Laurel to T.R. Reid

For extraordinary clarity in explaining foreign health systems

As I have posted many times on Campaign Desk, the media, for the most part, has hardly touched how health care works in the rest of the developed world. Special interests, instead, have filled in the blanks with shrill and false advertising about socialized medicine and rationing. The public discussion has become so polarized and virulently nasty that it’s nearly impossible for any lessons from abroad to gain traction.

In last Sunday’s Washington Post, T.R. Reid, a former Post reporter and would-have-been host of Frontline’s “Sick Around America” last March, busts five myths about foreign health care, in an article based on reporting for his new book, The Healing of America: a Global Quest for Better, Cheaper, and Fairer Health Care. What’s remarkable about this piece is not that he challenges commonly held beliefs about how bad things are in England or Germany (other groups have tried to do that), but that he does it with clarity, simplicity, and honesty—three attributes that have been missing from much of this year’s health care reportage.

Myth one: It’s all socialized medicine out there. No, says Reid. Some countries, like Britain and Cuba, provide health care in government hospitals with the government paying the bills. But in other countries, like Canada, private-sector providers give the care that is paid for under their national health systems. “In some ways, health care is less socialized overseas than in the United States,” he writes.

Myth two: Overseas care is rationed through limited choices or long lines. Generally not, Reid points out. In most places, patients can go to any doctor or have choices of providers. There are no limits like we have in the U.S.—no lists of in-network doctors and pre-authorization forms. In Canada, he acknowledges, some people wait for non-emergency care, but Britain, Germany, and Austria outperform the U.S. when it comes to waiting times for appointments and elective surgeries. Waiting times are so short in Japan, most people don’t bother making appointments. I know from my own reporting in Japan that people simply walk into any hospital, and pronto, they are seen.

Myth three: Foreign-health care systems are inefficient, bloated bureaucracies. All other payment systems are more efficient than ours, Reid writes. U.S. health insurers have the highest administrative costs in the world, spending about twenty cents of every dollar for paperwork, marketing, and claims review. Japan controls costs better than any other country, even though its population uses more services than Americans use. Quality is high, and life expectancy and recovery rates for major illnesses are better than in the U.S.

Myth four: Cost controls stifle innovation. That assertion is just plain false, Reid says. While groundbreaking research comes from the U.S., it also comes from other countries with much lower cost structures—like France, where hip and knee replacements were invented, or Canada, where the breakthrough in deep-brain stimulation to treat depression was made.

Myth five: Health insurance has to be cruel. In America, insurance companies routinely reject applicants with preexisting medical conditions, and rescind policies of those who accumulate big medical bills. That doesn’t happen in other countries, where all the national insurance schemes must accept everyone and pay all the bills that citizens present. Reid observes that the key difference between the U.S. and other systems is that foreign health plans exist only to pay medical bills; they aren’t in business to make a profit.

The most persistent myth of all, says Reid, is that “America has the finest health care in the world. We don’t.” When you compare results, most other industrialized countries have much better statistics. For awhile at the beginning of the presidential campaign, advocacy groups and politicians talked about the under-performing U.S. health care system. But that was before Celinda Lake advised Democrats not to mention statistics like how America ranks thirty-seventh in the world in health outcomes. When spokespeople and politicans stopped talking about America’s bad showing, so did the media.

Reid reminds us why we need to keep reminding audiences how and why America falls short, and he offers a fine template for reporters needing help breaking down health bill complexities, misinformation, and the half-truths that will keep floating around. We urge readers of Campaign Desk who are not journalism professionals to see what Reid has to say. Apparently Post readers are already doing that: Post ombudsman Andy Alexander told me that Reid’s story was the most widely viewed story on the paper’s Web site Sunday and Monday.

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Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR's healthcare desk, which is part of our United States Project on the coverage of politics and policy. She also blogs for Health News Review. Follow her on Twitter @Trudy_Lieberman.