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di - 29 Luglio 2011
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In response to rationed care, waiting lists and limited choice the observer need only consider the “in-network” lists of doctors, or “preauthorization” requirements by U.S. insurance companies to note that, even if France and Japan do not allow a choice of insurance company, the insured does get a choice of providers of any type anywhere in the country.[12] And, while Canada and Great Britain do suffer from notorious waiting lists for nonemergency care (emergency care is provided[13]) because they limit the number of specialists and operating rooms to save money, other countries such as Germany, France, Sweden and Denmark still outperform the U.S.
The United States spends roughly 20 cents of every dollar for nonmedical costs: paperwork, reviewing claims, marketing, profits, etc., the highest administrative costs in the world—this is a wasteful system run by a bloated bureaucracy.[14]
Health insurance companies do not have to be cruel. In fact, in France, Germany, Japan and Switzerland insurers have to accept all applicants, regardless of any previous conditions, they cannot cancel coverage as long as you pay your premiums and they must pay any claim within tight time limits.[15] U.S. insurance companies are mainly profit-making enterprises. They enhance their profits not by paying for people’s health care, but by finding ways not to pay. U.S. health insurance companies are cruel because their first priority is to make a profit to pay dividends to investors. The U.S. is the only nation that lets insurance companies profit from the basic health care package.
Each of the four systems[16] of health care is in use in the U.S., which dispels of the myth that the systems are too foreign to work in the U.S. For veterans, active-duty military personnel, and Native American, the U.S. uses the British model (Beveridge). For people over sixty-five, the U.S. has adopted the Canadian model (National Health Insurance). For working people who get insurance through their employers, the U.S. follows the German model (Bismarck). For the rest of U.S. Americans, the U.S. is an Out-of-Pocket country.
The insurance lobby’s public campaign against the public option in conjunction with its reluctant agreement to new restrictions and regulations defeated the public option.
The most important new restriction is the “guaranteed issue” rule; that is, as of 2014, insurers will be obliged to issue, or renew, a policy to anybody, regardless of any preexisting condition. This change should provide coverage to about 16 million U.S. Americans who cannot get coverage now. It is necessary, though, that “guaranteed issue” be combined with the “individual mandate” rule.[17] Since Congress did not require a strict penalty for people who do not buy insurance, many healthy people may try to avoid the “individual mandate.”[18]
Beyond this, the law outlaws rescission, the practice of rescinding or cancelling coverage when the insured incurs exorbitant medical bills. The law also prohibits the designation of annual or lifetime limits on reimbursement, and requires insurers to keep administrative costs at or below twenty percent of the premium income. And, even though insurers may still deny a claim, they must report the number of claims rejected annually. But, insurers are not required to pay honoured claims within any strict limits, and they may still profit on the basic package of coverage.[19]
The PPACA will extend insurance coverage to millions of U.S. Americans currently uninsured, and it will eliminate some of the insurance companies’ harsher practices, but the U.S. will still have the most complicated, expensive and inequitable health care system of any developed nation. It certainly is not universal health care coverage at a reasonable cost.


12.  Id. at 231.

13.  A hospital is not, as a general rule, required to provide non-emergency care to persons unable to pay. See Scott Becker, Health Care Law: A Practical Guide, 2008, Sec. 21.01(3). It is also not required to continue treatment in the face of nonpayment of bills. Id. In the 1980’s, there were several cases of patients who were “dumped” onto the streets in their hospital robes because they could not pay. Id. at 220-221. The Emergency Medical Treatment and Active labor Act of 1986 was passed requiring any hospital receiving Medicare funds to admit and treat anybody who is (1) facing severe risk of death, or (2) in active labor (the two least frequent emergency scenarios), until the patient’s medical condition is “stabilized—a subjective standard. Reid, The Healing of America at 231.

14.  Id. at 232.

15.  Id. at 233.

16.  In the Bismarck model, found in Germany, Japan, Belgium, Switzerland and Latin American, both health care providers and payers are private entities. The model uses private health insurance plans, usually financed jointly by employers and employees through payroll deduction. These plans, however, do not make a profit.
In the Beveridge model, health care is provided for and financed by the government, through tax payments. Medical treatment is a public service. Usually all hospitals and clinics are owned by the government and even some doctors are government employees, but there are also private doctors who collect their fees from the government. This model is found in Great Britain, Italy, Spain and most of Scandinavia.
The National Health Insurance model contains elements of both the Bismarck and the Beverage models: The providers of health care are private, but the payer is a government-run insurance program into which every citizen must pay. Canada, and to some extent Taiwan, utilize this model.
In the Out-of-Pocket model, usually found in poor countries, such as rural regions of Africa, India, China and South America, the patient pays 100% of his health care costs; the result, the rich get medical care and the poor stay sick or die. Id. at 17-19.

17.  As an economic principle, a unified system is a powerful force for cost control. Since the single health care system is the only buyer of medical services, the system maintains powerful market clout in negotiating fees. Id. at 235, 241.
In both Taiwan, an emerging Asian island, and Switzerland, an ancient European confederation, new universal health care systems were successfully introduced in 1994, even though in both, as in the U.S. today, there was a vigorous democracy with fierce competition between political parties and powerfully influential financial and insurance industries where payment for medical care was dominated by health insurance plans tied to employment. Both countries reasoned that everyone has a right to health care. To realize this end, both exacted mandatory, individual financial contribution into the system—the “individual mandate” rule. This mandated customer base provided a broad enough risk pool to pay for the “guaranteed issue.” Id. at 165-166, 248.

18.  U.S. conservative politicians have filed a lawsuit arguing the “individual mandate” is unconstitutional. The argument is that the Government cannot dictate that an individual must purchase a particular product. This argument fails. Id. at 248.
The U.S. Government already mandates that it is illegal to walk down the street nude. That is a mandate to buy clothes. People are jailed for failing to feed their children—that is a Government mandate to buy food. Id.

19.  Id. at 248-249.

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