In researching his new book, what did T.R. Reid find among countries that provide universal coverage? “In the first place, it’s not all socialized medicine,” he said, noting that many systems have private physicians, private hospitals and private health care plans. “And it doesn’t have to be single payer,” he said, citing, among others, Japan, which has 3,000 payers but manages to cover all its citizens while spending a lot less on health care than we do.
All the countries Reid visited face the same daunting issues as the U.S., including an aging population and tremendously promising but expensive advances in technology.
He cited four models of health care worldwide, ranging from true socialized medicine in Great Britain to the Bismarck model in Germany, which he says is even less socialized than the American health care system. Germans are required to carry private insurance; the insurance companies, in turn, are required to cover everybody and to pay for all care deemed appropriate by physicians. In France, which uses the Bismarck model, insurers must pay every claim within three days—a concept that awed the MGMA crowd.
Canada uses a third system—what Reid calls the national health insurance model, in which doctors and hospitals are private but the payment system is public. He said critics are correct when they point to lengthy waits to get treated for non-acute issues in Canada, which purposely limits the number of specialists and certain medical procedures, such as MRIs, to control costs. But Taiwan, which uses the Canadian model, has shorter wait times than the United States for most medical care.
The fourth model Reid cited is the “out-of-pocket” system, common in the Third World: If you don’t have money, you don’t get care. “It’s a brutal, simple fact of life in most countries,” he said.
The U.S. employs all four models, Reid said: Native Americans and veterans are covered under a socialized system similar to Britons; working people with employer plans are in a German-like insurance system; Americans over 65 use the Canadian system, with private providers paid with public funds; and the 47 million uninsured are in an out-of-pocket system.
“All other countries have settled on one model for everybody,” Reid said, which is “vastly cheaper. You have one set of rules and, in some countries, one set of prices. The savings are huge.”
He called the American private insurance system “the most expensive, least efficient” system in the world, asserting that administrative costs can add up to 30 percent to
a health care bill. In the countries that provide universal coverage, administrative expenses are no more than 5 percent of health care costs. “The Government Accountability Office found that if we could get down to France’s administrative costs, we could pay for all the uninsured in the U.S.,” he said.
Because other countries cover citizens from cradle to grave, Reid said they are much more incentivized to provide preventive medicine. Americans with employer insurance average just five years with the same plan, and those with private coverage average 18 months with the same plan. No wonder insurers aren’t motivated to help foot the bill for preventive care that would only pay off over a long term.
Reid said he began to research his book with a very objective question in mind: how do other countries cover all their residents while spending so much less on health care than the U.S.? But ultimately, a more subjective question came to the fore: Why do they do it? And, more to the point, why has the United States so far refused to do it?
In every other country, guaranteeing health care for everyone is a moral issue, Reid said. It’s no less a moral issue here, he claimed. “If you never sit down and decide you want everybody to get health care, maybe you get a system in which rich people get the best care in the world and tens of millions of people are left out.”
On the other hand, he says, “if the United States could find the political will to provide health care for everybody, the other rich countries of the world could show us the way.”
Reid’s book is The Healing of America: A Global Quest for Better, Cheaper and Fairer Health Care.
Bill Santamour is H&HN's managing editor blogging live from MGMA 2009 conference.
