Private or Public Approaches to Insuring the Uninsured: Lessons from International Experience with Private Insurance
Newton D. Baker, Baker and Hostetler Professor, College of Law, and Professor, College of Medicine and Public Health, The Ohio State University; Visiting Professor of Law, Spring 2000, Washington and Lee University. B.A., 1970, University of California, Santa Cruz; J.D., 1975, University of Chicago.
While the United States, virtually alone among developed countries, relies primarily on private health insurance to deliver access to health care services, private health insurance is not unknown elsewhere in the world. In this Article, Timothy Jost surveys the mixed public and private health insurance systems of Australia, Chile, Germany, and the Netherlands, as well as the largely public systems of Canada, France, and the United Kingdom. He shows that countries that place significant reliance on private health insurance also regulate the private insurance market heavily; only where private insurance merely supplements universal public insurance is the private market largely unregulated. Professor Jost concludes from his comparative analysis that market-reliant systems are unlikely to reduce the growing number of Americans who are uninsured, and that the differences between highly regulated private insurance systems and largely public insurance systems are less pronounced than generally assumed. While the United States politically is unlikely to move towards public insurance, he writes, a turn towards greater privatization would tend to worsen, rather than improve, the problem of the uninsured.