This is preposterous

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A review of Zeke Emanuel’s new book comparing health systems across the world has as good a description of the American maze as I’ve seen.

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Britain is so lucky to have the NHS; I find it literally impossible to explain to people here how the system doesn’t have to be this way.

By contrast, the US health care system—if one can call it that—excludes more people, provides thinner coverage, and is far less affordable. It combines socialized medicine practiced by the Department of Veterans Affairs, four-part federal Medicare (A, B, C, D) for the elderly and disabled, state-by-state Medicaid for the poor, health coverage provided by employers, and policies bought privately through an insurance agent or an Affordable Care Act exchange—all of which still leave 10 percent of the population unprotected. Among the biggest problems, says Emanuel, is that Americans are baffled by their health care: uncertain of the benefits they’re entitled to, the providers that will accept their insurance, the amount of their deductibles and copays, and the accuracy of the bills they receive. It is a system, moreover, in which people are regularly switching insurers out of choice or necessity—a process known as churning. “The United States basically has every type of health financing ever invented,” Ezekiel adds. “This is preposterous.”

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