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The importance of community rating

Uwe Reinhardt has a good overview of how the German, Swiss and Dutch health-care systems work, focusing on the widespread acceptance of "community rating" -- everyone paying the same insurance premiums regardless of health risk -- in each.

By Ezra Klein  |  January 12, 2010; 10:42 AM ET
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A huge point that Reinhardt doesn't make in that post is that here in the U.S. we pay more than double per person what most of those countries pay, so the increased hit on younger workers and middle class folks with lower incomes mandated to buy insurance will be very painful. Total community rating (we all pay the same regardless of age or health) would be a lot more acceptable to Americans if the cost averaged half as much as it does now.

Posted by: AuthorEditor | January 12, 2010 11:39 AM | Report abuse

Regular readers know the Swiss and Dutch systems are in trouble. The German system is stealth single payer. All three have much lower per capita health spending and more homogeneous populations. The U.S. is about to learn the hard way that we cannot afford anything but Medicare for All.

Posted by: bmull | January 12, 2010 12:08 PM | Report abuse

The piece is good, But why does Profesor Reinhardt continue to claim that Germany doesn't have a public health insurance provider? Look at the AOK (Allgemeine Ortskrankenkasse), founded by Bismarck, for yourself and see if you agree:

The AOK was a public corpaoration till January 2009 when it became a non-profit private-law association under a public regulator. The staff ceased to be civil servants. But would you really place it now in the private sector?

Posted by: JamesWimberley | January 12, 2010 6:47 PM | Report abuse

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