As a society, we are dealing with the way health costs should be met. The Affordable Care Act is just the latest part of that ongoing discussion. I am aware that many nations cover health care as part of their responsibility, including costs. I am very curious about other countries' abilities to assume that cost. Is there a book available that can explain that to me?

— Paul, Medford

 

Although it's now several years old, journalist T.R. Reid's bestseller "The Healing of America: A Global Quest for Better, Cheaper and Fairer Health Care" still provides a good primer on how different countries around the world approach health care.

Reid explores the health care systems in France, Germany, Japan, the United Kingdom, Canada and India. Although Americans might assume most of those countries offer government-run health care paid for with high taxes, they actually differ.

In Germany, insurance companies operate as nonprofits and cannot bar people with pre-existing conditions. Almost everyone is required to sign up for health insurance. Germany keeps a lid on costs by determining payments for care.

Britain essentially has socialized medicine, with most health care employees working for the government and the government being the single payer for care.

Canada also pays for care, but health care providers are mostly private entities. The country struggles with long wait times for some types of care.

People in India largely pay out-of-pocket, with the poor going without.

Reid points out that America actually has a mix of all types of care.

As in Germany, many U.S. workers younger than 65 get health insurance from companies, although they can be for-profit.

Those older than 65 on Medicare go to various providers, with the bill paid for by the government. For those who buy it, supplemental insurance helps make up Medicare coverage gaps.

The government is the payer and provider of health care for military personnel and veterans.

Uninsured Americans either pay out-of-pocket or go without.

Since the passage of the federal Affordable Care Act in 2010, more low-income people, including those with jobs, have government-subsidized health insurance, and those with pre-existing conditions cannot be barred. Later editions of Reid's book provide an update on changes from the act.

With its hodgepodge system, the United States pays the most for health care, at $9,237 per person, but lags behind other industrialized countries on health outcomes, according to a research paper published this year in the journal The Lancet.

Japan is among the countries that have better health outcomes. It spends less than $4,000 per person.

Japan requires everyone to participate in a universal health insurance system, with fees set by committee.

No matter how they pay for care, countries worldwide face the challenge of rising health care costs from aging populations, rising consumer expectations, the increasing prevalence of chronic and lifestyle diseases such as obesity and adult-onset diabetes, costly medical innovations and rising prescription drug prices, according to global organizations that analyze health care spending.

The United States — which bans the import of most prescription drugs and does little to regulate drug prices — has been hardest hit by skyrocketing prescription prices, according to global organizations.

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