Their systems are more efficient, have fewer redundancies and conflicts of interest. Ours are largely proprietary and invisible, largely because we prefer our government benefits to be invisible or deniable:
While people start out thinking about government programs as welfare for the poor, most of the “tax expenditures” actually help the affluent and widen the gap between rich and poor. ~
While it may be tempting to look at the American model and regard it to be a ‘free market’ system compared to the ones in Canada and Europe, that’s a pretty misleading view. America’s system allocates tax expenditures into a system of employer-insured health-care, effectively farming out the function (at public expense) to the private sector, which in turn soaks up its margins and rake-offs:
Americans with good jobs live in a socialist welfare state more generous, cushioned and expensive to the public than any in Europe. Like a European system, we pool our resources to share the burden of catastrophic expenses, but unlike European models, our approach doesn’t cover everyone. ~
In the American system, the pooling is done piecemeal, which means in order to be paid the doctor/hospital/provider must employ full-time employees to deal with multiple insurers, each of which has its own system of billing codes and approval processes. On the other end of the arrangement, most employers must employ full-time people to deal with insurers. By contrast, the European and Canadian systems don’t burden employers or health care providers with these costs or requirements.
American health care providers face a particular problem their overseas peers don’t; they often have to deal with the uninsured, who cannot pay for their care. A Reagan-era regulation now requires American care providers to render urgent service to these people, and naturally it’s made providers pad their margins in order to recoup those losses; consequently, we pay higher prices for everything because we don’t insure everyone, because (circular reasoning alert!) we don’t want to pay the high prices of covering everyone… right?
We pay higher prices because our system is designed to be relatively invisible- it’s funding is tied to employment, the money is taxes your employer would’ve been required to pay anyhow, and this creates a cottage industry of speculators and middle-men who capitalize on our desire to both enjoy a lavish socialism and to not be seen as doing so.
One important thing to understand about our politics is that we like to shame those who receive benefits from the government, while at the same time we like to receive benefits from the government. Perhaps as a consequence, the better-off you are, the less-visible your benefits tend to be:
More and more things that the government does for citizens are invisible, Mettler emphasizes, but for a variety of reasons. For example, the government pays for many services that are actually delivered by a private company. One in four Medicare beneficiaries last year got their benefits through a private company. Even though the government paid the bill, that arrangement may have rendered the government’s role invisible to the beneficiary. Students (and their parents) who benefit from loans for higher education often receive the loan from a private bank (which is profiting from the deal) and may lose sight of the fact that government guarantees and subsidies make it a better deal for both the student and the bank. ~
If you’re insured through your employer, you receive an indirect government benefit, but you don’t face the shame associated with being a cost to taxpayers. If you find yourself uncomfortable with the term “tax expenditures” to refer to deductions and credits, you’re not alone in America. Many of us bristle at the notion that the government is somehow giving us a “benefit” by not taking as much of our hard-earned money in taxes. But whatever we like to call them, these tax breaks/expenditures add up to more than $1 trillion every year – more than the cost of Medicare and Medicaid combined – and if the government did away with those tax provisions, it would have the cash to cover pretty much everyone who needs it and you wouldn’t be paying jacked up prices on everything. Instead of doing that, it recruits your employer to administer your health coverage, and burdens doctors with the need to negotiate with all those insurers, and pours those tax expenditures into the system we have. To understand it, follow the money.