There are three major types of rich democracies in the developed world. These are social democracies, Christian democracies, and conservative democracies. Japan, Germany and the United States are good examples of these different kinds of rich democracies.

Japan is an example of a social democracy. In a social democracy government tends to be larger, taxes higher, and services such as health care better. By having the government run or closely control large industries such as healthcare, costs can be kept under control. The second example is Germany, a Christian democracy. In a Christian democracy much of the politics are multiparty based. The ruling party tends to have a slim majority at best and often needs to reach out to other groups to accomplish its goals. Christian democracies tend to preserve class differences while still being strong welfare states. This is seen in their health care systems which tend to be privately run but closely controlled by the government, making them similar to social democracies. Lastly there are Conservative democracies such as the United States. In Conservative democracies free markets tend to rule the economy including health care. The institutions I would like to compare in each country are payment systems, percent of GDP spent on health care, and access to technology such as scanner units.

In Japan 8% of the national GDP is spent on health care. The Japanese payment system works around a non profit insurance provider from a person's community. In addition the government negotiates with the hospitals every two years to set the price for each procedure. Because Japan is a social democracy, it has a strong government that has the final word on pricing. If a hospital were to refuse to use the government's pricing book they wouldn't be able to get paid by the government supported insurance plans. This system helps keep costs low by putting the government, and in turn the people, in a good position to bargain over costs. It encourages the providers and equipment makers to find ways to provide what is needed for a lower price. An excellent example of this is MRI machines. Japan has 40.1 MRI machines per million people. In Japan an MRI procedure only costs roughly $98. That is much less than most other countries, and yet they still have one of the highest number of MRI machines per capita in the world. Japan is able to have such low prices on their MRIs because the government refuses to pay more. Searching for ways to lower costs on MRI machines has lead to many advances in technology which Japan now exports to other countries.

Germany, an example of a Christian democracy, spends 10.7 % of its GDP on health care and handles its payment system similarly to that of Japan. In Germany they use the Bismark model of health care. People buy insurance from private sickness funds that are non profit organizations that compete for customers. The heads of these sickness funds are paid based on the number of clients. This serves to help foster competition in a non profit industry. Insurance is mandatory in Germany. The richest people can opt out of the sickness funds and buy more expensive private insurance but everyone must be covered. In Germany the number of MRI machines per capita is much lower than Japan at 7.1 per million.

The United States of America is a conservative democracy. The USA spends 16.2% of GDP on health care; more by a large margin than any of the other countries compared here. Health care systems in the USA are based around free market trade and run for the most part by for profit businesses. There is no central organization for the United States' health care system. The payment system depends on the person or family involved. Insurance is often provided by the employer, making it possible to be lost in times of unemployment. Some people buy their own insurance privately or go without insurance altogether. A small portion of the population is covered by a government single payer system; namely Medicare and Medicaid. Due to lack of much governmental control the health care industry is essentially run by large for profit corporations. The United States treats health care as a commodity whereas the other two nations treat it as a right that all citizens should have access to. In the United States there are 26.6 MRI machines per million people. A major difference here is that while the US does have a large number of MRI machines, not as many as Japan but man more than Germany, the cost is much higher. In the US an MRI can cost $1,500 compared to $98 in Japan.

Conservative democracies like the United States tend to let business take the lead in policy making. This leads to a health care system where there is a large spread between socioeconomic class and the accessibility of health care. Social democracies such as Japan focus on health care being a right and a necessity of all its citizens and focuses its system to provide for all. This is possible because they tend to have a strong central government that is able to push through policies that large corporations may not like. In Christian democracies like Germany health care is considered a right similar to Japan. This type of government tends to keep the health care industry in the private sector but regulate it heavily to make sure everyone can have access to basic care.

Some of the trade-offs between a free market system and more a government controlled system include wait times, quality of care available to rich people, peace of mind, and accessibility to all the population. In a free market system such as the USA there is very good care for the richest citizens, but poor to non-existent care for the lower class. In Japan there may be less polished waiting rooms and not as nice care for the richest few, but there is adequate coverage for all, and the citizens have the peace of mind of knowing that no matter what becomes of them they won't have to give up their homes to pay hospital bills. Germany as a Christian democracy falls in between Japan and the US. Germans pay more for health care than the Japanese, but still far less than Americans. Germans have the satisfaction of knowing that they and their neighbors all have access to high quality health care. One of the trade-offs in Germany is that doctors tend to feel under paid. This has lead to a strike of doctors in 2006.

In my opinion the best type of health care is that of Japan. By being a social democracy, the government of Japan has the power to bargain and control costs in a meaningful fashion. I feel that access to medical care is a basic human right, and should be treated as such. Japan does not treat health care as a commodity to be used for personal wealth, but rather as resource to be managed and regulated for the benefit of all. It will be interesting to see how the health care debate in the USA develops in the course of this year.


Sources

Draper, Alan, and Ansil Ramsay. The Good Society: An Introduction to Comparative Politics (MyPoliSciKit Series). 1 ed. New York: Longman, 2007. Print.

"Health care in the United States - Wikipedia, the free encyclopedia." Wikipedia, the free encyclopedia. N.p., n.d. Web. 12 Feb. 2010. <http://en.wikipedia.org/wiki/Health_care_in_the_United_States>.

Reid, T. R.. "FRONTLINE: sick around the world: five capitalist democracies & how they do it | PBS." PBS. N.p., n.d. Web. 12 Feb. 2010. <http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries/>.