With all the controversy going on over the ACA (which I’m aware is not universal), I’m wondering if any other countries have faced a similar situation where substantial numbers of their population had their health insurance taken away from them.
Is there any precedent for this elsewhere?
I’m also interested in the answer. A quick googling didn’t turn up anything. Perhaps it happened as a result of regime change, but I can’t imagine it happening in the normal course of events. Someone will know the answer.
The USSR, sort of did. It went from a socialist state run system, to one based on private health insurance (but would still probably qualify as ‘Universal’ by most peope’s standards):
“The ****** party wants to take away universal health care” - in Canada, that’s an accusation usually hurled round at election time, and it elicits the same visceral response as threats to the second amendment might in the USA. (But obviously, from a different demographic.)
The Canadian system coerces doctors to participate. Provincial plans set the rules, but for federal funding they must meet Federal requirements. A doctor must charge the official fee schedule for covered treatments for ALL patients, or not be in the system. If they are not in the system, neither they nor the patient get reimbursed for medical procedures. There is no private health insurance offered to substitute for the federal system, so the only opportunities are jobs like pro sports team doctor, private doctor to the 1%, or doing not-covered procedures like vanity plastic surgery. (Although a plastic surgeon might do a mix of that and covered things like reconstructive surgery for burn victims or cancer survivors).
So the big fear is that introducing any for of for-profit would allow Canada to end up like Britain, with a parallel public and private system. Provinces had considered for-profit services; for example, jump the wait queue for MRI by paying for one at a private clinic (Or run down to the USA for one). Some provinces with more retrograde governments have floated the idea of allowing people to pay the $20,000-plus for a knee replacement to jump the queue. The worry is this sort of thing is a slippery slope, there is less incentive to cure the wait-time problem, then people feel obliged to mortgage their house instead of waiting their turn, employers offer private health care coverage, and pretty soon we are back to the USA’s situation, but also paying for a huge healthcare system that half the people don’t use. Next thing you know, people with money and connections pay and get first dibs on heart transplants…
So keeping the system public and universal is a constant PR battle in Canada.
Chile under Pinochet heavily reformed and privatised a system that previously resembled universal healthcare.
Any democracies that have made this decision with the support of the people?
IIRC, after the Swiss did a controversial insurance reform in the mid-90s (individual mandate & non-profit insurance companies), an attempt at a voter repeal failed. They ended up liking it too much.
Yes, Iraq. As I recall, the first thing the US did when it assumed occupation of Iraq was to abolish Saddam’s universal health care, and call in private insurance vendors. (Going from memory – no cite)
@MD2000: Not to derail this into a debate on the Canadian System:
Canada has the best system in the world… right up until you need it. As a Canadian, I’m sad to say our system (in Ontario at least) is a pathetic joke. Ridiculous waiting times. No family doctors. We should repeal our crappy universal health care and move to a formalized two tier system, why? because we already have one. If you need treatment and have money you already go to the USA. Why do we let that money flow out of our system? Because of some BS left wing philosophy and deluding ourselves about how great our system is.
Personal story: 3 years ago, a routine check found my wife has a possibly cancerous cyst on her esophagus. Her doctor called the main cancer centre, Princess Marg. in Toronto to set up an MRI. After 12 weeks, we still hadn’t heard anything. We called and were told we were “on the list to get a call”, they didn’t know how long until we got the appointment call and said once we did it would take “several more weeks” to get the MRI.
The whole time we’d been an mess thinking my wife has cancer, but we’re polite average Canadians, who aren’t medically connected and don’t have anyone to pull strings for us, so we just suck it up because we have no choice.
It just happened that a few days after that call, a friend who lives near Niagara Falls tore his ACL (on a Thursday). I spoke to him on Sunday and he said he’d had his MRI done on Friday and was seeing his doctor and a surgeon on Monday. WTF? He said he drove to a clinic in Buffalo, paid $300 with “same day results”. On Monday, we called my wife’s doctor, told he we were going to Buffalo. She begged us not to and said she’d “make a call”. My wife was in for the MRI 2 days later!
This is wrong in so many ways - the wait time, the fact that the doc can magically make a call and a spot opens. This was the moment that made me realize what a broken ridiculous system Ontario has.
Time to repeal it and put in a public / private hybrid.
Where did he find a clinic in Buffalo that was offering MRI scans for three hundred dollars? Two or three thousand dollars would be a typical figure.
But derailment is just what you’ve done, big time. For every story like yours there are a thousand worse horror stories in the American system where cash is king when it comes to access to health care. I’ve lived a long life in Canada and my parents even longer ones and I’ve experienced the quality of care and the quality of the triage system first-hand. In any system run by human beings there can be failures – triage can fail and priorities not handled with the appropriate urgency. I’m sorry if that’s been your experience but personally I’ve never seen it – and I’ve seen dozens of examples of the converse, of excellent and caring and quality treatment of even the most elderly. And moreover I feel that I literally owe my life to the prompt management and advanced technology of the Canadian health care system due to a cardiac event just last month, the first time in my life I’ve ever had a serious medical issue. So my lifelong commitment to our health care system now has a rather personal element to it.
md2000 laid out a pretty fair and balanced assessment of the conflicting forces in the Canadian health care system. Let’s leave it at that. I personally think there are very strong logistical reasons for an absolute ban on private insurance for medically necessary procedures, as we have today in Canada, because of the threat of encroachment of powerful US health care interests, a problem that for various economic and cultural reasons is much less of a concern in Europe, where a marginal private tier can generally operate without threatening the public system.
China rolled back their health system after 1978. However they never really had a true universal system.
Iraq under Saddam instituted a UHC system, then let it fall apart after the sanctions. That is my understanding but like with China, I don’t know if what they had in their heydey (the 80s) was truly a UHC system.
Free standing imaging centers can be less expensive but $300 is very cheap, ~$780 is the norm for something simple like a no-contrast wrist or ankle scan.
Free standing imaging center have lower overhead and do not need to make up the $45.9 billion a year in uncompensated care, nor do they have to pay for 24x7 coverage or the same cost of Medical Malpractice Insurance.
While I am sure there are savings to be had it should be noted that the free standing scans are only really usable for some use cases, and they use lower cost machines that take longer to scan and apparently have lower image quality.
I was hit by a car walking the dog this year and suffered a torn MCL, I tried to save money for ethical reasons and went to an imaging center but the signal to noise ratio was to high and ended up needing to go in for a scan in a hospital anyway. While I have no idea what to look for the image quality was very different, or appeared to be to a non-expert.
I am not a radiologist but the doctor did say that the cheaper machines were good enough for a lot of use cases.
The whole point is that the Canadian doctor may not have been concerned because they wanted to charge for the scan but because the lower cost machines machines wouldn’t show what they needed to see.
What do you consider a good model for a public/private hybrid? I assume you mean a public plan that covers everyone, but also you can pay extra for private insurance that gives faster/better care.
Isn’t that how Australia’s system works? Public/private hybrid?
Cite?
I don’t think a change to social policy made by an invading occupying power counts as the country having made a decision.
I’m not familiar with the Aussie (or British) hybrid systems, so I can’t comment on either. I’m sure they both have pros and cons.
I would toss out the broken “only government-paid universal healthcare” ideology and have an evidence-based look around the world to see what delivers the highest standards of affordable care for the best value for public taxpayers.
Once we decide the standards that we want to meet and what can we afford, then lets look at the options from around the world that meet or exceed those standards and figure how do we adapt that system.
It may not be a hybrid model, but I strongly suspect it will be. We know the purely taxpayer funded Canadian model doesn’t work and the old privately funded US model is quite bad. in 2013 (prior to ACA), USA spent more per person on healthcare than anywhere else in the world and has one of the worst overall outcomes- lowest life expectancy of the countries compared, high rates of chronic conditions: [http://www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-care-from-a-global-perspective]
Unfortunately, in Canada (maybe similar to the USA) you can’t even start the discussion on this topic. It turns an ideological screaming match and reformers inevitably get shouted down. Google “does Canada allow for-profit blood donations” and see what I mean. Meanwhile, while the ideologues protest “social exploitation”, surgeries are cancelled and delayed because Canada has a blood shortage…
Yes - we have a universal coverage system, funded through the personal taxation system, and a supplementary private system.
I believe universal health coverage was introduced, as Medibank, by the Whitlam Govt in the 1970s, and the Liberals [our conservative party] tried to wind it back, but the resulting public outcry meant they could only get away with the private system bolted on to the side. Confusingly, Medibank Private is now one of the private suppliers, and the main universal healthcare provider is called Medicare.
Does it work? Enough that many American friends of mine feel they need to comment how they wish they had it. Constant pressures to deregulate and allow greater penetration of American style health consortia, as well as dismantling Pharmaceutical Benefits Scheme which subsidises critical medicines.
I don’t quite understand the OP’s question about having health insurance taken away from people.
There is a minority in the UK that wants to break up the dominance of the NHS’s position as owner of the bulk of provision and primary/monopsonist contractor with the services it doesn’t directly provide (which makes it a central setter of standards and prices across everything it pays for). And similarly, when it comes to payment, there’s always an argument (about to become more lively, I suspect) about whether people should be expected to contribute at the point of use or by some sort of supplementary insurance rather than just through increasing taxes and central government budgeting.
But that’s not quite the same as taking away a pre-existing arrangement. It’s never been a starter for anyone to propose forcing people in or out of the NHS altogether.
*Indonesia *just instituted universal heath care. INDONESIA. I believe the buy-in is the equiv of $5 per month. Now padi farmers would struggle with this but people who have what we’d consider menial jobs can afford this. I’m not saying the care is first rate, especially places where black magic and the healers who can dispense with curses are a competing system but it’s slightly better than nothing.