saudi Arabia, South Korea, Seychelles, Sri Lanka[11] and Taiwan have universal health care.
Thailand plans to have universal coverage.[12][7]
India has partial universal health care system run by the local governments. Although the hospitals - called government hospitals - are not best of the class, they still provide free treatment, free condoms & to some extent free medicines.
Main articles: Medicare (Australia)
Medicare was introduced by the Whitlam Labor Government on 1 July 1975 through the Health Insurance Act 1973. The Australian Senate rejected the changes multiple times and they were passed only after a joint sitting after the 1974 double dissolution election. Yet Medicare has been supported by subsequent governments and became a key feature of Australia’s public policy landscape. The exact structure of Medicare, in terms of the size of the rebate to doctors and hospitals and the way it has administered, has varied over the years. The original Medicare program proposed a 1.35% levy (with low income exemptions) but these bills were rejected by the Senate, and so Medicare was originally funded from general taxation. In October 1976, the Fraser Government introduced a 2.5% levy. The program is now nominally funded by an income tax surcharge known as the ''Medicare levy'', which is currently set at 1.5% with exemptions for low income earners. In practice the levy raises only a fraction of the money required to pay for the scheme. If the levy was to fully pay for the services provided under the medicare banner then it would need to be set at about 8%. There is an additional levy of 1.0%, known as the Medicare Levy Surcharge, for those on high annual incomes ($50,000) who do not have adequate levels of private hospital coverage. This is part of an effort by the current Coalition Federal Government to encourage people towards private health insurance.
Main articles: Health care economics
Universal health care in most countries has been achieved by a mixed model of funding, based on elements of compulsory safety net insurance for all (which may be levied on the individual and/or an employer), with special protections for the poor and disadvantaged (funded by taxation) with the option of private payments (either direct or via optional insurance) for services beyond that covered by the safety net.
This is usually enforced via legislation. Sometimes there may be a choice several funds providing a basic service (e.g. as in Germany) or sometimes just a single fund (as in Canada).
Some countries (notably the UK) effectively have stripped away the pretence that there is insurance for the safety net and choose to fund health care directly from taxation.
Other countries with insurance based systems effectively meet the cost of insuring those unable to insure themselves via social security arrangements funded from taxation.
This term is used in the US debate to describe a funding mechanism meeting the costs of medical care from a single fund. Although the fund holder is sometimes assumed to be the government allocating funding from taxation, its proponents do not rule out the possibility of some other mechanism. It is therefore as yet undetermined whether a future US single-payer universal health care system would be funded from taxation, from compulsory insurance or a mixture of both.
Private insurance is most often used to meet what the core safety net services do not provide. E.g. cosmetic surgery for reasons of vanity, for special comforts like private rooms, or to obtain service more quickly than is otherwise possible.
Medical (health) insurance is subject to the well-known economic problem of adverse selection which may also be referred to as a market failure. Adverse selection in insurance markets occurs because those providing insurance have limited information with which to estimate the risks their clients wish to insure against. In simple terms, those with poor health will apply for insurance, raising the cost of providing insurance; those with good health will find the cost of insurance too expensive, raising costs further. In practical terms, adverse selection means that private insurers are economically incentivized to spend substantial sums on 'weeding out' bad risks in advance by providing medical insurance only to the most healthy. Among the potential solutions posited by economists are forms of universal health insurance, such as requiring all citizens to purchase insurance, limiting the ability of insurance companies to deny insurance to individuals or vary price between individuals. Compulsory universal health insurance is a common thread, be it through single payer systems or by requiring individuals to have private health insurance.[14] [15]
The table below gives some indications of financial inputs and medical in a number of different countries, some of which have universal coverage and some of which do not. Interpreting data of this kind can be difficult because of other factors (e.g. genetic differences, diet) that are not controlled for.
Most European systems are financed through a mix of public and private contributions.[16] The majority of universal health care systems are funded primarily by tax revenue (e.g. Portugal). Some nations, such as Germany, France[1] and Japan[18] employ a multi-payer system in which health care is funded by private and public contributions. In 2001 Canadians paid $2,163 per capita versus $4,887 U.S., according to the Los Angeles Times (also, see table above). According to Dr. Stephen Bezruchka, a senior lecturer in the School of Public Health at the University of Washington in Seattle, Canadians do better by every health care measure. According to a World Health Organization report published in 2003, life expectancy at birth in Canada is 79.8 years, versus 77.3 in the U.S[19].
A distinction is also made between municipal and national healthcare funding. For example, one model is that the bulk of the healthcare is funded by the municipality, speciality healthcare is provided and possibly funded by a larger entity, such as a municipal co-operation board or the state, and the medications are paid by a state agency. One advantage of tying health care to local budgets is that that health care improvements and cost savings can be obtained by cross subsidy. For instance in Finland, type II diabetes patients can get discounted access to municipal owned sports facilities such as gyms and swimming pools, the discounts being rewarded to the community in the longer term because fitter patients will not need more expensive medical or personal care later in life. No entirely private health care system exists, although the reform bill in Massachusetts attempts to make private health care more affordable. Bill Frist argued in the ''New England Journal of Medicine'' that the free market will keep costs down, because individuals who have to pay for their own health care will make wiser decisions and not spend money on unneeded or inefficient care. A deregulated free market, Frist argues, will also encourage efficiency and innovation.
Main articles: Health care politics
Because most developed and many developing countries already have systems for universal health care that have been in place for many years, universal health care per se is not a matter of political debate. The exception is the United States of America which does not have such a system currently and where health care is currently a hot political issue.
Within the United States, those in favor of implementing universal health care argue that it would provide health care to the people who currently do not have it. Opponents of universal health care argue that universal healthcare will require higher taxes and a great likelihood of poorly performing healthcare facilities and physicians. [20] These opponents also claim that the absence of a market mechanism may slow innovation in treatment and research, and leads to rationing of care through waiting lists.[21] Both sides of the political spectrum have also looked to more philosophical arguments, debating whether or not people have a fundamental right to have health care provided to them by their government.
A statistical comparison shows that it is not universal health care that leads to a doctor shortage, but the payment system to doctors that causes a doctors shortage. A 2001 study showed that doctors in Italy,[22] are paid a fee per patient per year, a per capita salary, without causing a doctor shortage; even maintaining the highest doctor per patient ratio seen at, 5.8 doctors per 1,000 patients. Canada has a doctor per patient ration of 2.1 doctors per 1,000 patients, compared to the UK with 1.8 and the US with 2.7.
In Canada, the self regulation of the health industry by the doctors union, the Canadian Medical Association, and its self regulatory wing, College of Physicians and Surgeons of Ontario [23] are not required to respond publicly to complaints against doctors unless disciplinary action was given, leading to cases where doctors have been taken to court multiple times for similar actions[24]
Main articles: Health care in the United States
The United States does not have a universal health care system but does have certain publicly funded health care programs help to provide for the elderly, disabled, military service families and veterans, and the poor[25] and federal law ensures public access to emergency services regardless of ability to pay.[26] The Commonwealth of Massachusetts is attempting to implement a near-universal health care system by mandating that residents purchase health insurance by July 1, 2007.[27] California, Maine, Pennsylvania, and Vermont also are attempting universal systems.[28] In addition, certain types of medical spending and particularly health insurance benefit from significant tax subsidies; in particular, employer-sponsored health insurance is a non-taxable benefit. In all, government spending (including tax benefits) accounts for more than 44.6% of total health spending in the U.S.[29]
Proponents of implementing a universal health care system in the United States argue that there are many flaws in the reasoning used against having such a system. Proponents cite the low life expectancy of American citizens compared to other industrialized nations, including those with national healthcare systems, such as Australia, the United Kingdom, Canada, and Sweden.[30] Infant mortality rates remain higher in the United States, despite declines in recent decades, and are higher than the average of the European Union. -see table[31]
In turn, critics note that there is very little correlation between life expectancy and infant mortality with the quality of health care, due to such factors as alternate causality and variations in the way countries collect their statistical data.[32] In fact, the United States led the world in life expectancy twenty years ago with virtually the same health system. Rather, many analysts attribute the lower life expectancy to the astronomical surge in obesity rates.[33][34][35]
Current estimates put US healthcare spending at approximately 15% of GDP, which is the highest in the world.[36] Despite this, only an estimated 84.3% of citizens have some form of health insurance coverage, either through their employer or purchased individually.[37]
[38] In 2003, approximately 61 million adults, or 35 percent of individuals, ages 19 to 64, had either no insurance, sporadic coverage, or insurance coverage that exposed them to high health care costs.[39] Employers that do provide insurance, on average, spend between 4.6 and 8.7% of their payroll in health insurance premiums.
Common arguments forwarded by supporters of universal health care systems include:
★ Health care is a basic human right[40][41] or entitlement.[42]
★ Ensuring the health of all citizens benefits a nation economically.[43]
★ Coverage should be provided to all citizens regardless of ability to pay.
★ The current US system is already funded 64% by tax money with the remaining 36% split between private and employer spending. A universal healthcare system would merely replace private/employer spending with tax revenues. Total spending would go down for individuals and employers.[44]
★ A single payer system could save $286 billion a year in overhead and paperwork.[45] Administrative costs in the US health care system are estimated to be substantially higher than in other countries and than in the public sector in the US: one estimate put the total administrative costs at 24 percent of US health care spending.[46]
★ For profit healthcare has been shown to have higher expenses and worse results.[47][48]
★ Several studies have shown a majority of taxpayers and citizens across the political divide prefer a universal healthcare system over our current system[49][50][51]
★ Health care is increasingly unaffordable for businesses and individuals.[52]
★ Universal health care would provide for uninsured adults who may forgo treatment needed for chronic health conditions.[53]
★ Providing access to medical treatment to those who cannot afford it reduces the severity of epidemics by reducing the number of disease carriers.
★ Wastefulness and inefficiency in the delivery of health care would be reduced.
★ America spends a far higher percentage of GDP on health care than any other country, and has worse ratings on a variety of subjects such as quality of care, efficiency of care, access to care, safe care, equity, right care and wait times according to the commonwealth fund. New Zealand, which spends one third per capita what the US spends on health care beats the US on every marker of efficiency and care. Although not definitive, this does lend credence to the idea that universal health care is more efficient than our for profit health care system as the US was inferior to Germany, the UK, Australia, New Zealand and to a lesser degree Canada in nearly all health care quality issues. This despite the fact that the US system costs 2-3x more per capita than the systems in these other countries.[54]
★ A universal system would align incentives for investment in long term health-care productivity, preventive care, and better management of chronic conditions.[55]
★ By reducing paperwork a universal system would allow doctors to spend more time with patients, thereby increasing physician productivity.[56]
★ Patients would be encouraged to seek preventive care enabling problems to be detected and treated earlier.
★ A centralized national database would make diagnosis and treatment easier for doctors.
★ Universal health care could act as a subsidy to business, at no cost thereto. (Indeed, the Big Three of U.S. car manufacturers cite health-care provision as a reason for their ongoing financial travails. The cost of health insurance to U.S. car manufacturers adds between USD 900 and USD 1,400 to each car made in the U.S.A.)[57]
★ Managed care networks, with their extensive provisions and guidelines, reduce doctor flexibility and limit patient choice.
★ The profit motive adversely affects the cost and quality of health care. If managed care programs and their concomitant provider networks are abolished, then doctors would no longer guaranteed patients solely on the basis of their membership in a provider group and regardless of the quality of care they provide. Theoretically, quality of care would increase as true competition for patients is restored.[58]
★ The profit motive adversely affects the motives of healthcare. Because an applicant with a pre-existing condition (possibly from birth) would require more care, they are often blackballed from being able to obtain health insurance at a reasonable cost. Health insurance companies have greater profits if fewer medical procedures are actually performed, so agents are pressured to deny necessary and sometimes life-saving procedures to help the bottom line.
★ According to an estimate by Dr. Marcia Angell roughly 50% of healthcare dollars are spent on healthcare, the rest go to various middlemen and intermediates to providing healthcare. A streamlined, non-profit, universal system would increase the efficiency with which money spent on healthcare goes to healthcare.[56]
★ Socialized Medicine
★ Health Care
★ Health care systems
★ Publicly-funded health care
★ Journal of Health Care for the Poor and Underserved
★ Health savings account
★ Medical savings account
★ Medicare (United States)
★ Two-tier health care
★ Massachusetts 2006 Health Reform Statute
★ California Speaks
★ The Citadel
★ Sicko (film)
1. Physicians for a National Health Program"International Health Systems".
2. For an international comparison of ten different health care systems in ten developed countries - nine universal systems and one non-universal system (the US) - and their relative costs and key health outcomes, see http://www.nao.org.uk/publications/Int_Health_Comp.pdf. For a wider international comparison of 16 countries, each with universal health care, see the World Health Organisation publication at http://www.euro.who.int/document/e85400.pdf.
3. Portugal: Bentes M, Dias CM, Sakellarides C, Bankauskaite V. ''Health Care Systems in Transition: Portuagal.'' WHO are Regional Offices for Europe on behalf of the European Observatory on Health Systems and Policies, 2004.
4. ''Physicians for a National Health Program "International Health Systems''
5. http://www.spartacus.schoolnet.co.uk/2WWbeveridgereport.htm
6. New generation surgery-centres to carry out thousands more NHS operations every year
7. G20 Health Care: "Health Care Systems and Health Market Reform in the G20 Countries." Prepared for the World Economic Forum by Ernst & Young. January 3, 2006.
8. Government of Canada, Social Union, News Release, "A Framework to Improve the Social Union for Canadians: An Agreement between the Government of Canada and the Governments of the Provinces and Territories, February 4, 1999," URL accessed 20 December 2006.
9. http://scc.lexum.umontreal.ca/en/2005/2005scc35/2005scc35.html
10. ''The Health Care System in Israel- An Historical Perspective'' Israel Ministry of Foreign Affairs. Retrieved June 7, 2006.
11. ''Ministry of Health and Nutrition, Sri Lanka''
12. ''The Universal Coverage Policy of Thailand: An Introduction''
13. G20 Health Care: "Health Care Systems and Health Market Reform in the G20 Countries." Prepared for the World Economic Forum by Ernst & Young. January 3, 2006.
14. Michael Rothschild and Joseph Stiglitz, "Equilibrium in Competitive Insurance Markets: An Essay on the Economics of Imperfect Information," Quarterly Journal of Economics, November 1976 (90:629-649) (known as the Rothschild-Stiglitz Model)
15. Paulo Belli, ''How Adverse Selection Affects the Health Insurance Market''
16. Bentes M, Dias CM, Sakellarides C, Bankauskaite V. ''Health Care Systems in Transition: Portuagal.'' WHO are Regional Offices for Europe on behalf of the European Observatory on Health Systems and Policies, 2004.
17. Physicians for a National Health Program"International Health Systems".
18. Chua, Kao-Ping. "Single Payer 101". February 10, 2006.
19. [1]In Health, Canada Tops US; Our neighbors to the north live longer and pay less for care. The reasons why are being debated, but some cite the gap between rich and poor in the US, by Judy Foreman, Los Angeles Times, February 23, 2004.
20. http://www.jwpcivitasinstitute.org/newsroom/Magazine/Winter%2006%20Magazine.pdf; page 22.
21. [2]
22. Comparisons of Health Systems - Doctors per patients p.13
23. Michener Awards: Finalists for 2001 Award
24. The unkindest cut. ''The Star.com
25. Centers for Medicare & Medicaid Services. CMS Programs & Information. Retrieved August 30, 2006.
26. Centers for Medicare & Medicaid Services. Emergency Medical Treatment & Labor Act. Retrieved August 30, 2006.
27. Fahrenthold DA. "Mass. Bill Requires Health Coverage." ''Washington Post''; Wednesday, April 5, 2006; Page A01.
28. ''New York Times''; January 9, 2007; California’s Governor Seeks Universal Care
29. http://www.nybooks.com/articles/18802 Krugman, Paul, and Wells, Robin, "The Health Care Crisis and What to Do About It", New York Review of Books, March 23, 2006.
30. CIA World Factbook table of life expectancies by country
31. ''CIA World Factbook''; Guide to Rank Order Pages[3] and the complete article on the United States [4]
32. National Center for Public Policy Analysis. [5] Retrieved August 08, 2007.
33. New England Journal of Medicine. [6] Retrieved August 08, 2007.
34. Journal of the American Medical Association. [7] Retrieved August 08, 2007.
35. Center for Disease Control and Prevention. [8] Retrieved August 08, 2007.
36. "The World Health Report 2006 - Working together for health."
37. "Income, Poverty, and Health Insurance Coverage in the United States: 2004." U.S. Census Bureau. Issued August 2005.
38. Health care in the United States
39. Insured But Not Protected: How Many Adults Are Underinsured
40. Center for Economic and Social Rights. "The Right to Health in the United States of America: What Does it Mean?" October 29, 2004.
41. National Health Care for the Homeless Council. "Human Rights, Homelessness and Health Care".
42. Kereiakes DJ, Willerson JT. "US health care: entitlement or privilege?." ''Circulation.'' 2004 Mar 30;109(12):1460-2.
43. William F. May. [http://www.religion-online.org/showarticle.asp?title=106 "The Ethical Foundations of Health Care Reform." ''The Christian Century'', June 1-8, 1994, pp. 572-576.
44. "Won’t this raise my taxes?" PHNP.org.
45. Public Citizen. "Study Shows National Health Insurance Could Save 6 Billion on Health Care Paperwork:" http://www.citizen.org.
46. http://content.healthaffairs.org/cgi/content/full/23/3/10 Reinhardt, Hussey and Anderson, "U.S. Health Care Spending In An International Context", Health Affairs, 23, no. 3 (2004): 10-25
47. Physicans for a national health program"For-Profit Hospitals Cost More and Have Higher Death Rates" http://www.pnhp.org March 1, 2006.
48. Physicans for a national health program"For-Profit HMOs Provide Worse Quality Care" http://www.pnhp.org
49. Teixeira , Ruy. "Healthcare for All?" MotherJones September 27, 2005 .
50. CBSNews. "Poll: The Politics Of Health Care" CBSNews March 1, 2007 .
51. Blake, Aaron. "Poll shows many Republicans favor universal health care, gays in military" TheHill.com June 28, 2007.
52. Messerli, Joe. "Should the Government Provide Free Universal Health Care for All Americans?" BalancedPolitics.org. March 1, 2006.
53. http://covertheuninsured.org/media/docs/release050205a.pdf
54. "Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care" by Karen Davis, Ph.D., Cathy Schoen, M.S., Stephen C. Schoenbaum, M.D., M.P.H., Michelle M. Doty, Ph.D., M.P.H., Alyssa L. Holmgren, M.P.A., Jennifer L. Kriss, and Katherine K. Shea Commonwealth Fund, May 15, 2007 .
55. "The Best Care Anywhere" by Phillip Longman, Washington Monthly, January 2005.
56. "Statement of Dr. Marcia Angell introducing the U.S. National Health Insurance Act" www.pnhp.org
57. "Detroit's big three seek White House help" Guardian Unlimited, November 15, 2006
58. http://news.pajamasmedia.com/2006/05/18/8722240_Book_tells_how_p.shtml
59. "Statement of Dr. Marcia Angell introducing the U.S. National Health Insurance Act" www.pnhp.org
★ American Medical Student Association (AMSA)
★ Connecticut Coalition for Universal Health Care
★ Physicians for a National Health Program (PNHP)
★ Universal Health Care Action Network (UHCAN)
★ Universal Health Care / National Health Insurance
★ Universal Health Care in America
★ Capitalism Magazine
★ The Problems with Socialized Health Care from Mark Valenti's Liberty Page
★ British, Canadian Experience Shows Folly of Socialized Medicine, Analyst Says. Press release, Heritage Foundation. Sept. 29, 2000.
★ The Heartland Institutes' Health Care Issue Suite
★ Dead Meat On The Fence's short film about Canada's socialized healthcare system.
★ BalancedPolitics.org - "Should the Government Provide Free Universal Health Care for All Americans?"
★ Hidden costs, value lost: uninsurance in America. Institute of Medicine Committee on the Consequences of Uninsurance. Washington, DC: National Academies Press, 2003.
Universal health care is provided in most developed countries, and many developing countries across the globe. In the 1880s, most Germans became covered under the mandatory health care system championed by Bismarck. The National Health Service in the United Kingdom was the world's first universal health care system provided by government. It was established in 1948. The most comprehensive today is in France, and the second most is in Italy. Other examples are Medicare in Australia, established in the 1970s, and by the same name Medicare in Canada, established between 1966 and 1984. Universal health care contrasts to the systems like health care in the United States or South Africa, though South Africa is one of the many countries attempting health care reform.[1]
Some government health care systems allow private practitioners to provide services, and some do not. In the U.K., doctors are allowed to provide services outside the government system; in Canada, some services are permitted and some are not.
Implementation
Main articles: Health care systems
Map of countries with universal health care
Universal health care is a broad concept and has been implemented in several ways. The common denominator for them all is that every resident of a geographic area — such as a country — is mandated to have guaranteed health care access at reasonable cost.
Most countries implement universal health care through legislation and taxation. Legislation directs what care must be provided, to whom, and on what basis. Usually some costs are borne by the patient but are heavily subsidised by direct taxation and compensated to the patient to some extent either directly by the government or by some form of compulsory insurance.[2]
Europe
All of Europe has publicly sponsored and regulated health care. Countries include Austria, Belgium, Bosnia, Bulgaria, Croatia, Czech Reublic, Denmark, Finland, Estonia, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, the Netherlands, Norway, Lichtenstein, Luxembourg, Poland, Portugal,[3] Romania, Russia, Slovakia, Slovenia, Spain, Sweden, Switzerland and the United Kingdom.[4]
United Kingdom
Main articles: National Health Service
The NHS is the world's largest centralised health service, and the world's third largest employer after the Chinese army and the Indian railways. It provides a very wide range of health services to virtually the entire population. Unlike most health systems, it does not bill its services to either its patients, an insurance fund or to the government. Even in-patient medicines, hospital supplies such as bandages and hip joints, as well hospital supplied meals and refreshments all are free to in-patients, and even outpatients receive free loans of medical aids such as crutches. This is a factor which reduces administration costs considerably over insurance based systems. It is entirely funded from general taxation. It was created in the aftermath of World War II, by Clement Attlee's Labour government, based on the proposals of the Beveridge Report, prepared in 1942.[5] The structure of the NHS in England and Wales was established by the National Health Service Act 1946 (1946 Act). Governments since 1997 have spent more money on the NHS and UK spending on health is now closer to (but still below) the European average. The new money has reduced waiting times and modernised the infrastructure, and has improved the salaries of medical staff. The outsourcing of medical services and support to the private sector is a recent innovation. Hospitals may have both medical services (such as "surgicentres"),[6] and non-medical services (such as catering) provided under long-term contracts by the private sector. Capital projects such as new hospitals have been privatised through the Private Finance Initiative, enabling the public sector borrowing requirement to be reduced.
Americas
Argentina, Brazil, Costa Rica, Canada, Chile, Cuba and Uruguay all have public health care provided. Mexico is planning to launch its own universal health care network.[7]
Canada
Main articles: Health care in Canada, Medicare (Canada)
The federal government of Lester B. Pearson, pressured by the New Democratic Party (NDP) who held the balance of power, introduced the Medical Care Act in 1966 that extended the HIDS Act cost-sharing to allow each province to establish a universal health care plan. It also set up the Medicare system. In 1984, the Canada Health Act was passed, which prohibited user fees and extra billing by doctors. In 1999, the prime minister and most premiers reaffirmed in the Social Union Framework Agreement that they are committed to health care that has "comprehensiveness, universality, portability, public administration and accessibility."[8]
The Canadian system is for the most part publicly funded, yet most of the services are provided by private enterprises or private corporations. Most doctors do not receive an annual salary, but receive a fee per visit or service. About 30% of Canadians' health care is paid for by the private sector or individuals. This mostly goes towards services not covered or only partially covered by Medicare such as prescription drugs, dentistry and optometry. Many Canadians have private health insurance, often through their employers, that cover these expenses.
The Supreme Court of Quebec ruled, in Chaoulli v. Quebec, that private services must be allowed to compete with the public program.[9]
Asia-Pacific and Africa
India, Australia, Israel [10] Japan, New Zealand, Saudi Arabia, South Korea, Seychelles, Sri Lanka[11] and Taiwan have universal health care.
Thailand
Thailand plans to have universal coverage.[12][7]
India
India has partial universal health care system run by the local governments. Although the hospitals - called government hospitals - are not best of the class, they still provide free treatment, free condoms & to some extent free medicines.
Australia
Medicare brand
Main articles: Medicare (Australia)
Medicare was introduced by the Whitlam Labor Government on 1 July 1975 through the Health Insurance Act 1973. The Australian Senate rejected the changes multiple times and they were passed only after a joint sitting after the 1974 double dissolution election. Yet Medicare has been supported by subsequent governments and became a key feature of Australia’s public policy landscape. The exact structure of Medicare, in terms of the size of the rebate to doctors and hospitals and the way it has administered, has varied over the years. The original Medicare program proposed a 1.35% levy (with low income exemptions) but these bills were rejected by the Senate, and so Medicare was originally funded from general taxation. In October 1976, the Fraser Government introduced a 2.5% levy. The program is now nominally funded by an income tax surcharge known as the ''Medicare levy'', which is currently set at 1.5% with exemptions for low income earners. In practice the levy raises only a fraction of the money required to pay for the scheme. If the levy was to fully pay for the services provided under the medicare banner then it would need to be set at about 8%. There is an additional levy of 1.0%, known as the Medicare Levy Surcharge, for those on high annual incomes ($50,000) who do not have adequate levels of private hospital coverage. This is part of an effort by the current Coalition Federal Government to encourage people towards private health insurance.
Economics
Main articles: Health care economics
Funding Models
Universal health care in most countries has been achieved by a mixed model of funding, based on elements of compulsory safety net insurance for all (which may be levied on the individual and/or an employer), with special protections for the poor and disadvantaged (funded by taxation) with the option of private payments (either direct or via optional insurance) for services beyond that covered by the safety net.
Compulsory Insurance
This is usually enforced via legislation. Sometimes there may be a choice several funds providing a basic service (e.g. as in Germany) or sometimes just a single fund (as in Canada).
Taxation
Some countries (notably the UK) effectively have stripped away the pretence that there is insurance for the safety net and choose to fund health care directly from taxation.
Other countries with insurance based systems effectively meet the cost of insuring those unable to insure themselves via social security arrangements funded from taxation.
Single-payer
This term is used in the US debate to describe a funding mechanism meeting the costs of medical care from a single fund. Although the fund holder is sometimes assumed to be the government allocating funding from taxation, its proponents do not rule out the possibility of some other mechanism. It is therefore as yet undetermined whether a future US single-payer universal health care system would be funded from taxation, from compulsory insurance or a mixture of both.
Private Insurance
Private insurance is most often used to meet what the core safety net services do not provide. E.g. cosmetic surgery for reasons of vanity, for special comforts like private rooms, or to obtain service more quickly than is otherwise possible.
Medical (health) insurance is subject to the well-known economic problem of adverse selection which may also be referred to as a market failure. Adverse selection in insurance markets occurs because those providing insurance have limited information with which to estimate the risks their clients wish to insure against. In simple terms, those with poor health will apply for insurance, raising the cost of providing insurance; those with good health will find the cost of insurance too expensive, raising costs further. In practical terms, adverse selection means that private insurers are economically incentivized to spend substantial sums on 'weeding out' bad risks in advance by providing medical insurance only to the most healthy. Among the potential solutions posited by economists are forms of universal health insurance, such as requiring all citizens to purchase insurance, limiting the ability of insurance companies to deny insurance to individuals or vary price between individuals. Compulsory universal health insurance is a common thread, be it through single payer systems or by requiring individuals to have private health insurance.[14] [15]
Financial Inputs and Outcomes compared
The table below gives some indications of financial inputs and medical in a number of different countries, some of which have universal coverage and some of which do not. Interpreting data of this kind can be difficult because of other factors (e.g. genetic differences, diet) that are not controlled for.
| Country | Life expectancy | Infant mortality rate | Physicians per 1000 people | Nurses per 1000 people | Per capita expenditure on health (USD) | Healthcare costs as a percent of GDP | % of government revenue spent on health | % of health costs paid by government |
|---|---|---|---|---|---|---|---|---|
| Australia | 80.5 | 5.0 | 2.47 | 9.71 | 2,519 | 9.5 | 17.7 | 67.5 |
| Canada | 80.5 | 5.0 | 2.14 | 9.95 | 2,669 | 9.9 | 16.7 | 69.9 |
| France | 79.5 | 4.0 | 3.37 | 7.24 | 2,981 | 10.1 | 14.2 | 76.3 |
| Germany | 80.0 | 4.0 | 3.37 | 9.72 | 3,204 | 11.1 | 17.6 | 78.2 |
| Japan | 82.5 | 3.0 | 1.98 | 7.79 | 2,662 | 7.9 | 16.8 | 81.0 |
| Sweden | 80.5 | 3.0 | 3.28 | 10.24 | 3,149 | 9.4 | 13.6 | 85.2 |
| UK | 79.5 | 5.0 | 2.30 | 12.12 | 2,428 | 8.0 | 15.8 | 85.7 |
| USA | 77.5 | 6.0 | 2.56 | 9.37 | 5,711 | 15.2 | 18.5 | 44.6 |
Most European systems are financed through a mix of public and private contributions.[16] The majority of universal health care systems are funded primarily by tax revenue (e.g. Portugal). Some nations, such as Germany, France[1] and Japan[18] employ a multi-payer system in which health care is funded by private and public contributions. In 2001 Canadians paid $2,163 per capita versus $4,887 U.S., according to the Los Angeles Times (also, see table above). According to Dr. Stephen Bezruchka, a senior lecturer in the School of Public Health at the University of Washington in Seattle, Canadians do better by every health care measure. According to a World Health Organization report published in 2003, life expectancy at birth in Canada is 79.8 years, versus 77.3 in the U.S[19].
A distinction is also made between municipal and national healthcare funding. For example, one model is that the bulk of the healthcare is funded by the municipality, speciality healthcare is provided and possibly funded by a larger entity, such as a municipal co-operation board or the state, and the medications are paid by a state agency. One advantage of tying health care to local budgets is that that health care improvements and cost savings can be obtained by cross subsidy. For instance in Finland, type II diabetes patients can get discounted access to municipal owned sports facilities such as gyms and swimming pools, the discounts being rewarded to the community in the longer term because fitter patients will not need more expensive medical or personal care later in life. No entirely private health care system exists, although the reform bill in Massachusetts attempts to make private health care more affordable. Bill Frist argued in the ''New England Journal of Medicine'' that the free market will keep costs down, because individuals who have to pay for their own health care will make wiser decisions and not spend money on unneeded or inefficient care. A deregulated free market, Frist argues, will also encourage efficiency and innovation.
Politics
Main articles: Health care politics
Because most developed and many developing countries already have systems for universal health care that have been in place for many years, universal health care per se is not a matter of political debate. The exception is the United States of America which does not have such a system currently and where health care is currently a hot political issue.
Within the United States, those in favor of implementing universal health care argue that it would provide health care to the people who currently do not have it. Opponents of universal health care argue that universal healthcare will require higher taxes and a great likelihood of poorly performing healthcare facilities and physicians. [20] These opponents also claim that the absence of a market mechanism may slow innovation in treatment and research, and leads to rationing of care through waiting lists.[21] Both sides of the political spectrum have also looked to more philosophical arguments, debating whether or not people have a fundamental right to have health care provided to them by their government.
A statistical comparison shows that it is not universal health care that leads to a doctor shortage, but the payment system to doctors that causes a doctors shortage. A 2001 study showed that doctors in Italy,[22] are paid a fee per patient per year, a per capita salary, without causing a doctor shortage; even maintaining the highest doctor per patient ratio seen at, 5.8 doctors per 1,000 patients. Canada has a doctor per patient ration of 2.1 doctors per 1,000 patients, compared to the UK with 1.8 and the US with 2.7.
In Canada, the self regulation of the health industry by the doctors union, the Canadian Medical Association, and its self regulatory wing, College of Physicians and Surgeons of Ontario [23] are not required to respond publicly to complaints against doctors unless disciplinary action was given, leading to cases where doctors have been taken to court multiple times for similar actions[24]
United States
Main articles: Health care in the United States
Washington DC's St. Elizabeths Hospital
The United States does not have a universal health care system but does have certain publicly funded health care programs help to provide for the elderly, disabled, military service families and veterans, and the poor[25] and federal law ensures public access to emergency services regardless of ability to pay.[26] The Commonwealth of Massachusetts is attempting to implement a near-universal health care system by mandating that residents purchase health insurance by July 1, 2007.[27] California, Maine, Pennsylvania, and Vermont also are attempting universal systems.[28] In addition, certain types of medical spending and particularly health insurance benefit from significant tax subsidies; in particular, employer-sponsored health insurance is a non-taxable benefit. In all, government spending (including tax benefits) accounts for more than 44.6% of total health spending in the U.S.[29]
Proponents of implementing a universal health care system in the United States argue that there are many flaws in the reasoning used against having such a system. Proponents cite the low life expectancy of American citizens compared to other industrialized nations, including those with national healthcare systems, such as Australia, the United Kingdom, Canada, and Sweden.[30] Infant mortality rates remain higher in the United States, despite declines in recent decades, and are higher than the average of the European Union. -see table[31]
In turn, critics note that there is very little correlation between life expectancy and infant mortality with the quality of health care, due to such factors as alternate causality and variations in the way countries collect their statistical data.[32] In fact, the United States led the world in life expectancy twenty years ago with virtually the same health system. Rather, many analysts attribute the lower life expectancy to the astronomical surge in obesity rates.[33][34][35]
Current estimates put US healthcare spending at approximately 15% of GDP, which is the highest in the world.[36] Despite this, only an estimated 84.3% of citizens have some form of health insurance coverage, either through their employer or purchased individually.[37]
[38] In 2003, approximately 61 million adults, or 35 percent of individuals, ages 19 to 64, had either no insurance, sporadic coverage, or insurance coverage that exposed them to high health care costs.[39] Employers that do provide insurance, on average, spend between 4.6 and 8.7% of their payroll in health insurance premiums.
Debate
Common arguments forwarded by supporters of universal health care systems include:
★ Health care is a basic human right[40][41] or entitlement.[42]
★ Ensuring the health of all citizens benefits a nation economically.[43]
★ Coverage should be provided to all citizens regardless of ability to pay.
★ The current US system is already funded 64% by tax money with the remaining 36% split between private and employer spending. A universal healthcare system would merely replace private/employer spending with tax revenues. Total spending would go down for individuals and employers.[44]
★ A single payer system could save $286 billion a year in overhead and paperwork.[45] Administrative costs in the US health care system are estimated to be substantially higher than in other countries and than in the public sector in the US: one estimate put the total administrative costs at 24 percent of US health care spending.[46]
★ For profit healthcare has been shown to have higher expenses and worse results.[47][48]
★ Several studies have shown a majority of taxpayers and citizens across the political divide prefer a universal healthcare system over our current system[49][50][51]
★ Health care is increasingly unaffordable for businesses and individuals.[52]
★ Universal health care would provide for uninsured adults who may forgo treatment needed for chronic health conditions.[53]
★ Providing access to medical treatment to those who cannot afford it reduces the severity of epidemics by reducing the number of disease carriers.
★ Wastefulness and inefficiency in the delivery of health care would be reduced.
★ America spends a far higher percentage of GDP on health care than any other country, and has worse ratings on a variety of subjects such as quality of care, efficiency of care, access to care, safe care, equity, right care and wait times according to the commonwealth fund. New Zealand, which spends one third per capita what the US spends on health care beats the US on every marker of efficiency and care. Although not definitive, this does lend credence to the idea that universal health care is more efficient than our for profit health care system as the US was inferior to Germany, the UK, Australia, New Zealand and to a lesser degree Canada in nearly all health care quality issues. This despite the fact that the US system costs 2-3x more per capita than the systems in these other countries.[54]
★ A universal system would align incentives for investment in long term health-care productivity, preventive care, and better management of chronic conditions.[55]
★ By reducing paperwork a universal system would allow doctors to spend more time with patients, thereby increasing physician productivity.[56]
★ Patients would be encouraged to seek preventive care enabling problems to be detected and treated earlier.
★ A centralized national database would make diagnosis and treatment easier for doctors.
★ Universal health care could act as a subsidy to business, at no cost thereto. (Indeed, the Big Three of U.S. car manufacturers cite health-care provision as a reason for their ongoing financial travails. The cost of health insurance to U.S. car manufacturers adds between USD 900 and USD 1,400 to each car made in the U.S.A.)[57]
★ Managed care networks, with their extensive provisions and guidelines, reduce doctor flexibility and limit patient choice.
★ The profit motive adversely affects the cost and quality of health care. If managed care programs and their concomitant provider networks are abolished, then doctors would no longer guaranteed patients solely on the basis of their membership in a provider group and regardless of the quality of care they provide. Theoretically, quality of care would increase as true competition for patients is restored.[58]
★ The profit motive adversely affects the motives of healthcare. Because an applicant with a pre-existing condition (possibly from birth) would require more care, they are often blackballed from being able to obtain health insurance at a reasonable cost. Health insurance companies have greater profits if fewer medical procedures are actually performed, so agents are pressured to deny necessary and sometimes life-saving procedures to help the bottom line.
★ According to an estimate by Dr. Marcia Angell roughly 50% of healthcare dollars are spent on healthcare, the rest go to various middlemen and intermediates to providing healthcare. A streamlined, non-profit, universal system would increase the efficiency with which money spent on healthcare goes to healthcare.[56]
See also
★ Socialized Medicine
★ Health Care
★ Health care systems
★ Publicly-funded health care
★ Journal of Health Care for the Poor and Underserved
★ Health savings account
★ Medical savings account
★ Medicare (United States)
★ Two-tier health care
★ Massachusetts 2006 Health Reform Statute
★ California Speaks
★ The Citadel
★ Sicko (film)
References
1. Physicians for a National Health Program"International Health Systems".
2. For an international comparison of ten different health care systems in ten developed countries - nine universal systems and one non-universal system (the US) - and their relative costs and key health outcomes, see http://www.nao.org.uk/publications/Int_Health_Comp.pdf. For a wider international comparison of 16 countries, each with universal health care, see the World Health Organisation publication at http://www.euro.who.int/document/e85400.pdf.
3. Portugal: Bentes M, Dias CM, Sakellarides C, Bankauskaite V. ''Health Care Systems in Transition: Portuagal.'' WHO are Regional Offices for Europe on behalf of the European Observatory on Health Systems and Policies, 2004.
4. ''Physicians for a National Health Program "International Health Systems''
5. http://www.spartacus.schoolnet.co.uk/2WWbeveridgereport.htm
6. New generation surgery-centres to carry out thousands more NHS operations every year
7. G20 Health Care: "Health Care Systems and Health Market Reform in the G20 Countries." Prepared for the World Economic Forum by Ernst & Young. January 3, 2006.
8. Government of Canada, Social Union, News Release, "A Framework to Improve the Social Union for Canadians: An Agreement between the Government of Canada and the Governments of the Provinces and Territories, February 4, 1999," URL accessed 20 December 2006.
9. http://scc.lexum.umontreal.ca/en/2005/2005scc35/2005scc35.html
10. ''The Health Care System in Israel- An Historical Perspective'' Israel Ministry of Foreign Affairs. Retrieved June 7, 2006.
11. ''Ministry of Health and Nutrition, Sri Lanka''
12. ''The Universal Coverage Policy of Thailand: An Introduction''
13. G20 Health Care: "Health Care Systems and Health Market Reform in the G20 Countries." Prepared for the World Economic Forum by Ernst & Young. January 3, 2006.
14. Michael Rothschild and Joseph Stiglitz, "Equilibrium in Competitive Insurance Markets: An Essay on the Economics of Imperfect Information," Quarterly Journal of Economics, November 1976 (90:629-649) (known as the Rothschild-Stiglitz Model)
15. Paulo Belli, ''How Adverse Selection Affects the Health Insurance Market''
16. Bentes M, Dias CM, Sakellarides C, Bankauskaite V. ''Health Care Systems in Transition: Portuagal.'' WHO are Regional Offices for Europe on behalf of the European Observatory on Health Systems and Policies, 2004.
17. Physicians for a National Health Program"International Health Systems".
18. Chua, Kao-Ping. "Single Payer 101". February 10, 2006.
19. [1]In Health, Canada Tops US; Our neighbors to the north live longer and pay less for care. The reasons why are being debated, but some cite the gap between rich and poor in the US, by Judy Foreman, Los Angeles Times, February 23, 2004.
20. http://www.jwpcivitasinstitute.org/newsroom/Magazine/Winter%2006%20Magazine.pdf; page 22.
21. [2]
22. Comparisons of Health Systems - Doctors per patients p.13
23. Michener Awards: Finalists for 2001 Award
24. The unkindest cut. ''The Star.com
25. Centers for Medicare & Medicaid Services. CMS Programs & Information. Retrieved August 30, 2006.
26. Centers for Medicare & Medicaid Services. Emergency Medical Treatment & Labor Act. Retrieved August 30, 2006.
27. Fahrenthold DA. "Mass. Bill Requires Health Coverage." ''Washington Post''; Wednesday, April 5, 2006; Page A01.
28. ''New York Times''; January 9, 2007; California’s Governor Seeks Universal Care
29. http://www.nybooks.com/articles/18802 Krugman, Paul, and Wells, Robin, "The Health Care Crisis and What to Do About It", New York Review of Books, March 23, 2006.
30. CIA World Factbook table of life expectancies by country
31. ''CIA World Factbook''; Guide to Rank Order Pages[3] and the complete article on the United States [4]
32. National Center for Public Policy Analysis. [5] Retrieved August 08, 2007.
33. New England Journal of Medicine. [6] Retrieved August 08, 2007.
34. Journal of the American Medical Association. [7] Retrieved August 08, 2007.
35. Center for Disease Control and Prevention. [8] Retrieved August 08, 2007.
36. "The World Health Report 2006 - Working together for health."
37. "Income, Poverty, and Health Insurance Coverage in the United States: 2004." U.S. Census Bureau. Issued August 2005.
38. Health care in the United States
39. Insured But Not Protected: How Many Adults Are Underinsured
40. Center for Economic and Social Rights. "The Right to Health in the United States of America: What Does it Mean?" October 29, 2004.
41. National Health Care for the Homeless Council. "Human Rights, Homelessness and Health Care".
42. Kereiakes DJ, Willerson JT. "US health care: entitlement or privilege?." ''Circulation.'' 2004 Mar 30;109(12):1460-2.
43. William F. May. [http://www.religion-online.org/showarticle.asp?title=106 "The Ethical Foundations of Health Care Reform." ''The Christian Century'', June 1-8, 1994, pp. 572-576.
44. "Won’t this raise my taxes?" PHNP.org.
45. Public Citizen. "Study Shows National Health Insurance Could Save 6 Billion on Health Care Paperwork:" http://www.citizen.org.
46. http://content.healthaffairs.org/cgi/content/full/23/3/10 Reinhardt, Hussey and Anderson, "U.S. Health Care Spending In An International Context", Health Affairs, 23, no. 3 (2004): 10-25
47. Physicans for a national health program"For-Profit Hospitals Cost More and Have Higher Death Rates" http://www.pnhp.org March 1, 2006.
48. Physicans for a national health program"For-Profit HMOs Provide Worse Quality Care" http://www.pnhp.org
49. Teixeira , Ruy. "Healthcare for All?" MotherJones September 27, 2005 .
50. CBSNews. "Poll: The Politics Of Health Care" CBSNews March 1, 2007 .
51. Blake, Aaron. "Poll shows many Republicans favor universal health care, gays in military" TheHill.com June 28, 2007.
52. Messerli, Joe. "Should the Government Provide Free Universal Health Care for All Americans?" BalancedPolitics.org. March 1, 2006.
53. http://covertheuninsured.org/media/docs/release050205a.pdf
54. "Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care" by Karen Davis, Ph.D., Cathy Schoen, M.S., Stephen C. Schoenbaum, M.D., M.P.H., Michelle M. Doty, Ph.D., M.P.H., Alyssa L. Holmgren, M.P.A., Jennifer L. Kriss, and Katherine K. Shea Commonwealth Fund, May 15, 2007 .
55. "The Best Care Anywhere" by Phillip Longman, Washington Monthly, January 2005.
56. "Statement of Dr. Marcia Angell introducing the U.S. National Health Insurance Act" www.pnhp.org
57. "Detroit's big three seek White House help" Guardian Unlimited, November 15, 2006
58. http://news.pajamasmedia.com/2006/05/18/8722240_Book_tells_how_p.shtml
59. "Statement of Dr. Marcia Angell introducing the U.S. National Health Insurance Act" www.pnhp.org
External links
Support
★ American Medical Student Association (AMSA)
★ Connecticut Coalition for Universal Health Care
★ Physicians for a National Health Program (PNHP)
★ Universal Health Care Action Network (UHCAN)
★ Universal Health Care / National Health Insurance
★ Universal Health Care in America
Opposition
★ Capitalism Magazine
★ The Problems with Socialized Health Care from Mark Valenti's Liberty Page
★ British, Canadian Experience Shows Folly of Socialized Medicine, Analyst Says. Press release, Heritage Foundation. Sept. 29, 2000.
★ The Heartland Institutes' Health Care Issue Suite
★ Dead Meat On The Fence's short film about Canada's socialized healthcare system.
Neutral
★ BalancedPolitics.org - "Should the Government Provide Free Universal Health Care for All Americans?"
★ Hidden costs, value lost: uninsurance in America. Institute of Medicine Committee on the Consequences of Uninsurance. Washington, DC: National Academies Press, 2003.
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