Dear FRONTLINE,

I find it amusing that so many talk about tort reform. Do they mean to say that if a doctor killed a loved with their negligence that nobody should be held accountable. This is another example of the brainwashing by the insurance companies. The only way the heath care disaster in this country can be fixed is by removing the profit motive. This will never happen because Americans are greedy and put making money above all else.

Akron, OH

Dear FRONTLINE,

I enjoyed this show and think it is very informative, but I feel there is a large side to the story of health care that is not given enough emphasis, and that is the impact of diet on health.

A population of healthy people would naturally cost less to take care of than the perpetually sick who frequent traditional, expensive remedies for conditions which are entirely diet and lifestyle related.

Most people do not understand that many of the leading causes of death in America are entirely preventable and reversible with a healthy diet. The costs of treating heart disease, diabetes, Multiple Sclerosis, and cancers with traditional western medicine and treatments is tremendous. The results of these treatments are depressing -- heart disease is the leading cause of death in our country despite the multitude of pills, tests, and surgical procedures that profit doctors, pharmaceutical companies, and health care management companies. Traditional treatments and medicine for cancer, heart disease, and MS can cause horrible side effects, yet to increase your chances of preventing, halting, or reversing these diseases calls for following a simple, healthy diet which sadly too few know about.

The conditions and diseases I mentioned can be prevented and many can be reversed with a healthy low-fat whole plant foods diet such as that promoted by many leading vegan doctors and vegetarian societies. While many people will no doubt think that last sentence is an outlandish claim, I would urge them to look into the medical science themselves, and refer them to such books as The China Study by T. Colin Campbell, Dr. McDougall's books, the many books that are now available on reversing heart disease and Type II diabetes, and also Dr. Roy Swank's life long work helping MS patients halt and prevent the debilitating results of their disease by following a low-fat nearly vegan diet.

I don't think it is very likely, but if the traditional medical industries would take an honest look at what works and what doesn't regarding these diseases which affect so many thousands of Americans, they could easily bring about a healthy population who would not need their services as much, providing more room for money to go where it's really needed - comprehensive health care coverage for all.

Not to mention following a low-fat healthy vegan diet costs a lot less than paying for a heart bypass surgery.

Carolyn Avery
San Francisco, CA

Dear FRONTLINE,

Excellent program and very timely in light of the current Congressional Bill HR 676 (US National Health Insurance) that has been proposed with 70 co-sponsors so far! As a small business owner, I support a national insurance program so that we are not tied to our jobs because of fear of losing insurance, but instead can start our own businesses if we wish - isn't that part of the American Dream? I must correct the few naysayers who argue against learning from these other countries because they don't think that health care should not be free. NOTHING IS FREE. We all pay taxes already - if we had a better FINANCING system (like single payer), we would just have better care with the same money by eliminating the bureaucratic waste of private insurance companies (average 20% overhead compared to govt -run Medicare with 3%). Don't we want our taxes to go to good causes such as health care for all? Don't we want to live in a society where we take care of our most vulnerable as well as ourselves (especially when it does not cost more than what we are already paying!)?

Bella Dinh-Zarr
Washington, DC

Dear FRONTLINE,

Personal responsbility evangelists are ready to explain away the glaring flaws in our system, discount the role of government in our society but while personal accountability may be an issue, it is only an anecdotal explanation for a small fraction of our problems.

Our neglect of the un- and under insured is a profound statement about the value we place on human life, welfare and dignity. Our arrogance as a nation will be our downfall. We can learn from others and must appear foolish to those who have it figured out. Would I forego the latest and greatest pill so that many fellow human beings could get basic medical care without having to decide to pay the bill or feed themselves, ABSOLUTELY!

The free-market that so many cling to is the cause that Insurance companies are in the business to pay as FEW claims as possible. This is no different than the home, life or auto insurance industries. It's practice defies it's very purpose on a daily basis.

Wake up America, demand more, demand better!

moorhead, mn

Dear FRONTLINE,

Your story was excellent, but you omitted one important part of the solution - the role of individuals in keeping themselves well or participating in a chronic disease management program if you aren't well.We need educational incentives, but more importantly, financial incentives for people to take responsibility. If everyone is required to pay into the system, then healthy lifestyles and active participation in your health care can result in lowered premiums (or taxes) and the entire health care system will be less costly.

Steve Hurd
Grand Junction, Colorado

Dear FRONTLINE,

This was a disappointing Frontline episode, to be honest. A few crucial points were missed entirely, which any counterpoint would have addressed.

First, innovation in medicine happens primarily in the US because it is economically rewarded here. The fact that Germany admits to "negotiating" lower prices on drugs means only that the US health care payer is paying for the Germans as well. Innovation in health care will disappear if we move to socialized medicine. In our lifetimes, the largest price will likely be paid in speed of advancement in cancer care.

Second, exposure to lawsuits and other liabilities are a primary driver of healthcare costs in the United States, and are far more substantial than administrative costs. Tort reform will do more to lower costs than importing MRI machines from Japan.

Third, the implication of the program is that the US represents some kind of free market system, while productive and efficient socialized systems are showcased across the world. Let's keep in mind that a substantial portion of healthcare spending is done through Medicare and Medicaid: the US government. This is a not a free market. "Fixed" prices admired in the program (and experienced by many here as well) result only in shortages in services or quality, or both. There is no free lunch, unless we want to continue to borrow from China for our health care costs and then burden our children with paying for it, plus interest.

Fourth, bankruptcy is a recurring theme in this Frontline episode. Yet, bankruptcy represents a method to pass the true costs of unpaid care back to the system. How is this different from coerced taxation and lowered standards of living for everybody?

Fifth, what is the moral calculus for valuing the life of a 70 year old less than that of one who is 65? Hasn't the 70 year old "paid in" longer in the first place? Does Frontline endorse this calculation by Germany, Japan, and elsewhere as part of the rationing of services through statistical calculations of one's value? Is a 40 year old female breast cancer patient worth more than a heart bypass for a 45 year old male? Should bureaucrats decide this?

Finally, some would disagree that longevity statistics or cost are definitive measures of success. Why not ban smoking and alcohol, which would lengthen life expectancy in the US? Should we ban motorcycles? Doritos? Bungee jumping? Free societies mean a freedom to live life according to one's own priorities. Not everyone wants to live to 120, a bias that must be removed from any analysis of outcomes.

When is the rebuttal going to be aired to this version of Sicko for the elites?

Boston, MA

Dear FRONTLINE,

It is clear that our current health care system is not serving our citizens very well - unless they hapen to have a decent supply of money. Change will be difficult but we need to take care of our own with no exceptions. The issue of malpractice insurance is not as straightforward and those who complain about it would have you believe. In 2001 and 2002 I lived in AZ and recall a report on NPR regarding the loss of obstetricians from neighboring Nevada. The cause was extremely high malpractice insurance. The insurance companies blamed the high cost of lawsuits but investigative reporting found that the actual cost of lawsuits was relatively small. The real reason the insurance companies were hurting was that they lost big time in their stock and real estate investments. A few years later I heard a similar tale from Colorado. Sadly, our country is overburdened with a lot of phony, self-serving assertions all the way from main street to the highest levels of government.

T Larson
Helena, MT

Dear FRONTLINE,

I was born in the UK, emigrated to Australia, and now (having married a US citizen) live in the USA.

I do not know what changes have taken place in Australia since I left, but an Australian businessman to whom I spoke a couple of years ago was horrified at the amount we are paying for health insurance. In Australia it is no more than 2.5% of taxable income, so those without income are covered automatically. It's a mixed system, with the government-run plan covering basic health care and many private insurance companies offering upgrades (everybody has to choose one of these). The 2.5% levy covers both the basic and the upgrade.

It's even longer since I lived in UK, so I don't know all the details of how it works currently, but we experienced the system ourselves while visiting with a young child, and we saw how it worked for my parents in the final years of their lives. Our infant son developed a high fever one Sunday, and the on-call GP came to the house on Sunday evening -- no charge. The normal prescription charge was waived because the patient was less than 12 months old. (And way back it used to be that even over-the-counter medication was covered by the NHS. I don't know whether that is still the case, and the prescription charge is much higher these days anyway.)

My parents lived in their own home to the very end. Doctors and nurses made house calls. The normal prescription charges were waived because of their age. The ambulance service transported them to hospital when necessary -- no charge. (They also got an allowance to pay a part-time home help, with no account being taken of their income or assets.)

It's true that the tax rate is higher in UK and Australia than in the USA, but if you add up taxes and health insurance premiums in the USA, I think the Brits and Aussies get a better deal.

Zeeland, Michigan

Dear FRONTLINE,

Changing our healthcare system will by no means be easy when there are so many private for-profit interests involved, everyone from pharmaceutical companies, medical device makers, medical supply companies, insurance companies, hospitals, health care providers, lawyers, etc.

Reform will be stifled as long as each of these concerns have as their first priority "how much money can I make" versus "how can we make sure no one is denied health care".

Neither are consumers innocent. When insurance premiums were more affordable, it was easy to be unconcerned about how much health care was costing and not to question unnecessary procedures.

We all need to play a part in fixing our system. I volunteered as a physician in a free neighborhood clinic here after Katrina; several things became crystal clear: 1) more than 80% of the patients needed only low-tech primary care 2) they needed ACCESS to nearby, convenient, low-cost facilities 3) most of them were coming in for problems related to diabetes and hypertension, conditions and cases that were very preventible. Many of these patients merely been heavily medicated over the long-term instead of being encouraged to reduce their own symptoms and need for medication

We can all do things to stay more healthy and reduce our need for expensive care and we all better be ready to pay higher taxes for a fairer medical system where everyone gets care. Or stay with our current black hole of a system and be ready to go bankrupt paying medical bills.

Dr. Lexa Lee
New Orleans, LA

Dear FRONTLINE,

While I found this program interesting and instructive, I found the interviews with healthcare experts on the FRONTLINE website even more valuable. Our ability to improve healthcare in the U.S. largely depends on two cultural factors which are difficult to change: social consensus and political will. In a mature democracy like ours, it is hard to say which of these is the horse and which the cart. As we have learned ( too often the hard way ) as a consequence of our ballot initiative process in California, the electorate is in favor of many progressive ideas, but unwilling to pay for them. Until we truly reach the conclusion that universal access to affordable healthcare is something that we as a society insist on and are willing to pay the price for, it will be nearly impossible to move forward. No current political leadership exists that is willing to enact meaningful healthcare reform that runs counter to public sentiment. And public sentiment on this has typically been expressed as "Yes, everyone should have access to healthcare, but, no, I'm not willing to pay for anyone else's." I think that the clarification of terms that Uwe Reinhardt urges in his FRONTLINE interview must be understood by a broader audience. The distinction between a system of socialized insurance as opposed to socialized medicine is a critical one. Letting the government regulate coverage and payment, but not "own" the providers, might be the approach that can work. However, the first step is for the government to realize that providers cannot be reimbursed less than their actual costs of delivering care if the system is to be sustainable. In this respect, Medicare and Medicaid are glaring examples of how not to do things.

Gerald Arcuri
Thousand Oaks, California

Dear FRONTLINE,

Thank you for this show. As an Certified Elder Law Attorney, I found it interesting that nothing was mentioned regarding the provision and payment for long term care in any of the countries. Another show comparing countries on that topic would be appreciated as well.

Leslie Wizelman
Towanda, PA

Dear FRONTLINE,

I am a Briton who has lived in the US for two years. We are very fortunate in that we have excellent health insurance at a cost that is much less than our UK tax. We have received excellent care here and it has made me question the NHS. For a start, not all hospitals are as nice as the one shown--the show picked one of the best and it's far from the average. Your program showed preventive care brochures in a GP office and then stated that prevention is practiced? Not correct.

For example, I am 42 and never once had a full check-up in the UK. It's not done-not for sports, for university, pregnancy, etc. A nurse does a pap smear every 1-5 years but there is never a doctor check--even when pregnant (that is handled by midwives). When I had my children I was monitored by a midwife--no doctor--and I was on a ward with a dozen women. I also never had a blood test or any health check-until I moved here. Turns out I have a thyroid condition for which I now receive treatment. The asthma my son suffered with is no also gone--because the NHS baseline treatment did not work for him. Yes, the NHS has one prescribed care treatment for each ailment--the cheapest option is the only approved option.

My best friend waited over a year for gallballder surgery and had to quit work as she was too sick to continue. She and her husband finally paid to have the surgery at a private hospital and the $60K in bills have forced them to sell their home. All to keep her from suffering. Yes, sadly this happens in the US, too, but in the UK the system she pays into is supposed to help her.

The Frontline program, like so many others, is the type of expose that we need in order to see change in the US. I don't recall hearing one key item mentioned: it is only in the US and New Zealand that allows pharma companies to advertise. How do we stop that?

The US system definitely needs help, but please show more of the truth about the rest of the world when trying to help with change.

Jennifer Andreson
Philadelphia, PA

Dear FRONTLINE,

I am a naturalized citizen, originally from Western Europe, and have lived in the US legally for 18 years. I love it here. I am 35. The only 2 reasons why I ever think of moving back to Europe are the questions: "What will happen to me if I get really sick?" and "What will happen to me when I get old?" Although still young, that worries me a lot. Thanks for the program. And I will still take advantage of universal coverage while visiting my family overseas.

Chicago, IL

Dear FRONTLINE,

While I support universal healthcare (the stated goal of the producers of this program), I fear that this program added little to the current debate regarding how to provide universal healthcare in the US. While excessive administrative costs and relatively high doctor compensation are important differences between the US healthcare system and the healthcare systems in most other developed nations, there are at least three other major differences that are equally, if not more, important that the program failed to sufficiently address: first, our excessive use of expensive technology; second, providing expensive end-of-life care devoid of any cost-benefit analysis; and third, the high costs of our malpractice system (which results in both high malpractice insurance costs and redundant and unnecessary treatment). No serious discussion of the US healthcare system, and its differences with other systems in the developed world, can occur without meneangful consideration of these matters.

Corey Brown
Houston, Texas

Dear FRONTLINE,

One of the topics I blog about, as a former insurance executive, is health care. The difference between Taiwan's cost of overhead versus American's (2% and 22% respectively) is driven by the population's willingness to forego a great deal of privacy.

The business side of me took this favorably while the personal side of me responded in fear because I don't want Big Brother knowing about my every ailment and treatment. After all this information could be used against me in applying for a job or even to blackmail me if a hacker gains access to this marvelous, centralized goldmine of data.

After a few hard swallows and a night's sleep I've come to see it in a more favorable light. While you could say the business side of me won out (cutting 20% is attractive), actually my acceptance is more a matter of philosophy than the result of number crunching.

One of the reasons none of us wants our TRUE medical history known is that we are subjected to a system wherein insurers can deny us coverage based on our health. In the Taiwanese system (as indeed with all five of the systems covered in the program) there is no medical underwriting, therefore no denial of coverage.

The second reason I'm prepared to participate in such a program has to do with entering into a larger social contract. Look, NONE of us has perfect health, none of us descended from perfectly health people and our environment makes it difficult to maintain mental, physical and spiritual health. Participating in a universal program is sort of like entering the locker room in Junior High. I worried a bit about it that summer between six and seventh grades, but when I finally entered it, I saw that even the most popular, lively, shapely and otherwise other-worldly girls had pimples on their backs and mismatched undergarments - just like mine.

The more we share the less we have to fear and the better prepared our health care system will be to deal with the TRUE depth and breadth of health issues in the population.http://tamelarich.com/2008/04/16/sick-around-the-world-part-1-big-brother-watching/

Tamela Rich
Charlotte , NC