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Health Systems Abroad Offer Lessons for U.S. Reform Plan

August 28, 2009 at 12:00 AM EST
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As part of the NewsHour's series of conversations about health care reform, Betty Ann Bowser talks to Washington Post correspondent T.R. Reid, author of a new book about health care systems around the world and what the U.S. can learn from them.
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JEFFREY BROWN: And now a conversation about health care reform.

As the debate in this country continues, health correspondent Betty Ann Bowser talked to writer T.R. Reid about what we might learn from the experience of others.

DOCTOR: Breathe. OK, I’m going to check your lungs.

BETTY ANN BOWSER: The search for successful health care reform has taken many shapes. Embattled lawmakers have crunched numbers, studied business models, and researched payment options. But one prominent journalist thinks he’s found a better way to achieve affordable high-quality health care in America, by looking outside the nation’s borders.

In a new book and a 2008 PBS “Frontline” documentary, T.R. Reid, a correspondent for The Washington Post, reports on national health systems in other industrialized countries. Some are government-run. Some rely on private insurance companies, but all have one thing in common. Almost everybody gets covered.

The “NewsHour” spoke with him as part of our ongoing series on health care reform.

First of all, thank you for being with us.

T.R. REID: I love your show. I am delighted to be on it.

BETTY ANN BOWSER: So, let’s begin with what other industrialized countries do. What do they do about health care?

T.R. REID: Well, all the other countries manage to cover everybody with high quality and spend half as much as we do. And I was trying to figure out, how do they do that?

You know, in Germany, you can pick any one of 200 health insurance plans. If you don’t like your plan, you can switch to the other guy, with no increase in premium. How do they do that?

I went to this hospital in Canada, 800 beds. The billing office is two part-timers. How do they do that?BETTY ANN BOWSER: Well, how do they?

Different approaches to health care

T.R. REID: Well, I think I figured that out. And they don't all do it the same way. It's not all socialized medicine.

Many countries cover everybody at reasonable costs with private docs, private hospitals and private insurance. That's the kind of stunning discovery of this tour. It doesn't have to be government-run. It doesn't have to be single-payer. Japan has 3,000 payers.

BETTY ANN BOWSER: But all of these countries have some sort of government control or regulation, do they not?

T.R. REID: Yes, these are all regulated, even in the countries that are private. But I argue in my book that some foreign countries are less socialized than the United States.

In the U.S., everybody, when they turn 65, switches to government-run health insurance, Medicare. In Germany, Netherlands, Switzerland, et cetera, people stay with the private insurer cradle to grave. Yes, it's regulated insurance. That's definitely true. But it's private.

BETTY ANN BOWSER: So, what are some of the things that they do that the United States could perhaps benefit from -- from learning from them?

T.R. REID: Well, the regulation of the payment system, for example.

On the payment side, where they have insurance companies, the insurers have to cover everybody. They have to pay every claim. They can't deny any claim, as long as it is certified by a doc. They usually have to pay within a week or two. They have very strict time limits.

Get this. In Switzerland, if they don't pay in five days, your next month's premium is free. Now, that's health insurance. And -- and they allow you to switch. If you don't like your plan, you can switch to another one. And, usually, they can't raise your premium.

This is done by regulation. And the way they do it is, the governments say to the insurance companies, you want to be in this business, we are going to put a limit on your paperwork costs, your administrative costs. So, you know what? France, 61 million people, 14 payers, administrative costs of 4 percent.

In our private insurance industry, the administrative costs are about 20 percent.

BETTY ANN BOWSER: And what are the health outcomes in some of these other industrialized nations that you went to?

Better health results

T.R. REID: Yes, this was really depressing for me, frankly, to find out that almost all the other countries have better health results than we do, longer life expectancy, much lower neonatal death rates, better recovery rates from major diseases.

And, to me, at my age, here's the stunning one. Life expectancy at age 60, when you turn 60, can you -- how long will you live and be healthy? All the other countries do better than we do. The United States ranks 23rd out of the 23 richest countries on life expectancy at 60.

BETTY ANN BOWSER: You said in your book that, when all of these other countries, the ones that recently have done health care reform, that they went and looked to see what other countries were doing. There doesn't seem to be any attempt to do that in the United States.

T.R. REID: Doesn't it seem obvious? I mean, these are countries like us. They're advanced free market democracies. They have exactly the same problems, aging populations, rapidly increasing health care costs. And, yet, they have found good solutions.

BETTY ANN BOWSER: What is socialized medicine? Is that what they have in Great Britain? And how does it work?

T.R. REID: Well, it's a good question.

BETTY ANN BOWSER: What is...

T.R. REID: What is socialized medicine?

BETTY ANN BOWSER: What is it, really?

What is socialized medicine?

T.R. REID: So, the term was invented by a P.R. firm working for the American Medical Association in 1947, when Harry Truman tried to do universal health care. You know, the argument was, if you want to provide health care for your neighbor, you're a commie kind of thing.

What is socialized medicine? I think Britain probably comes pretty close. Government owns the hospitals. Government pays all the bills. Government buys most of the pills. Government owns the labs.

In Britain, government employs about 40 percent of the doctors. The other 60 percent are private, but they bill the government. Isn't that socialized medicine? If the government pays, and the government provides the care, that is socialized medicine.

Now, Canada, Taiwan, Australia, in those systems, the government pays the bills, but the providers are private and the hospitals are private. So, what do you call that, quasi-socialized medicine. I don't know.

But then let's go to Japan, Netherlands, Switzerland, France, private docs, private hospitals, private insurance plans. To me, that's not socialism.

BETTY ANN BOWSER: Is there one thing that all of these countries have in common?

T.R. REID: Yes. They all agreed, first of all, what the goal was: We're going to make sure that everybody in our country is who is sick can have access to a doctor.

And then they found a way to get there.

BETTY ANN BOWSER: Rather than focus on cost?

T.R. REID: Yes.

That's quite interesting. If you look at the problems in America are -- you could say cost, coverage and quality. And Washington seems to be focused on dealing with costs first. It's kind of logical. Let's get the costs down. We can cover everybody.

All the other countries did it differently. They said, let's cover everybody. And, once you get everybody in the system, then you have the political will to make tough decisions about cost control. And they're tough decisions. We're learning that now. But, if you have everybody in, then you can make those decisions.

BETTY ANN BOWSER: One of the things you hear a lot, now that the temperature has increased around this debate, is that, in countries -- Canada and Great Britain come up all the time -- you have to wait six months if you have breast cancer to have an operation, those kinds of things. Is it true?

Rationing of health care

T.R. REID: Every country rations health care. They all do it. Nobody can afford to pay for everything.

And the United States rations health care. And I think the key distinction is, we ration differently from everybody else. All the other countries have a basic floor of care that everybody can get. And you know the result? Nobody dies in those countries because they can't see a doctor.

In the United States, some people have no ceiling. They get the greatest care in the world with no waiting. And a lot of people don't have access to much of anything. And the result is, as you know, the National Academy of Sciences says 20,000 Americans die every year of treatable diseases because they can't see a doctor.

To me, that's the harshest form of rationing in the world. All countries ration. Nobody rations the way we do.

BETTY ANN BOWSER: Do you think universal health care is a moral issue or a political issue?

T.R. REID: Well, in all the other countries, they made a fundamental ethical decision, a moral decision: Everybody in our country is going to get health care.

Obviously, the design of any country's health care system, it's a political issue, it's a medical issue, it's an economic issue. I concluded, after going around the world, that, fundamentally, it's a moral question. If a country decides, doggone it, we want to cover everybody, there's a way to do it.

And the other countries have done it. But we have never made that decision. The thing I would kind of like to say is, you know, I went around the world trying to figure out why it is all the other countries manage to cover everybody and spend half as much as we do.

And I thought I had to figure out how they do it. But you know what? A more important question turns out to be, why do they do it? Why does a country commit to provide health care to everybody who needs it?

And that leads to the question, why doesn't the richest country commit to provide health care to everybody who needs it? Well, in my book, I think I answer the how do they do it. I think I answer the why do they do it. But I still can't figure out why we don't do it.

JEFFREY BROWN: On our Web site, NewsHour.PBS.org, you can find a link to "Frontline"'s documentary with T.R. Reid. It's called "Sick Around the World."

We will have more perspectives on health care reform next week.