Izinguquko zokunakekelwa kwezempilo ziye zaba yingxabano eqhubekayo e-US amashumi eminyaka. Amagama amabili asetshenziselwa ukuxoxisana kukhona ukuhlinzekwa kokunakekelwa kwezempilo jikelele kanye nesistimu yokukhokha eyodwa. Akuzona into efanayo, naphezu kokuthi abantu ngezinye izikhathi bawasebenzisa ngokungafani.
Futhi ngenkathi izinhlelo ezikhokhwa ngabasha zihlanganisa ukufakwa kwendawo yonke, amazwe amaningi aye afinyelele ukumbozwa kwendawo yonke ngaphandle kokusebenzisa uhlelo olulodwa lokukhokha.
Ake sibheke ukuthi la magama amabili asho ukuthini, futhi ezinye izibonelo zendlela asetshenziswa ngayo emhlabeni jikelele.
Ukuhlanganisa Okuphelele
"Ukusabalala kwendawo yonke" kubhekisela ohlelweni lokunakekelwa kwezempilo lapho wonke umuntu enesifo sempilo. Ngokusho kwe-US Census Bureau, kwakunezigidi ezingama-28.1 zaseMelika ngaphandle kokutholakala komshuwalense wezempilo ngo-2016 (lokhu kwaba ukunciphisa okubukhali kusuka ku-46.6 million abazange baqinisekiswe eminyakeni eyishumi ngaphambili; ukunciphisa kwakungenxa yokuqaliswa koMthetho Wokunakekelwa Okunenzuzo ).
Ngokuphambene, azikho izakhamizi zaseCanada ezingaqinisekisiwe - uhlelo lwazo lukahulumeni oluhlinzekwayo luhlinzekwa ngokugcwele. Ngakho-ke, iCanada inakekelwa ukunakekelwa kwezempilo emhlabeni wonke, kuyilapho i-United States ingabi (kubalulekile ukuqaphela ukuthi lezigidi ezingama-28.1 ezingaqinisekisiwe e-US zihlanganisa abalinganiselwa abangaba ngu-4.7 abayizifiki ezingekho ngaphansi kwamakhompiyutha. Uhlelo lukahulumeni lwe-Canada aluhambisani nokuthunyelwa kwabangaphandle kwabangaphandle).
Uhlelo lokukhokha olulodwa
Ngakolunye uhlangothi, "uhlelo lokukhokha olulodwa" olulodwa lapho kukhona khona inhlangano eyodwa-ngokuvamile uhulumeni ophethe imisebenzi yokukhokha izimangalo zezempilo. E-US, Medicare kanye ne-Veterans Health Administration yizibonelo zezinhlelo zokukhokha ezilodwa. I-Medicaid ngezinye izikhathi ibizwa ngokuthi yi-single-payer system, kodwa empeleni ixhaswe ngokuhlanganyela nguhulumeni wesifundazwe nohulumeni ngamunye kahulumeni.
Ngakho-ke nakuba kuyindlela yokwaziswa kwezempilo okuxhaswa nguhulumeni, imali evela emithonjeni emibili kunomunye.
Abantu abahlanganiswe ngaphansi kwezinhlelo zempilo ezixhaswe ngumqashi noma izinhlelo zempilo emakethe ngayinye e-US (kubandakanya izinhlelo ze-ACA-ezivumelanisiwe) aziyona ingxenye yendlela yokukhokha eyodwa, futhi umshuwalense wabo wezempilo awusiwo ohulumeni. Kulezi zimakethe, izinkulungwane zezinkampani zomshuwalense ezizimele, zinezibopho zokukhokha izimangalo zamalungu.
Ezimweni eziningi, "ukuhlanganiswa kwendawo yonke" kanye "nohlelo lokukhokha olulodwa" kuyahambisana, ngoba uhulumeni wesifundazwe uyona ongakhetha kakhulu ukuphatha nokukhokhela uhlelo lokunakekelwa kwempilo oluhlanganisa izigidi zabantu. Kunzima ukucabanga inhlangano yangasese njengenkampani yomshuwalense enezinsiza, noma ngisho nokuthambekela okuphelele, ukuqala uhlelo lokuhlinzeka ngempilo yonke jikelele.
Kodwa-ke, kunokwenzeka ukuthi kube nokuhlanganiswa kwendawo yonke ngaphandle kokuba ne-single-payer system, futhi amazwe amaningi emhlabeni wonke akwenzile. Abanye ochwepheshe baye basikisela ukuthi i-United States kufanele iguqule ngokuqhubekayo isimiso sayo sokunakekelwa kwezempilo samanje ukuze inikeze inetha lokuphepha elixhasiwe nguhulumeni kulabo abagulayo kanye nabampofu (uhlobo lwenqubomgomo ekhulisiwe ye- ACA's Medicaid expansion ), ngenkathi edinga labo abanenhlanhla ezempilo-ezihlakaniphile kanye nezemali ukuthenga izinqubomgomo zabo.
I-gridlock yezombangazwe eye yahlala phezu kwe-Care Affordable Act eminyakeni embalwa edlule yenza kube nzima ukucabanga ukuthi leso siphakamiso sithola ukulandelana okwanele. Kodwa kungenzeka ngokusemthethweni ukwakha uhlelo olunjalo, oluzohlinzeka ngokuhlanganisa yonke indawo ngenkathi futhi bebahola abaningi.
Nakuba kungenzeka ukuthi kungenzeka ukuthi ube nesistimu ye-single-payer kazwelonke ngaphandle kokuthola impilo yonke, akunakwenzeka neze ukuthi kungenzeka ukuthi umkhokhi oyedwa ohlelweni olunjalo ngeke abe nguhulumeni wesifundazwe. Uma ngabe uhulumeni wesifundazwe kufanele athathe uhlelo olunjalo, angeke abe ngumgomo wezepolitiki ukuba angabandakanyi noma yisiphi isakhamuzi esisodwa ekukhuleni kwezempilo.
I-Socialized Medicine
"Imithi yokwelapha" yinye inkulumo evame ukukhulunywa ngayo ekukhulumisaneni ngokubhalwa komuntu oyedwa kanye nokuhlanganisa yonke indawo, kodwa kuyisistimu lapho umkhokhi oyedwa ethatha isinyathelo esengeziwe. Esikhathini sohlelo lwezokwelapha, umphakathi uhlawula ukunakekelwa kwempilo futhi usebenza nezibhedlela futhi usebenzise odokotela nabanye ochwepheshe bezokwelapha. E-United States, uhlelo lwe-Veterans Administration (VA) luyisibonelo semithi yomphakathi, njengoba uhulumeni ephethe futhi esebenza lokho izibhedlela ze-VA, futhi ukhokhela izikweletu.
I-National Health Service (NHS) e-United Kingdom yisibonelo sesistimu lapho uhulumeni ekhokhela khona izinsizakalo futhi enezibhedlela futhi esebenzisa odokotela. Kodwa eCanada, ene-single-payer system esebenza ngokugcwele, izibhedlela ziqhutshwa ngasese futhi odokotela abaqashiwe nguhulumeni-bavele baxoxe uhulumeni ngezinsizakalo abazihlinzekayo.
Ezempilo Emhlabeni Wonke
Ngokusho kwedatha evela ku-Organisation for Economic Cooperation and Development, amazwe amaningana azuze ukutholakala kwendawo yonke, kanti amaphesenti angu-100 wabantu bawo ahlanganiswe. Lokhu kuhlanganisa i-Australia, iCanada, iFinland, iFrance, iJalimane, iHungary, i-Iceland, i-Ireland, i-Israel, i-Netherlands, i-New Zealand, iNorway, iPortugal, iSlovak Republic, iSlovenia, iSweden, iSwitzerland ne-United Kingdom. Ngaphezu kwalokho, amanye amazwe amaningana afinyelele ukutholakala kwendawo yonke nabantu abangaphezu kwamaphesenti angu-98 wabantu ababheke umshwalense, kuhlanganise ne-Austria, iBelgium, iJapane neSpain.
Ngokuphambene nalokho, kuphela amaphesenti angaphezu kuka-91 wabantu base-US ababengabhekene ne-insured ngo-2016, futhi ukulandelela kwe-Gallup kubonise ukuthi iphesenti labantu baseMelika abanokuphepha kwezempilo behlele ngaphansi kwamaphesenti angu-88 ngasekupheleni kuka-2017.
Ake sibheke izindlela ezehlukene emazweni athile azuze ukutholakala kwendawo yonke (noma eduze jikelele):
EJalimane
I-Germany ine-coverage yonke, kodwa ayisebenzi uhlelo olulodwa lokukhokha. Esikhundleni salokho, wonke umuntu ohlala eJalimane udinga ukugcinwa kwezempilo. Iningi labasebenzi baseJalimane babhalise ngokuzenzakalelayo kwelinye lezinkulungwane ezingaphezu kwezingu-100 "zezimali zokugula," ezikhokhelwa ngokuhlanganiswa komsebenzi nomqashi. Ngaphandle kwalokho, kunezinhlelo zomshuwalense wempilo yangasese ezitholakalayo, kodwa kuphela amaphesenti angu-11 asezakhamuzi zaseJalimane akhetha umshuwalense wezempilo wangasese.
ESingapore
ISingapore ine-cover universal, kanti izindleko ezinkulu zokunakekelwa kwezempilo zihlanganiswa (ngemuva kokudonswa) yi-system-insurer yomshwalense obizwa ngokuthi i-MediShield. Kodwa iSingapore idinga ukuthi wonke umuntu abe negalelo phakathi kwamaphesenti angu-7 no-9.5 emali engenayo kwi-akhawunti ye-MediSave. Uma iziguli zidinga ukunakekelwa kwezempilo njalo, zingathatha imali kuma-akhawunti azo a-MediSave ukuze zikhokhele-kodwa imali ingasetshenziswa kuphela izindleko ezithile, njengemithi ehlwini oluvunyiwe nguhulumeni. Ngaphezu kwalokho, uhulumeni uxhasa ngokuqondile izindleko zokunakekelwa kwezempilo ngokwayo (kunokuba izindleko zomshuwalense, njengoba kunjalo nangendlela yokuthengwa okuthengwe nge-ACA-edalwe ukuhwebelana e-US, isibonelo), ukuze inani labantu likhokhwe ngoba ukunakekelwa kwabo kuncane kakhulu kunokuba kungenjalo.
Japan
I-Japan ine-coverage yonke, kodwa ayisebenzisi uhlelo olulodwa lokukhokha. Ukuhlinzekwa ngokuhlinzekwe ngokuyinhloko yezinkulungwane zemigomo yomshuwalense wezempilo emncintiswaneni ohlelweni lwe-Insurance Statutory Health (SHIS). Izakhamuzi zidinga ukubhalisa ekukhokhweni futhi zikhokha izinkokhelo eziqhubekayo zokuhlinzeka nge-SHIS, kodwa kunendlela yokuthenga umshuwalense wezempilo wangasese.
I-United Kingdom
I-UK iyisibonelo sezwe elinokufakwa kwendawo yonke kanye nesistimu eyodwa yokukhokha , futhi njengoba kuphawuliwe ngenhla, isimiso se-UK singachazwa ngokuthi imithi yomphakathi, ngoba uhulumeni unezibhedlela eziningi futhi uqasha abahlinzeki bezokwelapha. Imali ye-National Health Service yase-UK ivela kwingeniso yentela. Izakhamuzi zingathenga umshuwalense wezempilo wangasese uma zifuna, futhi zingasetshenziswa ngezinqubo zokukhetha ezibhedlela ezizimele, noma zifinyelele ukufinyelela okusheshayo kokunakekelwa, ngaphandle kwesikhathi sokulinda esingase sibekwe yi-NHS ngezimo ezingekho eziphuthumayo.
Imithombo:
> Gallup. Isilinganiso se-Uninsured sase-US esiphezulu ku-12.2% ngo-Quarter wesine ka-2017. NgoJanuwari 16, 2018.
> Inhlangano Yokubambisana Kwezomnotho Nokuthuthukiswa. Ukulinganisa Ukuphakama Kwezempilo. May 2016.
> US Census Bureau, Health Insurance Coverage e-United States, ngo-2016 . eshicilelwe ngo-September 2017.
> US Census Bureau, Income, Poverty, and Health Insurance Coverage e-United States, 2005 . Kushicilelwe ngo-Agasti 2006.