Americans don’t have a good understanding of our own health care system, in large part because it’s not one system.

It’s at least four major systems:

A government run system … socialized medicine for our military veterans and Native Americans. This is similar to Great Britain’s system.

An employer-based system … in which employers receive tax credits from the federal government in return for helping to subsidize insurance coverage for their employees. This is similar to the systems in Germany and France.

Government subsidies … in which the private sector handles the health care (Medicare and Medicaid). This is similar to the Canadian system.

A system for the uninsured … who must pay their own way, without government help. This is basically the Third World system.

Because the United States has such a hodgepodge of health delivery systems, it’s difficult to figure out what to do.

And this helps explain why costs are so high. Administering health care in this country is a nightmare, and has much more to do with our high cost than either profit margins of insurance companies or medical malpractice lawsuits.

For instance, private health insurance companies spend about 20 percent of the clients’ premium income on things other than health care. And estimates of the impact of malpractice range from 1 percent to 2 percent of the total health care system.

Some of that expense is spent denying claims. About 30 percent are initially denied, health writer T.R. Reid reports, though some are eventually paid after appeals.

If the United States could reduce administrative costs to the Canadian level, it could pay for all the uninsured.

A new book by Reid helps focus the issues: The Healing of America: A Global Quest for Better, Cheaper and Fairer Health Care.

There are two major problems with the American health care smorgasbord:

It’s costly. For all of its expense, it doesn’t provide a great difference in life expectancy with other industrialized nations. 

Too many are uninsured. And hundreds of thousands each year must declare bankruptcy due to medical costs.

This doesn’t happen in any other developed country. And if health care makes a statement about the nation, what does that say?

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