(4) Will We All Have To Become Biologically Enhanced Superhumans? | LinkedIn

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Bertalan Meskó, MD, PhD 

Director of The Medical Futurist Institute (Keynote Speaker, Researcher, Author & Futurist)

November 28, 2023

Okay, hands up who can tell who’s the most famous biologically enhanced superhuman in the world? True, it’s a quite close call between Captain America and The Incredible Hulk (sorry Spidey, you’re not even close). But are human-invented superhumans just a thing of a Stan Lee comic, or is it an actual scientific idea from a real laboratory?

As a matter of fact, enhancing human capabilities has been on the minds of people for ages, but it has come a long way from ancient training methods to exoskeletons. Enhancing our abilities, be it permanently or temporarily is a tempting but risky matter. Will it be possible in the not-too-far future to gear up superhuman powers so we don't lag behind the others? Let’s dive in and see how (and if) we can be our better selves.

A brief history of human enhancement

First, we need to ask what ‘enhancement’ exactly is. Throughout history, the enhancement of humans by various tools from physical addendums (remember Icaros?) to drugs (from ferocious Viking “berserkers” to the Nazi army or East German swimmers – or many of the cyclists still today), or even love (just google ‘Sacred Band of Thebes’) have been on the minds of leaders, military chiefs or inventors alike. Or philosophers, as a matter of fact.

The urge to live forever has not passed with our predecessors, let's take a look at Bryan Johnson's Blueprint project with its straightforward goal: don't die. Granted, most of us don't have 30 doctors and millions of dollars to spend on enhancing ourselves in all possible ways. On top of that, I feel a slight contrast between his efforts and the initiative to sell extra virgin olive oil as the omnipotent elixir to the less fortunate. But we can't deny he has gone the extra mile in every possible way to make the most of what money and science offer today and I truly appreciate the dedication here.

However, biological enhancement is a much deeper issue.

The dawn of digital health brought an era of technological advancements and within, the recreation of the human body or body parts or -functions came within reach. It started as a restoration of a certain human function, like eyesight or hearing, or the replacement of a missing limb. Technologies like CRISPR gene editing, nanotechnology and even the revolution of wearables and sensors brought new possibilities in human enhancement, and although longevity is still far away for many, living longer and possibly healthier is a de facto case for the human race. (That is, if we survive the climate catastrophe we created.)

The science of it also has a philosophical backing called transhumanism; a movement that “advocates the enhancement of the human condition by developing and making widely available sophisticated technologies that can greatly enhance longevity and cognition.” The concept states that humankind will evolve into a new intelligent species. That is yet to be seen, however: current affairs indicate no such evolution. But transhumanists live and strive among us. And sometimes episodes of the series Black Mirror have more links to reality than we wish. To know more, read our in-depth interview with one of the world’s most influential transhumanists, Zoltan Istvan!

There is a variety of fields where a superhuman feature could potentially be created. And that will not be the result of a single discipline but of the convergence of multiple scientific fields. Currently, these have a restorative focus rather than a developmental one, although each can evolve towards that in the future. In this article, we split the possible directions into 3 main categories:

1. Removable cyborg extensions – the tools enhancing the individual can easily be put away at the end of use
2. Cyborg-humans – technologies causing lasting, but not irreversible transformation like prosthetic limbs, digital tattoos and bionic implants
3. Technologies changing humans forever – genetic editing (such as CRISPR) is the one that raises the most ethical and moral questions.

This time we categorize the possibilities for enhancements horizontally and have a look at 5 fields where human enhancements would be possible.

1. Brainpower

A microchip in the brain that will enhance our cognitive functions by a zillion – how we all could use such a thing during exams! The concept was first raised back in 1968 by architect Nicholas Negroponte at MIT, and it has come a long way since. Hacking the human brain is more difficult than we could imagine and cannot be solved with a single microchip implant.

But Elon Musk’s other company, Neuralink aims to do just that. The idea is to have a chip implanted in one’s brain; that neural implant will let you control a computer or mobile device anywhere you go. A lot of water has passed under the bridge since Musk presented the pigs with the implants and in 2023 the company is recruiting human candidates with quadriplegia for a six-year clinical trial.

But seeing what Elon Musk did to that poor pig, it did not at all look like the future. We at The Medical Futurist often say that before the digital health transformation, a cultural shift is inevitable. But having a neural implant somehow gives me the creeps – even if it could give me superpowers.

2. Brain-computer interface

With less media hype, Synchron, a company that has developed a minimally invasive brain-computer interface is further along the way. Their implant actually has been working in at least two patients for quite a long time and has now enrolled six patients with severe quadriparesis. The current trial runs in three clinical trial sites in the US. The Synchron implant does not require open brain surgery as it is implanted in the blood vessel on the surface of the motor cortex of the brain via the jugular vein, through a minimally-invasive endovascular procedure.

Once implanted, it is designed to detect and wirelessly transmit motor intent out of the brain, intended to restore the capability for severely paralysed patients to control personal devices with hands-free point-and-click.

Researchers have been investigating the possibilities of brain-computer interfaces or BCIs for quite a while now. At first, these were thought to be tools on one hand to provide constant monitoring of the brain’s electrical activity; this could support a wide range of applications from monitoring epilepsy or ADHD to pain management and sleep assessment. On the other hand, the concept was thought to be a solution for paralysed people to move and control things around them with only thoughts… Taking it onto the next level, such an implant could also be used as an external hard drive for the mind.

Enhancing cognitive performance would be able to change the lives of millions suffering from memory loss, and neurological or psychological disorders. Restorative processes like stroke rehabilitation would also gain from the technology. Or, as a matter of fact, these can help reduce the cognitive effects of ageing. No wonder there are many studies that focus on the possibilities such technology can provide for seniors.

3. Muscle strength and robotic exoskeletons

There is a huge cultural acceptance issue with technological solutions for restoration vs. tech for boosting performance. According to a study on the matter, the public almost unanimously agrees with technological enhancement if it’s used for restorative purposes: 95% support physical restorative applications, and 88% support cognitive restorative applications. But when it comes to the enhancement of human capabilities for the reason of boosting performance – well, that’s a big no-no, according to the study. Only 35% of respondents agree with the concept.

Robotic exoskeletons are also becoming more and more common. Paralyzed people or those who lost a limb have now the chance to move again with such technological advancements. Certain industries like construction also make use of the extra power robotics can give. The next step will be the AI-powered prosthesis; or ones that can supplement healthy individuals with additional limbs. Not to mention a future where we share bodies and senses with machines.

But what are advanced technologies worth if only the wealthiest can afford them? That has been the case with many exoskeletons therefore it's so great to see more and more covered by health insurance.

In 2023 October ReWalk Robotics, Inc. announced that the Centers for Medicare & Medicaid Services (CMS) finalized a rule benefitting its exoskeleton technology. "Earlier this year, CMS released a proposal aiming to establish new regulatory definition of “brace.” Adding the definition of brace would expedite coverage and payment for newer technology and powered devices, according to CMS. This potentially enables faster access to the newer technologies, like those made by ReWalk and Myomo as well."

The new CMS proposal includes personal exoskeletons in the Medicare benefit category for braces meaning that benefits would extend to exoskeletons which allow paralyzed patients to stand and walk. This follows a similar announcement from Germany from 2022.

4. Enhancing the senses

What if technology could aid humans to have better hearing than bats? What if we could filter out the smell of urban decay and only experience pleasant odours? Or what if implants could let us see microscopic objects? Or special features, such as the heat map of an abandoned terrain? These questions led us to list how technology could help augment human senses in our previous article. One exciting example of this was the AI-supported hearing aid presented at the 2021 CES. This device features an onboard deep neural network that gives people with hearing loss a better experience. And there are many more examples of that.

Supercharging human senses with technology for the blind or the deaf are entirely feasible enhancements. When a person loses a sense, the area of the brain that was responsible for handling that sensory information does not go unused. The brain rewires itself and uses that area to process other senses. This is neuroplasticity, the ability of the brain to change with experience. Researchers “just” need to find out how to use this natural superpower.

Temporary or long-term sensory enhancements are also not limited to the ones with certain disabilities: the technology goes beyond that. In the Handbook of Neuroethics, the authors explain that the enhancement tools “could be implemented in mainly two ways: either via the application of digital technology or by genetic engineering of the human body.” Augmented reality just takes this realm a step further.

Augmented reality is not only revolutionary but can also give us real superpowers. It is one of the most promising digital health technologies, from operations to providing information and education. Heightened capabilities of our vision by AR, VR, digital contact lenses or even retina chips have been bugging the minds of researchers for the past decade. And although many of the concepts have failed (remember Google’s glass or glucose-level measuring contact lenses?), these flops don’t necessarily mean the concepts are wrong.

5. Genetic engineering – a brave new world?

A lot of research is underway in gene therapies. CRISPR editing was a huge step in this direction. While its original vision, to serve as a tool offering gene therapies for patients is noble and just, there is a significant, primarily moral and ethical resistance against the method. For example, researchers in Oxford’s Nuffield Laboratory of Ophthalmology help restore eyesight to patients with genetic vision defects with gene therapy, which seems acceptable as a method; while genetic engineering on an embryo-level is more of a moral issue than a scientific one.

While CRISPR therapies are still considered experimental, and none have been approved, and some even have been unsuccessful, we've also seen some success stories and several creepier announcements.

Editing DNA can become a powerful tool in the diagnosis and the treatment of diseases. The European Union is trying to add the ethical component on the first level of its scientific programme in the genetic engineering leg of its human enhancement project. Sienna, and other such organisations and projects also raise and include ethical issues in their projects. However, with such technologies becoming more available, cases like the creation of first designer babies in China appear. After this scandal, the WHO launched a global registry to track research on human genome editing.

Transhumanists predict that with the convergence of new technologies in science, we could create healthier, smarter and stronger humans. They think it’s our duty to evolve into something beyond ourselves. But as much as I love science, my idea of a happier life does not begin with being faster and stronger. It begins with the core values of humankind: empathy, tolerance and kindness. And if we can cure something or someone with the help of science, we should do that. But my brave new world shall not take place in Gattaca.

Read more about these concepts in my book My Health Upgraded, elaborating on where health care and medicine is heading in the future.

https://www.linkedin.com/pulse/we-all-have-become-biologically-enhanced-superhumans-mesk%25C3%25B3-md-phd-dxftf/

LA County Invests Big in Free Virtual Mental Health Therapy for K-12 Students - California Healthline

 Los Angeles County public schools are rolling out an ambitious effort to offer free mental health services to their 1.3 million K-12 students, a key test of California Gov. Gavin Newsom’s sweeping, $4.7 billion program to address a youth mental health crisis.

Spearheaded by the county’s Medi-Cal plans — which provide health insurance to low-income residents — in collaboration with its Office of Education and Department of Mental Health, the LA school program relies on teletherapy services provided by Hazel Health, one of a clutch of companies that have sprung up to address a nationwide shortage of mental health services that grew much worse during the covid-19 pandemic.

The teletherapy effort is one of four LA County projects that will collectively receive up to $83 million from the state’s Student Behavioral Health Incentive Program, one component of the Democratic governor’s “master plan” to address gaps in youth mental health care access.

LA’s Hazel Health contract is aimed at helping overburdened schools cope with a surge in demand for mental health services. It promises to be a telling case study in both the efficacy of virtual therapy for students and the ability of educators and administrators to effectively manage a sprawling and sensitive program in partnership with a for-profit company.

For some Los Angeles County educators and families, the initial results are promising.

Anjelah Salazar, 10, said her Hazel clinician has helped her feel a lot better. After the fifth grader switched to a new school this year, Stanton Elementary in Glendora, she started having panic attacks every day.

Her mom, Rosanna Chavira, said she didn’t know what to do — even though she’s a clinical coordinator for a company that treats mental health conditions — and worried she wouldn’t be able to find an affordable therapist who accepted their insurance. Once Chavira learned about Hazel, she jumped at the opportunity.

“This being free and having a licensed professional teaching her coping skills, it just means the world,” Chavira said. “You can already see changes.”

Salazar said she’s met with her virtual therapist five times so far. One coping technique that she especially appreciates is a tapping exercise: Every night before bed, she taps her eyes, her cheeks, her chest, and her knees. With each tap, she recites the same affirmation: “I am brave.”
Christine Crone, parent of seventh grader Brady, said she has yet to see if the sessions have been effective for her son, who attends Arroyo Seco Junior High in Santa Clarita, but she knows he enjoys them.
“He struggles normally with being on time and prepared, but with these sessions, he always stops what he is doing and makes sure he is logged in on time,” Crone said. “He says that his therapist is nice, fun, and easy to talk to.”
Jennifer Moya, a mental health counselor at Martha Baldwin Elementary in Alhambra, a city east of Los Angeles, said her students like the flexibility of teletherapy, which allows them to meet with clinicians anytime between 7 a.m. and 7 p.m.
“This generation of kids has grown up digital,” said Moya, who is in charge of referring students to Hazel at her school. “They love that this is easy.”
Pablo Isais, a mental health counselor at Alhambra’s Granada Elementary School, said the services can also be a stopgap while a student waits for an in-person appointment, which can take six to eight weeks.
“To be able to let them know that there are services available that they can access within the next week is amazing,” Moya said.
Thus far, early in the rollout, only 607 Los Angeles County students have participated in Hazel sessions since they were first offered, in Compton, in December 2022, said Alicia Garoupa, chief of well-being and support services for the Office of Education. She acknowledged some bumps in the rollout but said Hazel is “another tool in our toolbox.”
 

LA County Invests Big in Free Virtual Mental Health Therapy for K-12 Students - California Healthline

BP check challenge: Only 1 in 159 med students gets perfect score | American Medical Association

This Fact is astonishing.   The only saving grace is that usually it is an aide or nurse that measures your blood pressure.

Check out your doctor !

Position is everything.  Sit in chair legs on ground, uncrossed, relax...

At a recent medical conference, 159 medical students volunteered to take part in a blood-pressure check challenge. Individually, students went into a mock exam room where a patient actor sat, legs crossed, on an elevated stool with no arm, back or foot support. An empty chair with support for the patient’s back and arms was next to the stool. A table that could support the patient’s arm properly was adjacent to the stool and an automated BP monitor, a tape measure and small, medium, large and extra-large BP cuffs sat on the table.

The students were told the patient actor was 50 years old, new to the practice and had not seen a doctor in several years, a scenario that calls for health professionals to check blood pressure in both arms. Researchers asked the students to measure the patient’s BP and write down the results. Professional observers evaluated the students in action and passed or failed them on 11 skills.

The results were “disappointing,” study authors said in an article published in The Journal of Clinical Hypertension. Just one student scored 100 percent. On average, students performed 4.1 of the 11 skills correctly. The “Blood Pressure Check Challenge” was held at the 2015 AMA Annual Meeting.

“Given these students represented schools in 37 states, the results suggest it is unlikely that current U.S. medical students are able to perform reliably the skills necessary to measure BP accurately,” the study authors wrote.

Most often, students did not have the patient rest in the chair for five minutes before taking a measurement, with just 6.9 percent of students remembering to do this. There were five other areas where fewer than 20 percent of students performed the skill correctly: deciding which arm should be used for future readings (13.2 percent); ensuring the patient placed his or her feet on the floor (15.1 percent) not allowing the patient to use a mobile phone or read during the measurment (17 percent); checking blood pressure in both arms (18.2 percent); and when asked, identifying the arm with the higher reading as being more clinically appropriate (15.1 percent).

Students were best at placing the cuff over a bare arm (83 percent) and selecting the correct cuff size (73.6 percent). In three areas, about half of students did well: ensuring a patient’s legs were uncrossed (52.2 percent); not allowing the patient to talk during the measurement (57.2 percent) and supporting the patient’s arm at heart level (61.0 percent).

Students in their second through fourth years of medical school scored higher than medical students in their first year of school, but the numbers still showed a need for more training. The older students performed about five of the 11 tasks correctly versus the younger students nearly four out of 11 tasks being properly performed.

“We believe the use of automated devices will reduce some common errors in measuring BP, but our study confirms that automated device use alone will not eliminate many common errors in BP measurement,” the study authors concluded. “Medical school training in these skills should be revised and studied to ensure it is effective.”

BP check challenge: Only 1 in 159 med students gets perfect score | American Medical Association

Clinician burnout in the US: New data, surprising insights

A new insight about physician burnout. Some factors such as increased patient volume, administrative bureaucracy, profit driven coroporate medicine are now only a part of a worldwide increase in chronic diseases.

The increase in chronic disease can be attributed to the elimination of diseases which end life in young, or middle-age.  

The Paradox Of Clinician Burnout In America

Doctors and nurses today are the beneficiaries of groundbreaking advancements in science, technology and disease treatments. With so many sophisticated tools available to diagnose and cure patient problems, you’d think this would be the golden era of clinician fulfillment. And yet, this period of radical advancement is marked by growing dissatisfaction and an exodus of physicians. Last year alone, 71,309 doctors quit the profession.

At a press briefing last month, Dr. Debra Houry, Chief Medical Officer at the Centers for Disease Control and Prevention, highlighted this growing threat to healthcare professionals.

“Burnout among these workers has reached crisis levels,” she said, noting that the COVID-19 pandemic had intensified long-standing challenges within the workforce. Fatigue, depression, anxiety, substance use disorders and suicidal thoughts are on the rise, according to the CDC.

In self-reported surveys about the causes of burnout, medical professionals point to the profit-centric American healthcare system that burdens them with countless bureaucratic tasks, endless prior authorization requirements, and a revolving door of patient visits.

All these complaints are valid, but new data on burnout from the nonprofit Commonwealth Fund raise another possibility and shed light on a potential solution.

Burnout: A Distinctly American Problem?

If the main drivers of burnout were indeed greedy insurance execs and a for-profit healthcare system, then you would expect that the Western nations with universal healthcare (which is paid for and provided by the government) would have dramatically lower physician burnout rates than in the United States.

But the Commonwealth Fund report tells a different story. Surprisingly, primary care physicians in the U.S. are in the middle of the pack when it comes to burnout. They report higher rates of satisfaction than their peers in the UK, Germany, Australia, New Zealand and Canada (but trail the Netherlands, Sweden, France and Switzerland in satisfaction).

If physician burnout isn’t a distinctly American phenomenon, deriving from unique aspects of the U.S. healthcare system, then what is causing doctor dissatisfaction around the world?

If we look at the biggest change to global medical practice in the 21st century, it’s not the corporatization of care or the administrative burdens heaped on clinicians. It’s the evolution of illness, itself.

Clinician burnout in the US: New data, surprising insights | LinkedIn

Cardiovascular Health of Middle-Aged US Adults by Income Level: From 1999 to March 2020 or Social Determinants of Healt (SDOH)

TAKE-HOME MESSAGE

Your risks depend upon your income.  

Low income persons are at higher risk of hypertension, while high income persons are more at risk for diabetes and obesity

In this serial cross-sectional analysis of NHANES data from middle-aged US adults between 1999 and 2020, the prevalence of hypertension increased among low-income adults, whereas the prevalence of obesity and diabetes increased among high-income adults. 

Cigarette use decreased only among high-income adults. Overall, the prevalence of modifiable risk factors was substantial, irrespective of the income category.

These findings highlight the persistent and increasing income-based disparities in the prevalence of major cardiovascular risk factors among adults in the US. Public health efforts targeting the diagnosis and control of these modifiable risk factors are critically needed in all populations.

Cardiovascular Health of Middle-Aged US Adults by Income Level: From 1999 to March 2020 | PracticeUpdate

Evaluating Plastic Syringes Made in China for Potential Device Failures: FDA Safety Communication

Date Issued: November 30, 2023

The U.S. Food and Drug Administration (FDA) is informing consumers, health care providers, and health care facilities that the FDA is evaluating the potential for device failures (such as leaks, breakage, and other problems) with plastic syringes manufactured in China. The FDA is collecting and analyzing data to evaluate plastic syringes made in China used for injecting fluids into, or withdrawing fluids from, the body. At this time, the issue does not include glass syringes, pre-filled syringes, or syringes used for oral or topical purposes.

The FDA received information about quality issues associated with several Chinese manufacturers of syringes. We are concerned that certain syringes manufactured in China may not provide consistent and adequate quality or performance.

Potential Syringe Failures

To date, the FDA is aware of quality issues from recent syringe recalls, Medical Device Reports (MDRs), and additional complaints about syringes made at various manufacturing sites in China. Quality issues reported have included leaks, breakage, and other problems after manufacturers made changes to the syringe dimensions. These quality issues may affect the performance and safety of the syringes including their ability to deliver the correct dose of medication when used alone or with other medical devices such as infusion pumps.  

Report any issues with syringes to the FDA

Health Care Systems - Four Basic Models | Which would you like?

Health Care Systems - Four Basic Models

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An excerpt from correspondent T.R. Reid’s upcoming book on international health care, titled “We’re Number 37!,” referring to the U.S.’s ranking in the World Health Organization 2000 World Health Report. The book is scheduled to be published by Penguin Press in early 2009.

There are about 200 countries on our planet, and each country devises its own set of arrangements for meeting the three basic goals of a health care system: keeping people healthy, treating the sick, and protecting families against financial ruin from medical bills.

But we don’t have to study 200 different systems to get a picture of how other countries manage health care. For all the local variations, health care systems tend to follow general patterns. There are four basic systems:

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The Beveridge Model

Named after William Beveridge, the daring social reformer who designed Britain’s National Health Service. In this system, health care is provided and financed by the government through tax payments, just like the police force or the public library.

Many, but not all, hospitals and clinics are owned by the government; some doctors are government employees, but there are also private doctors who collect their fees from the government. In Britain, you never get a doctor bill. These systems tend to have low costs per capita, because the government, as the sole payer, controls what doctors can do and what they can charge.

Countries using the Beveridge plan or variations on it include its birthplace Great Britain, Spain, most of Scandinavia and New Zealand. Hong Kong still has its own Beveridge-style health care, because the populace simply refused to give it up when the Chinese took over that former British colony in 1997. Cuba represents the extreme application of the Beveridge approach; it is probably the world’s purest example of total government control.

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The Bismarck Model

Named for the Prussian Chancellor Otto von Bismarck, who invented the welfare state as part of the unification of Germany in the 19th century. Despite its European heritage, this system of providing health care would look fairly familiar to Americans. It uses an insurance system — the insurers are called “sickness funds” — usually financed jointly by employers and employees through payroll deduction.

Unlike the U.S. insurance industry, though, Bismarck-type health insurance plans have to cover everybody, and they don’t make a profit. Doctors and hospitals tend to be private in Bismarck countries; Japan has more private hospitals than the U.S. Although this is a multi-payer model — Germany has about 240 different funds — tight regulation gives government much of the cost-control clout that the single-payer Beveridge Model provides.

The Bismarck model is found in Germany, of course, and France, Belgium, the Netherlands, Japan, Switzerland, and, to a degree, in Latin America.

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The National Health Insurance Model

This system has elements of both Beveridge and Bismarck. It uses private-sector providers, but payment comes from a government-run insurance program that every citizen pays into. Since there’s no need for marketing, no financial motive to deny claims and no profit, these universal insurance programs tend to be cheaper and much simpler administratively than American-style for-profit insurance.

The single payer tends to have considerable market power to negotiate for lower prices; Canada’s system, for example, has negotiated such low prices from pharmaceutical companies that Americans have spurned their own drug stores to buy pills north of the border. National Health Insurance plans also control costs by limiting the medical services they will pay for, or by making patients wait to be treated.

The classic NHI system is found in Canada, but some newly industrialized countries — Taiwan and South Korea, for example — have also adopted the NHI model.

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The Out-of-Pocket Model

Only the developed, industrialized countries — perhaps 40 of the world’s 200 countries — have established health care systems. Most of the nations on the planet are too poor and too disorganized to provide any kind of mass medical care. The basic rule in such countries is that the rich get medical care; the poor stay sick or die.

In rural regions of Africa, India, China and South America, hundreds of millions of people go their whole lives without ever seeing a doctor. They may have access, though, to a village healer using home-brewed remedies that may or not be effective against disease.

In the poor world, patients can sometimes scratch together enough money to pay a doctor bill; otherwise, they pay in potatoes or goat’s milk or child care or whatever else they may have to give. If they have nothing, they don’t get medical care.

These four models should be fairly easy for Americans to understand because we have elements of all of them in our fragmented national health care apparatus. When it comes to treating veterans, we’re Britain or Cuba. For Americans over the age of 65 on Medicare, we’re Canada. For working Americans who get insurance on the job, we’re Germany.

For the 15 percent of the population who have no health insurance, the United States is Cambodia or Burkina Faso or rural India, with access to a doctor available if you can pay the bill out-of-pocket at the time of treatment or if you’re sick enough to be admitted to the emergency ward at the public hospital.

The United States is unlike every other country because it maintains so many separate systems for separate classes of people. All the other countries have settled on one model for everybody. This is much simpler than the U.S. system; it’s fairer and cheaper, too.

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Note - Reid’s “Beveridge” model corresponds to what PNHP would call a single payer national health service (UK); “Bismark” model refers to countries that PNHP would say use non-profit “sickness funds” or a “social insurance model” (Germany); and “National health insurance” corresponds to single payer national health insurance (Canada, Taiwan). Reid’s “out-of-pocket” model is what PNHP would call “market driven” health care. Some countries have mixed models (e.g. Sweden has some features of a national health service such as hospitals run by county government; but other features of national health insurance such as physicians being paid on a FFS basis). This explains why Reid might classify the Scandinavian systems as “Beveridge” while PNHP classifies them as “single payer national health insurance.”

Health Care Systems - Four Basic Models | Physicians for a National Health Program