Understanding CA’s Health Care System

Every California legislator should read The Healing of America by T.R. Reid. An informative and entertaining world tour, Reid describes how health care models generally fall into four categories:

  • THE BISMARCK MODEL: Found in Germany, Japan, Belgium, Switzerland, and parts of Latin America, providers and payers in this multi-payer model are private but payers are non-profit.
  • THE NATIONAL HEALTH INSURANCE MODEL (NHI): Found in Canada and Australia and to some extent Taiwan and South Korea, providers are private but government is the only (single) payer.
  • THE BEVERIDGE MODEL: Found in Great Britain, Italy, Spain, most of Scandinavia and Cuba, government provides both care and financing.
  • THE OUT-OF-POCKET MODEL: In nations too poor to provide mass medical care, most medical care is paid out of pocket.

California’s health care system is a combination of all four:

  • Native Americans, military personnel and veterans are in Beveridge systems.
  • Californians over sixty-five or with end-stage renal disease are in a single-payer NHI system (Medicare).
  • Californians with incomes less than 138 percent of the poverty level are in a single-payer NHI system (Medi-Cal).
  • Employed Californians under 65 or with incomes greater than 138 percent of the poverty level are in a Bismarck system but with for-profit insurance companies.
  • Uninsured Californians are in an Out-Of-Pocket system.

Originally appeared on Medium, 3/23/18.