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Thanks for the ask Nagarajan Srinivas (நாகராஜன் ஸ்ரீனிவாஸ்)Short answer :Remove Chapter V-B from Industrial Disputes Act, 1947 (IDA) requiring firms employing more than 100 workers to seek government permission (that usually never comes) before lay offs.Fix the "Hotel California economy" ("You can check-out any time you like,But you can never leave") - by letting inefficient, loss making firms to exit the market. Introduce bankruptcy code, stop subsidising loss making PSUs, fast track debt recovery etc.Increase government expenditure on early-life health and nutrition programs.There are many more. Especially around difficulties of doing business that Kamal Gupta already mentioned. I feel this is more a matter of execution than new legislation or budget changes - very hard to fix by central government diktat.Similarly the situation with very poor outcome from primary education, vitally important to fix, is again a matter of execution, impossible to fix with central government policy from top, as it is mainly in the hands of state governments.Long AnswerLabour ReformsThere are over 200 labour laws at state and central government level. I mention above only IDA Chapter V-B because it is the one most often mentioned in multiple surveys and academic studies for years.Indian economy does not generate enough high quality jobs to absorb the 12 million young people starting work every year. Labour force is currently growing at 2.2% annually while employment growth is roughly 1.5% in a good year. Furthermore long run trend of labour force growth for every 1% growth in GDP is falling. [1]Good jobs are those in the formal sector, either in the government or in firms employing more than 10 workers. Currently less than 10% of the workforce are in formal sector. Number of jobs in government had been falling since 1990s and this is not going to change. So, India needs formal private sector jobs to grow. Wages in formal sector on average are 20 times higher than informal sector, they allow workers to build employment history making it easier to obtain bank loans, these firms train workers etc.About half the good jobs in private sector are in manufacturing. In repeated surveys these firms reported labour regulations as one of the main reasons for not hiring workers - specifically the dismissal norms in the Industrial Disputes Act (but also other labour regulations). If a firm employs more than 100 workers then it has to seek government permission before it can reduce workforce. In practice such permission is very hard to obtain.Firms do several things to avoid hiring more workers -Substitute capital for labour by investing more on modern machineries that reduce the need for labourStay small to avoid regulatory burden and riskHire contract workers and subcontract the work of regulation compliance and "managing inspectors" to the contract labour firm.A recent study[2] found that states with more rigid labour laws experienced faster increase in usage of contract workers. The below graph shows how share of contract workers increased in different types of states classified by labour regulation regimeAlso states with relatively more rigid labour laws experienced higher growth of informal, unregistered manufacturing firms[3] -But many firms do not like contract labour. In surveys they say they would hire regular workers if dismissal laws were different. Hiring workers through contractors is more expensive for firms, contractor workers do not feel as much loyalty as regular workers and often do not receive as much training as regulars as a result and do not receive as many employment benefits. So there is a strong case of relaxing dismissal laws to stop punishing larger firms for their size.Opponents of this change say this is anti worker/anti poor. But the perverse effect of the existing regulations have shut the poor out of the formal sector labour market. The existing regulations are protecting less than 5% of the labour force (excluding government jobs here) at the expense of everyone else.India's employment protection legislation (EPL) are far more stringent than most other places in the world. OECD created an index from various EPLs in different countries so that labour regulations can be compared internationally. The below graph shows how India's labour regulations compare internationally. Among both OECD members and other emerging market economies India's labour regulation are more stringent than everyone else except Indonesia.Speed up exit of loss making, inefficient firmsEasy entry of firms into market is an important characteristic of successful market economies. Not often talked about but an equally important characteristic is exit of inefficient, unsuccessful firms.In India unsuccessful, inefficient firms do not exit the market often. As this year's Economic Survey says - we have "moved from socialism with no entry to marketism with no exit". The finance ministry called it the Charkravyuha challenge (as in Mahabharata).[5]This has costs. These firms tie up scarce resources - funding, capital equipments, land and labour. Many of them manage to "ever green" their loans (with some help from banks) piling bad debt upon bad debt in banks' books, they increase borrowing cost of everyone else and reduce overall lending level in the economy.For large number of publicly owned firms when the government socialise their losses (Indian Airlines is an excellent example) it means government funds are diverted into some of the most inefficient firms in the country at the expense of other far more worthy projects (healthcare, primary education, sanitation to name just a few) . When such companies are operating (and many are not) they continue to provide competition to private firms, often more efficient, who do not have access to tax payers' funds.One way of seeing how bad the problem is to look at the size of older firms. In theory, productive efficient firms grow in size forcing out inefficient ones out of the market. So, older firms should be bigger in size. In USA for example 40 year old plants hire 8 times more workers than newer ones. In Mexico it is 2.5 times while in India an average 40 year old plant is only 1.5 times bigger than new ones -In India, the zombie firms remain, they cannot grow but they will not leave either.Obviously some firms leave, eventually, but the insolvency procedures are long and can drag on - on average it takes 4.3 years versus 1.7 years in OECD countries and the recovery rate is very low compared to most other economies. For example, the below from World Bank plots average insolvency procedure duration versus recovery rate. It is clear that as the duration increases, recovery rate falls. India has one of the worst duration and recovery rates in the world.The new bankruptcy code introduced in last parliament if passed this year will certainly help address some of this. Increasingly more assertive banks facing pressure from RBI, demanding their money back instead of ever greening loans will help as well.But there is more to this than just the bankruptcy code, the perpetually loss making government owned firms have the same effect and government should not keep funding them just because it is politically difficult to close them down. Below I quote one particularly egregious example of British India Corporation, but this is not unique (from Modi seeks to revive India’s ‘zombie factories’, not abandon them)In theory, British India Corporation sells army uniforms, rugs, blankets and tweed jackets, but it stopped manufacturing nine years ago after finishing its last order. Since then, the company, based in Kanpur, has lost about $50 million.British India Corporation employs about 1,800 people. All the employees come to work, everyone gets paid, earns a bonus, there are overtime shifts, promotions and job changes.There are bungalows for the managers, flats for workers, a hospital, schools and a subsidized shop. The gardeners, engineers and painters keep the grass trimmed, the machines in working order, and signs freshly painted.“This could easily be the worst-run company in India, maybe the world,” said Satyendra Nath, 58, head of the tax department, who spends his days reading the newspaper or watching television because there is no work to do. “Often, I think: what have I done in a previous life to end up working here?”A quarter of the country’s 277 state-run firms, which produce everything from condoms to scooters, have lost about $16 billion over the last decade, according to government records. At least 20 loss-making companies owned by the central government have stopped production or have almost no activity yet still pay staff full salaries, according to an official at the Board for Financial and Industrial Reconstruction, the agency charged with expediting restructuring or liquidation.Early-life health and nutrition programs.Children's health in early life and as importantly their mothers' health while they are in the womb has a significant impact on their cognitive development in later years and their earnings later in life. There had been multiple studies in this area, linking various types of early life interventions with later outcomes like test scores, wage etc.This year, ministry of finance's Economic Survey helpfully created a meta analysis of these papers. I show two graphs from that, showing how returns to investment in children vary with the age of the child - each dot is an estimate from some research paper showing the long run impact on cognitive ability (test score) or wages from a health program or other interventions -Two things are evident from above -Returns to investment are highest for programs that target very young children or in-utero healthThese programs targeting very young children are also cheaper than later year interventions. For example iodine supplements are cheaper and easier to provide than improving teachers' qualityNow lets look at the health of babies born in recent years in India -Height is often used as a proxy for early-life health as it is partly determined by early life nutrition and environment. Below figure shows how "height for age" evolved over the years in India in rural and urban areas. Blue dotted line is from 2005 data and the red line is 2013 dataFew things are clear -Indian children are on average much shorter than healthy average (two standard deviation shorter).The situation, though dire now, has improved over time - children surveyed in 2013/14 are taller than the ones in 2005/6There is a clear gap between rural and urban children that has not closed in the last decade. Rural children are much shorter.Poor early life health has adverse impact on later learning ability and subsequently earning ability.Given the above, there is a strong case for significant government effort to improve maternal health. There is obviously a very strong moral case for doing this, but there is also an overwhelming economic case for doing it.National Food Securities Act 2013 introduced a cash entitlement for pregnant women of at least Rs 6000 and it is indeed a good start. However getting government funds into pregnant women's hand and then ensuring that the funds indeed get used to buy food and extra rest is not that easy. So cash transfer has to be combined with education and public awareness campaign about maternal health. Such interventions and public awareness campaign has decent track record. For example there had been remarkable improvement in breast feeding rate of children under 6 months over short period of time. Now 62% of children under six months are exclusively breast fed with some of the best improvements coming from states like Haryana, Goa, Madhya Pradesh where this rate was lower than 20%.Footnotes[1] Economic Survey, 2014-15 - Volume 1, Chapter 1, Page 8 - http://indiabudget.nic.in/es2014...[2] Labor regulations and contract labor use: Evidence from Indian firms[3] Graph taken from Economic Survey, 2014-15, Chapter 10 - http://indiabudget.nic.in/es2015...[4] OECD Economic Surveys: India 2014 | OECD READ edition[5] Problems with firm exit is discussed here - http://indiabudget.nic.in/es2015-16/echapvol1-01.pdf

HelloThe U.S. health care system is unique among advanced industrialized countries. The U.S. does not have a uniform health system, has no universal health care coverage, and only recently enacted legislation mandating healthcare coverage for almost everyone. Rather than operating a national health service, a single-payer national health insurance system, or a multi-payer universal health insurance fund, the U.S. health care system can best be described as a hybrid system. In 2014, 48 percent of U.S. health care spending came from private funds, with 28 percent coming from households and 20 percent coming from private businesses. The federal government accounted for 28 percent of spending while state and local governments accounted for 17 percent.[1] Most health care, even if publicly financed, is delivered privately.In 2014, 283.2 million people in the U.S., 89.6 percent of the U.S. population had some type of health insurance, with 66 percent of workers covered by a private health insurance plan. Among the insured, 115.4 million people, 36.5 percent of the population, received coverage through the U.S. government in 2014 through Medicare (50.5 million), Medicaid (61.65 million), and/or Veterans Administration or other military care (14.14 million) (people may be covered by more than one government plan). In 2014, nearly 32.9 million people in the U.S. had no health insurance.[2]This fact sheet will compare the U.S. health care system to other advanced industrialized nations, with a focus on the problems of high health care costs and disparities in insurance coverage in the U.S. It will then outline some common methods used in other countries to lower health care costs, examine the German health care system as a model for non-centralized universal care, and put the quality of U.S. health care in an international context.In Comparison to Other OECD CountriesThe Organization for Economic Co-operation and Development (OECD) is an international forum committed to global development that brings together 34 member countries to compare and discuss government policy in order to “promote policies that will improve the economic and social well-being of people around the world.”[3] The OECD countries are generally advanced or emerging economies. Of the member states, the U.S. and Mexican governments play the smallest role in overall financing of health care.[4] However, public (i.e. government) spending on health care per capita in the U.S. is greater than all other OECD countries, except Norway and the Netherlands.[5]This seeming anomaly is attributable, in part, to the high cost of health care in the U.S. Indeed, the U.S. spends considerably more on health care than any other OECD country.The OECD found that in 2013, the U.S. spent $8,713 per person or 16.4 percent of its GDP on health care—far higher than the OECD average of 8.9 percent per person.[6] Following the U.S. were the Netherlands, which allocated 11.1 percent of its GDP, then Switzerland also at 11.1 percent, and Sweden, which allocated 11 percent of its GDP to health care in 2013. In North America, Canada and Mexico spent respectively 10.2 percent and 6.2 percent of their GDP on health care.On a per capita basis, the U.S. spends more than double the $3,453 average of all OECD countries (see chart[7] below).[8]Health Expenditure per capita, 2013 (or nearest year)Drivers of Health Care Spending in the U.S.Prohibitively high cost is the primary reason Americans give for problems accessing health care. Americans with below-average incomes are much more likely than their counterparts in other countries to report not: visiting a physician when sick; getting a recommended test, treatment, or follow-up care; filling a prescription; and seeing a dentist.[9] Fifty-nine percent of physicians in the U.S. acknowledge their patients have difficulty paying for care.[10] In 2013, 31 percent of uninsured adults reported not getting or delaying medical care because of cost, compared to five percent of privately insured adults and 27 percent of those on public insurance, including Medicaid/CHIP and Medicare.[11]While there is no agreement as to the single cause of rising U.S. health care costs, experts have identified three contributing factors. The first is the cost of new technologies and prescription drugs. Some analysts have argued “that the availability of more expensive, state-of-the-art medical technologies and drugs fuels health care spending for development costs and because they generate demand for more intense, costly services even if they are not necessarily cost-effective.”[12]In 2013, the U.S. spent $1,026 per capita on pharmaceuticals and other non-durable medical care, more than double the OECD average of $515.[13]Another explanation for increased costs is the rise of chronic diseases, including obesity. Nationally, health care costs for chronic diseases contribute huge proportions to health care costs, particularly during end of life care. “Patients with chronic illness in their last two years of life account for about 32% of total Medicare spending, much of it going toward physician and hospital fees associated with repeated hospitalizations.”[14] The National Academy of Sciences found that among other high-income nations the U.S. has a higher rate of chronic illness and a lower overall life expectancy. Their findings suggest that this holds true even when controlling for socio-economic disparity.[15] Experts are focusing more on preventative care in an effort to improve health and reduce the financial burdens associated with chronic disease.[16] One provision of the Patient Protection and Affordable Care Act, commonly referred to as simply the Affordable Care Act (ACA), implemented in 2013, provides additional Medicaid funding for states providing low cost access to preventative care.[17]Finally, high administrative costs are a contributing factor to the inflated costs of U.S. health care. The U.S. leads all other industrialized countries in the share of national health care expenditures devoted to insurance administration. It is difficult to determine the exact differences between public and private administrative costs, in part because the definition of “administrative” varies widely. Further, the government outsources some of its administrative needs to private firms.[18] What is clear is that larger firms spend a smaller percentage of their total expenditures on administration, and nationwide estimates suggest that as much as half of the $361 billion spent annually on administrative costs is wasteful.[19] In January 2013, a national pilot program implemented under the ACA began. The aim is to improve administrative efficiency by allowing doctors and hospitals to bundle billing for an episode of care rather than the current ad hoc method.[20]Health Insurance in the U.S.: Uneven CoverageWhile the majority of U.S. citizens have health insurance, premiums are rising and the quality of the insurance policies is falling. Average annual premiums for family coverage increased 11 percent between 1999 and 2005, but have since leveled off to increase five percent per year between 2005 and 2015.[21] Deductibles are rising even faster. Between 2010 and 2015, single coverage deductibles have risen 67 percent.[22] These figures outpace both inflation and workers’ earnings.The lack of health insurance coverage has a profound impact on the U.S. economy. The Center for American Progress estimated in 2009 that the lack of health insurance in the U.S. cost society between $124 billion and $248 billion per year. While the low end of the estimate represents just the cost of the shorter lifespans of those without insurance, the high end represents both the cost of shortened lifespans and the loss of productivity due to the reduced health of the uninsured.[23]Health insurance coverage is uneven and often minorities and the poor are underserved. Forty million workers, nearly two out of every five, do not have access to paid sick leave. Experts suggest that the economic pressure to go to work even when sick can prolong pandemics, reduce productivity, and drive up health care costs.[24]There were 32 million uninsured Americans in 2014, nine million fewer than the year prior. Experts attribute this sharp decline in the uninsured to the full implementation of the ACA in 2014.[25] Of American adults who had health insurance in 2014, 73 percent had one or more full-time workers in the family and 12 percent had one or more part-time workers in the family.[26] Just 49 percent of American adults reported getting health insurance from an employer in 2014.[27]Coverage by employer-provided insurance varies considerably by wage level. Firms with higher proportions of low-wage workers are less likely to provide access to health insurance than those with low-proportions of low-wage workers.[28]In 2014, 11.2 percent of full-time workers were without health insurance. However, the percentage of part-time workers without insurance was 17.7 percent, a significant decrease from 24 percent in 2013, thanks in part to the Affordable Care Act. The uninsured rate among those who had not worked at least one week also decreased from 22.2 percent in 2013 to 17.3 percent in 2014.[29]Smaller firms are significantly less likely to provide health benefits to full or part-time workers. Among all small firms (3-199 workers) in 2015, only 56 percent offered health coverage, compared to 98 percent of large firms.[30]After the Affordable Care Act allowed for many young adults (19-25) to remain on their parents’ health plans, there was a statistically significant increase in the percentage of insured young people from 68.3 percent in 2009[31] to 82.9 percent in 2014.[32] Over the same period, the percentage of young people aged 26-34 with insurance increased from 70.9 percent to 81.8 percent.[33]Minorities and children are disproportionately uninsured. In 2014, 7.6 percent of non-Hispanic Whites were uninsured, 11.8 percent of Blacks were uninsured, 9.3 percent of Asians, and 19.9 percent of people of Hispanic origin were uninsured.[34] The Kaiser Family Foundation has found that about 80 percent of the uninsured are U.S. citizens.[35] Among children, six percent were uninsured in 2014.[36] These children are 10 times more likely than insured children to have unmet medical needs and are five times as likely as an insured child to go more than two years without seeing a doctor.[37]Women in the individual market often faced higher premiums than men for the same coverage. Beginning in 2014, the Affordable Care Act banned this practice, as well as denying coverage for pre-existing conditions.[38]In 2014, 19.3 percent of the population living below 100 percent of the poverty line ($23,550 a year for a family of four) was uninsured.[39] According to the Kaiser Family Foundation, 90 percent of the uninsured have family incomes within 400 percent of the federal poverty level. This makes them eligible for either subsidized coverage through tax credits or expanded Medicaid eligibility under the Affordable Care Act’s state health exchanges. [40]Rising Healthcare PremiumsHealth insurance premiums in the U.S. are rising fast. From 2005 to 2015, average annual health insurance premiums for family coverage increased 61 percent, while worker contributions to those plans increased 83 percent in the same period. This rate of increase outpaces both inflation and increases in workers’ wages.[41]In 2005, the average annual premiums for employer-sponsored health insurance were $2,713 for single coverage and $8,167 for family coverage. In 2015, premiums more than doubled to $6,251 for employer-sponsored single coverage and $17,545 for employer-sponsored family coverage.[42]A growing number of workers face a deductible of $1,000 or more for individual plans. In 2015, 46 percent (compared to 38 percent in 2013 and 22 percent in 2009) of workers were enrolled in a plan with an annual deductible of $1,000 or more. Employees at small firms are more likely than those at large firms to have a deductible greater than $1,000.[43]The Union Difference: Union workers are more likely than their nonunion counterparts to be covered by health insurance and paid sick leave. In March 2015, 95 percent of union members in the civilian workforce had access to medical care benefits, compared with only 68 percent of nonunion members. In 2015, 85 percent of union members in the civilian workforce had access to paid sick leave compared to 62 percent of nonunion workers.[44] At the median, private-sector unionized workers pay 38 percent less for family coverage than private-sector nonunionized workers, according to a 2009 study.[45]Across states, there are significant disparities in both the availability and the cost of health care coverage.In 2012, Medicare reimbursements per enrollee varied from $6,724 in Anchorage, Alaska to $13,596 in Miami, Florida.[46] Annual premiums are similarly disparate. In 2015, the average family premium in the South was $16,785 while the same coverage averaged $18,096 in the Northeast.[47]Firms in the South were less likely to provide coverage for an employee’s domestic partner than other regions. In the South, 41 percent of firms reported providing benefits for same-sex partners (compared to 51 percent in the Northeast) and 20 percent reported offering benefits to opposite-sex domestic partners (compared to 46 percent in the Northeast).[48]High Costs Drive Americans into BankruptcyUniversal coverage, in countries like the United Kingdom, Switzerland, Japan, and Germany makes the number of bankruptcies related to medical expenses negligible.[49] Conversely, a 2014 survey of bankruptcies filed between 2005 and 2013 found that medical bills are the single largest cause of consumer bankruptcy, with between 18 percent and 25 percent of cases directly prompted by medical debt.[50] Another survey found that in 2013, 56 million Americans under the age of 65 had trouble paying medical bills.[51] Another 10 million will face medical bills they are unable to pay despite having year-round insurance.[52]It has been suggested, based on the experience of Massachusetts, where medical-related bankruptcies declined sharply after the state enacted its health reform law in 2006, that the ACA may help reduce such bankruptcies in the future.[53]The Affordable Care Act: Successes and Remaining ChallengesIn March, 2010, President Obama signed the ACA into law that made hundreds of significant changes to the U.S. healthcare system between 2011 and 2014. Provisions included in the ACA are intended to expand access to healthcare coverage, increase consumer protections, emphasizes prevention and wellness, and promote evidence- based treatment and administrative efficiency in an attempt to curb rising healthcare costs.Beginning in January 2014, almost all Americans are required to have some form of health insurance from either their employer, an individual plan, or through a public program such as Medicaid or Medicare. Since the so-called “individual mandate” took effect, the total number of nonelderly uninsured adults dropped from 41 million in 2013 to 32.3 million in 2014.[54] The largest coverage gains were concentrated among low-income people, people of color, and young adults, all of whom had high uninsured rates prior to 2014.[55]A major provision of the ACA was the creation of health insurance marketplace exchanges where individuals not already covered by an employer-provided plan or a program such as Medicaid or Medicare can shop for health insurance. Individuals with incomes between 100 percent and 400 percent of the federal poverty line would be eligible for advanceable premium tax credits to subsidize the cost of insurance. States have the option to create and administer their own exchanges or allow the federal government to do so. Currently, only 14 states operate their own exchanges.[56]Designed to promote competition among providers and deliver choice transparency to consumers, the state-based exchanges appear to be doing just that. A recent analysis by the Commonwealth Fund found that the number of insurers offering health insurance coverage through the marketplaces increased from 2014 to 2015.[57] Additionally, there was generally no reported increase in average premiums for marketplace plans over that period. The analysis found only a modest increase in average premiums for the lowest cost plans from 2015 to 2016.[58]The ACA also included a major expansion of the Medicaid program, although the Supreme Court ruled in 2012 that this expansion is a state option. As of November 2015, 30 states have chosen to expand Medicaid. As of 2014, adults with incomes at or below 138 percent of the federal poverty line are now eligible for Medicaid in the states that have adopted the expansion.[59]Despite improvements to the U.S healthcare system under the ACA, a number of challenges remain. In 2014, 10.4 percent of Americans were still uninsured[60], and those with insurance still face high deductibles and premium costs. Furthermore, in the 20 states that had not expanded Medicaid, an estimated three million poor adults fall into the “coverage gap” where their incomes are above current Medicaid eligibility limits but below the lower limit of premium credits on the healthcare exchanges. The bulk of people in the coverage gap are concentrated in the South, with Texas (766,000 people), Florida (567,000), Georgia (305,000) and North Carolina (244,000) having among the highest number of uninsured.[61]The ACA included a number of other provisions to improve healthcare access and affordability. The law banned lifetime monetary caps on insurance coverage for all new plans and prohibited plans from excluding children and most adults with preexisting conditions.[62] Insurance plans are also prohibited from cancelling coverage except in the case of fraud, and are required to rebate customers if they spend less than 85 percent (80 percent for individual and small group plans) of premiums on medical services. Additionally, the ACA established the Prevention and Public Health Fund to allocate $7 billion towards preventative care such as disease screenings, immunizations, and pre-natal care for pregnant women and between 2010 and 2015. Furthermore, $11 billion in funding for community health centers and $1.5 billion in additional funding for the National Health Service Corps was included in the law.[63]A number of cost control provisions were included in the ACA in an attempt to curb rising medical costs. Among them is the Independent Payment Advisory Board, which will provide recommendations to Congress and the President for controlling Medicare costs if the costs exceed a target growth rate. The administrative process for billing, transferring funds, and determining eligibility is being simplified by allowing doctors to bundle billing for an episode of care rather than the current ad hoc method. Additionally, changes were made to the Medicare Advantage program that would provide bonuses to high rated plans, incentivizing these privately-operated plans to improve quality and efficiency. Furthermore, hospitals with high readmission rates will see a reduction in Medicare payments while a new Innovation Center within the Centers for Medicare and Medicaid Services was created to test new program expenditure reduction methods.[64]Common Methods to Lower Health Care CostsBy taking an international perspective and looking to other advanced industrialized countries with nearly full coverage, much can be learned. While methods range widely, other OECD countries generally have more effective and equitable health care systems that control health care costs and protect vulnerable segments of the population from falling through the cracks. Among the OECD countries and other advanced industrialized countries, there are three main types of health insurance programs:A national health service, where medical services are delivered via government-salaried physicians, in hospitals and clinics that are publicly owned and operated—financed by the government through tax payments. There are some private doctors but they have specific regulations on their medical practice and collect their fees from the government. The U.K., Spain, and New Zealand employ such a system. [65]A national health insurance system, or single-payer system, in which a single government entity acts as the administrator to collect all health care fees, and pay out all health care costs. Medical services are publicly financed but not publicly provided. Canada, Denmark, Taiwan, and Sweden have single-payer systems.A multi-payer health insurance system, or all-payer system, which provides universal health insurance via “sickness funds,” used to pay physicians and hospitals at uniform rates, thus eliminating the administrative costs for billing. This method is used in Germany, Japan, and France.[66]A universal mandate for health care coverage defines these systems. Such a mandate eliminates the issue of paying the higher costs of the uninsured, especially for emergency services due to lack of preventative care.[67] Other methods for reducing costs may include:Funding health care costs in relation to income rather than risk or people’s medical history.[68]Negotiating the price of prescription drugs and bulk purchasing of prescription medications and durable medical equipment is a method used in other countries for lowering costs. This has been effectively used by the U.S. Department of Veterans Affairs, Medicaid, and Health Management Organizations in the U.S. Yet, it has been prohibited by law from traditional Medicare. Savings of up to five percent of total health care expenditures could result from the full adoption of these practices.[69]An International Case Study: How Germany Pays for Health CareGermany has one of the most successful health care systems in the world in terms of quality and cost. Some 240 insurance providers collectively make up its public option. Together, these non-profit “sickness funds” cover 90 percent of Germans, with the majority of the remaining 10 percent, generally higher income Germans, opting to pay for private health insurance. The average per-capita health care costs for this system are less than half of the cost in the U.S. The details of the system are instructive, as Germany does not rely on a centralized, Medicare-like health insurance plan, but rather relies on private, non-profit, or for-profit insurers that are tightly regulated to work toward socially desired ends—an option that might have more traction in the U.S. political environment.[70]The average insurance contributions to German sickness funds are based on an employee’s gross income, around 15.5 percent with an income cap at $62,781, and employers and employees each pay about half of the premium. Generally, an individual employee’s contribution is 8.2 percent and the employer pays the remaining 7.3 percent.[71] [72]Premiums are not based on risk and are not affected by a person’s marital status, family size, or health. Germans have no deductibles and low co-pays.[73]Doctors are private entrepreneurs and get a fee from insurers for every visit and procedure they perform. However, they are tightly regulated. Groups of office-based physicians in every region negotiate with insurers to arrive at collective annual budgets. Doctors must remain in these budgets, as they do not receive additional funding if they go over. This helps keep health care costs in check and discourages unnecessarily expensive procedures. The average German doctor also makes about one-third less per year than in the U.S., around $123,000.[74]Government general revenues cover premiums for children, on the premise that the next generation should be the entire nation’s fiscal responsibility, instead of just the responsibility of the parents.[75]Germany reformed its coverage for prescription drugs in 2010 after costs for prescription drugs continued to rise. Prior to reforms, drug companies set the price for new drugs and were not required to show that the new drug was an improvement over previously available prescription drugs. Pursuant to the reforms effective in 2011, manufacturers could set the price for the first 12 months a new drug is on the market. “As soon as the drug enters the market, a new process of benefit assessment begins.” Manufacturers must establish, through comparative effective research that the new drug has an “added benefit to the patient, compared to the previously existing standard treatment.” Drugs without added benefit will be reimbursed according to a government pricing list. New drugs without added benefits are available to patients, but the patient has to pay the price difference. For drugs with added benefit, a price will be negotiated between health insurers and the manufacturer.[76]Quality of U.S. Health Care in an International ContextU.S. health care specialists are among the best in the world. However, treatment in the U.S. is inequitable, overspecialized, and neglects primary and preventative care.[77] The end result of the U.S. approach to health care is poorer health in comparison to other advanced industrialized nations. According to the Commonwealth Fund Commission, in a 2014 comparison with Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the U.K., the U.S. ranked last overall. In terms of quality of care, the U.S. ranked fifth, but came in last place in efficiency, equity, and healthiness of citizens’ lives.[78]Comparing other health care indicators in an international context underscores the dysfunction of the U.S. health care system.Despite the relatively high level of health expenditure, in the U.S. there are fewer physicians per capita than in most other OECD countries. In 2013, the U.S. had 2.6 practicing physicians per 1,000 people—below the OECD average of 3.3.[79]In the U.S., there are only about 1.2 primary care physicians per 1,000 people. Projections indicate that the U.S. will need 52,000 more primary care physicians by 2025 to meet demand.[80] While population growth and aging make up a substantial proportion of this increased need, expanded access to insurance under the Affordable Care Act means more people will seek out treatment. Therefore, there are provisions in the legislation to increase the number of primary care physicians in the U.S.There is a significant spatial mismatch within the United States for physicians as well. While the U.S. averaged 225.6 doctors active in patient care per 100,000 people in 2014, there is a wide variance across states; Massachusetts ranks highest with 349.5 active doctors per 100,000 people, while Mississippi has only 170.3.[81]In 2013, the U.S. infant mortality rate was 5.96 per 1,000 live births[82], while the OECD median was 3.8.[83]The obesity rate among adults in the U.S. was 35.3 percent in 2013, down slightly from 36.5 in 2011. This is the highest rate among OECD countries. The average for the OECD countries was 19.0 percent in 2013.[84]Thanks

Originally Answered: American conservatives claim the Canadian healthcare system is inferior to that of the United States healthcare system, how valid is this claim?That was the original question, not the one indicated. Therefore my answer would appear to be the opposite to the question now appearing.There’s no evidence at all to support the claim that Canada’s HC system is inferior to that of the United States. In fact it’s very much the opposite. First of all, Canada actually has a healthcare system, separately administered by 13 different jurisdictions (provinces and territories). It is funded through various taxes across each province with shared funding kicked in by the federal government. Every Canadian has the same comprehensive plan. In accordance with the Canada Health Act, basic healthcare is available as a ‘right’ to every Canadian at the point of service, that is, at any hospital or clinic. No Canadian has ever been refused medical care and no Canadian ever goes into debt, or worse, goes bankrupt for reasons due to medical debt.Now, calling American healthcare a ‘system’ is a bit of a stretch. It’s a jumble of health insurance programs delivered through both public and private insurers. Costs are financed through a perplexing combination of public payers (Federal, State, County, and Municipal governments), along with private insurers and individual payers. On a national scale, most working-age Americans rely on their employers to make health coverage arrangements at their discretion. For most retired seniors, the military, and many chronically-ill, the government has established entitlement programs such as Medicare, Medicaid, the Veterans Administration, and the Affordable Care Act among other programs.Those ‘conservatives’ you mention who defend US healthcare, while being critical of the Canadian healthcare system, especially wait times for elective procedures, never seem to stipulate what tiny piece of the American health insurance pie they are defending compared to the broad national system they are criticizing.If the message is that their health plan works for them personally based on their experience, and wouldn’t want to wait 6 months for elective knee replacement like some Canadians do, then they are fortunate to have such a health plan. That tiny slice of health insurance coverage is the abundant version of the ‘American healthcare system.’ But are they seriously suggesting that a total of perhaps 30,000 Canadians waiting up to 6 months for non-urgent joint replacement surgery is worse than 30 million Americans who have no health insurance at all — and will never have the opportunity to get on any wait list, even for life-saving medical treatment? Lack of access to care, which is essentially an empty version of the American healthcare system, is why 45,000 Americans die unnecessarily every year.So let’s look at a few other statistics that American healthcare has produced and compare it to Canada.Fig 1. Increasing life expectancy gap Canada vs USGenerally, the more money a country spends on healthcare, the higher the life expectancy. The trend does not follow the rule in the case of the United States which is the only OECD country that is trending significantly lower at an increasing rate. Canada’s life expectancy at birth is 82.3 years up 0.4 years since 2013, in comparison to the US now at 78.6 years, down for the third consecutive year and lower than Cuba or Chile. By comparison the US now ranks 31st, near the bottom of 35 OECD countries in the survey.Fig 2. Maternal Mortality trend — US vs comparable countriesMore American women continue to die of pregnancy-related complications than any other developed country and the trend is rising unevenly across many American populations. Dramatically higher Texas maternal mortality rates were widely publicized at 35.8 per 100,000 live births, according a study in Obstetrics and Gynecology. To underscore that race really does matter in Texas, for African-American women the number of deaths was well above 60 per 100,000. A 2015 global survey by the UN concluded that women are more than three times as likely to die from causes related to pregnancy or childbirth in the US than in Canada. The US rate for maternal mortality is 23.8 per 100,000 live births, the only country in the developed world where rates are rising. Maternal mortality increased by 26.6%, from 18.8 in 2000 to 23.8 by 2014. (MacDorman, 2016). By comparison, Canada’s rate is 7.0 per 100,000 in 2015 (CIA Factbook 2017), unchanged since 1990 and about on par with all other OECD countries. The US is only one of a handful of countries to have a worse maternal mortality rate over the period along with Venezuela, North Korea and Zimbabwe.Fig 3. Growth in health expenditure per capita US vs Canada 1970-2018In 2018, the US is spending about 17.8% of GDP on healthcare while Canada is spending about 11%. This measure can be also be illustrated in the growth of costs per capita in Fig 3. , which is the space between the two lines. This is because Canada has managed to maintain a medical inflation rate that’s less than half of the US rate. Tight control on hospital budgets, physician compensation, drug prices, malpractice settlements, the practice of defensive medicine, and a myriad of other policies keep medical inflation on par with other OECD countries.I could go on and on, but I think the point has been made. Significant differences occur in almost every health-related and healthcare financial measure you can name. The three graphic images I’ve chosen are stunning and likely to remain in your memory. They are evidence that the health policy differences between Canada and the US have made a significant impact on each county’s population — Americans negatively, Canadians for the better. Canadians love their healthcare system and it’s reflected in opinion polls, surveys and empirical studies. Canada recently achieved the healthiest of 151 countries ranked, while the US came well down the list of the top industrialized countries at number 37. (Global Wellness Index) The plain inference is that Canada must be doing something right in healthcare, the US, not so much.The difference between the US and every other high-income country comes down to the US as a nation having given over its healthcare to private companies. The bottom line in Canada is patient outcomes, while the US is focused on profits and higher share values. Health outcomes and life expectancies are simply not metrics that matter in American healthcare.The significant under-performance and exorbitantly high costs of healthcare in the US represents a real threat to the health and financial stability of every American, and to the country as a whole. The conservatives who have been making false claims about healthcare are mostly politicians who gladly accept re-election campaign financing from the major healthcare companies. The quid pro quo is of course their defense of our crumbling healthcare structure, which puts them in deep conflict with American interests.It’s time to advocate for a much simpler and less costly method of distributing healthcare. Engaging a properly designed healthcare system would be a massive step toward protecting health and keeping people safe in their own homes — without the fear they will lose them over unaffordable medical bills. We must demand accountability from a state that makes rules in favor a few insurers and drug companies over the health and financial interests of hundreds of millions of its citizens. We must put an end to the mass suffering — and the medical inequities that the current health policies produce.