From the Sept. 4 edition of Street Roots
Anger and taunting in the public forum. Accusations of fascism. Rumors of proposed government death panels — rumors that opponents of reform did virtually nothing to quell. Gun-toting men waiting for their congressional representatives in the parking lot. The discussion, if it can be dignified with that word, over the state of the nation’s health care system is scuttling along the slimy sea floor of American politics.
Which is why it’s an ideal time for some actual information. What is it costing us to look after our nation’s sick? Who pays — literally and figuratively — for the threadbare patchwork of American health insurance coverage, a system that drop-kicks 700,000 people each year into bankruptcy because they can’t pay their medical bills? That, because they couldn’t see a doctor, puts 20,000 more in the grave? Are we really faced with a choice between things as they are and that conservative bogey, “socialized medicine”?
For such apt questions, T.R. Reid’s book couldn’t hit the shelves at a better time. “The Healing of America: A Global Quest for Better, Cheaper and Fairer Health Care” (Penguin Press) is a look at how wealthy democracies like ours — like France, Japan, Germany and the U.K. — provide health care, and the choices they faced as they constructed systems that are each unique but that all do a better job of keeping their citizens healthy, and they do it for less.
What do those countries have that we don’t? Each has decided that it has a basic duty to look after the health of its citizens.
Reid’s book would be just an exercise in comparative policy studies but for having busted his shoulder while in the U.S. Navy. A military surgeon had bolted the joint back together, but that was way back in 1972. “By the first decade of the 21st century,” writes Reid, “I could no longer swing a golf club. I could barely reach up to replace a lightbulb overhead or get the wine glasses from the top shelf.”
And so, “hoping for surcease from sorrow,” Reid takes his shoulder on the road. The result is a readable, informative, clearheaded look at health care elsewhere in the industrialized world, accompanied by the persistent questioning: Why not us?
Adam Hyla: When did you begin this book?
T.R. Reid: I’d like to say that in the spring of 2006 I knew that in the fall of 2009 our country would be obsessed with health care, but I really can’t say we planned it that way — we really lucked out. The timing worked out fine. I actually delivered the book a year late, and my editor was mad at me for being so late, but now I tell her I planned it like this. (laughter)
A.H.: Eighty-five percent of Americans tell pollsters that health care is a basic human right, yet so far in this national debate, that doesn’t seem to be very well-reflected.
T.R.R.: Yeah, every time we take on this issue the basic moral question gets lost in a discussion of winners and losers, hospital company profits and insurance company earnings. That’s always happened in our country. Every single country I visited made the basic moral commitment that every single person in our rich country who needs access to health care should have access to it. The richest country in the world has not made that guarantee.
I came off my ’round-the-world tour pretty optimistic; I think if we do make that commitment we can provide it for all, because all these other countries have.
A.H.: Why haven’t we made that commitment? Why are we so down in the weeds?
T.R.R.: I don’t know. I really struggle with that. With my book, I had three main tasks: to explain how other countries cover everybody at reasonable costs, and I think I got that; the other was to explain why other countries cover everybody, and I think I got that. That raises the question, why hasn’t the world’s richest country made this commitment?
I think my final assessment is that most people don’t know. Most people don’t know that 20,000 Americans die every year because they can’t see a doctor. They don’t know that an appallingly large number of people (around 700,000) lose everything they have because they get sick or get hit by a car. If they did, they wouldn’t stand for it; they don’t want to live in that kind of society.
Do you know how many people in Britain go bankrupt because of medical bills? Zero. France? Zero. Canada? Zero. Japan? Zero. No other country lets that happen.
A.H.: You write that the French system expresses this fundamental French notion of “solidarité.” What does our system say about us?
T.R.R.: Our system is designed to make sure that successful business people, entrepreneurs, those who create jobs and prosperity; that they stay healthy. If the primary goal of your society is good jobs and economic growth, you reward people who create those jobs. That’s fine — let rich people get good health care. The problem with it is that tens of millions of Americans don’t even get in the door.
I talk a good deal in my book about the long lines in Canada, where if you have an acute illness they treat you, but if you can wait, you wait. I complained to this economist in Canada about people waiting for months, and he replied, “We don’t mind waiting so much so long as the rich Canadian and the poor Canadian have to wait about the same amount of time.” Whereas in America, we take it for granted that rich people are going to get better care than poor people.
A.H.: Are we rewarding prosperity by making sure that insurers make a profit?
T.R.R.: Yes. We were taught in school that the competitive, for-profit system is the best way to achieve anything — that there are built-in efficiencies. This doesn’t seem to be true in health care because the American for-profit free-enterprise mechanism is the most wasteful in the world; there’s no question about that. Our for-profit companies’ administrative costs are about 20 percent; in France, administrative costs are about 4 percent. Japan has about 3,000 insurance companies and their administrative costs are 5 percent. All the other countries with private plans but that are non-profit are vastly more efficient than for-profit free-enterprise American plans.
A.H.: Is there a single reason why all these countries have lower costs?
T.R.R.: Yeah. In all these other countries, everybody is in one system. It doesn’t mean single-payer: Japan has thousands, Germany has 200. But there is one set of rules, one set of forms, and basically one set of prices. Everybody basically gets the same care at the same price. In the U.S. we have one system for veterans, one for Native Americans, one for people over 65, one for members of Congress. We have one for children under 16 at 140 percent of the poverty level, and one for children under 16 at 150 percent of the poverty level. We just have health care systems overlapping on other, competing health care systems, each with their own plan.
I went to this giant hospital in Canada: 900 beds. I asked to see the billing office. The billing office was two part-timers. A billing office in the U.S. for a hospital of that size is going to have 70 full-timers, maybe 100.
A.H.: What about overpaid doctors?
T.R.R.: We certainly pay doctors, hospitals and drug companies more than anywhere else in the world by a huge margin. The same pill made in the same factory costs $1.20 a pill in American and 20 cents in Britain. We pay vastly more than anyone else, and as we’ve seen this summer in Washington D.C., if you say, “Wait a minute, let’s cut the payment,” it gets very complicated.
A.H.: What have been some of the greatest mistruths you’ve heard in the health care debate?
T.R.R.: Well, first, the argument that it’s all socialized medicine overseas. A lot of rich democracies offer everybody high-quality care with private hospitals, private insurance and private doctors.
In some ways, a lot of countries are less socialized than the U.S. Here, everyone goes onto government Medicare when they turn 65. In Germany, Switzerland, Belgium, the Netherlands, a lot of people stay on private insurance from cradle to grave. The claim that it’s all big government nanny state: No, that’s not true.
And the idea that these other countries shove Granny off a cliff: We know that’s wrong. In all the other rich countries a person turning 60 has a longer life expectancy than an American of the same age. People live longer and healthier in other countries.
But the biggest mistruth is that other countries ration medical care. The fact is, the U.S. rations medical care every single day.
When insurance companies deny a claim, saying we won’t cover that, that’s rationing care. When they say we won’t buy that drug for you, you’ve got to buy the cheap drug, that’s rationing care. When some people get the greatest care in the world with no waiting, and others, tens of millions, don’t even get in the door: That’s rationing.
The argument that we don’t want reform because we don’t want to ration care is just nuts. We’re already doing it, and in the cruelest possible way.
A.H.: Yet as long as some people are covered well, we’ve been kind of OK with it.
T.R.R.: Yeah, that bugs me in this debate, the idea that “Hey, I’ve got my insurance, just leave me alone.” That seems un-American to me. When politicians tell you not to worry, if you’re happy with your current coverage you’ll be fine, that’s not the right appeal.
A.H.: How much does a nation’s health care system factor in the actual health of its populace?
T.R.R.: I think lifestyle and diet play a role. Japan has the healthiest population in the world: they live the longest and live longest without getting the chronic diseases of aging. Their diet is better, and hardly anyone drives to work: they walk or ride their bikes down to public transit. It’s very hard to park a car in any Japanese city. Another factor noted by Japanese economists is that nobody’s getting mugged or shot there.
But if you make quality medical care available to everybody, you get a healthier population. A major reason why we have a lower life expectancy, a lower rate of recovery from major diseases, is we leave millions of people out of the system. It’s not that we have bad care, it’s that we don’t give everybody access to it.
For me, the worst and cruelest statistic I came upon in this book is infant mortality, the percentage of children who die in the first year of life. Of the 23 richest countries, America is 23rd; we’re the worst. In Sweden and Japan, they have one-third the rate of neo-natal death that we do.
That’s really tragic; to me, a rich country if nothing else has an obligation to keep its babies alive. That’s — to me that’s morally unacceptable.
A.H.: Often, we spend just as much, if not more money, catching problems later on.
T.R.R.: Yeah, in the NICU, the newborn intensive care unit. We do these $600,000 operations on 2-month-old babies and save a lot of them, but we wouldn’t have to do that if we took better care of them leading up to birth.
All these other countries, as soon as you get pregnant they send nurses to the house, they tell you what to eat, they really carefully monitor that pregnancy because they want to keep the baby alive. In the United States every day, every day, women come to the emergency room in the ninth month of pregnancy, ready to give birth, and no doctor has seen them. It happens all over.
A.H.: What’s the case for a new president reforming health care first as opposed to, say, education?
T.R.R.: Two reasons. As President Obama says, it’s a moral obligation to make sure that everybody who needs health care has access to a doctor. As you noted, most Americans agree with that.
And the other reason is the cost. The government pays about 46 percent of the cost of health care in America; we’re paying vastly more than any other country. Obama says we’re going to reduce the cost of government over time by fixing health care and he’s right. We’re pouring hundreds of billions of dollars down the drain every year. If Canadian bureaucrats can run their system on 5 percent adminitrative costs, but Wellpoint and Aetna have to spend 20 percent — we’ve let them get away with it because we don’t lke regulating private companies, but the fact is we’re just wasting hundreds of billions every year on unnecessary administrative costs.
For me, though, the moral argument is enough. In the richest country in the world, children go to bed at night with an asthma attack or an earache or a toothache because their parents can’t afford to take them to the doctor. I don’t think we want to be that society. If we were Ecuador or Madagascar, we wouldn’t have the money to pay for everyone, but we do. Every other rich country has.
BY ADAM HYLA, Real Change
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