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.
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I admire TR Reid's dedication to task... IE de-bunking the mythology surrounding opposition to national health insurance in America. I would enjoy sitting down with him and explaining... answering the question why we in America are so opposoed to Medical care for all our citizens. I know...it took me a lifetime of inquiry, but I got it! And I am a "no-body" in his elite world.. I wish I could be in it for a day.
#1 Posted by rev mike, CJR on Fri 28 Aug 2009 at 09:25 PM
The Post also chose to place his piece in the "Opinion" section. Reid laid out clear facts on an issue that is important to the Post readers & they placed it not on the front page or the "News" section, but in the "Opinion" section. In the Post fact checking is opinion based..
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#3 Posted by E. Placeres, CJR on Sun 30 Aug 2009 at 12:54 AM
See this excellent YouTube video by Canadians on how well their system actually works! http://bit.ly/czjdy
#4 Posted by Paul, CJR on Sun 30 Aug 2009 at 07:20 AM
I agree wholeheartedly with Reid's myth-busting, but I do have a question: To what degree does litigation (e.g., frivolous lawsuits) play a role (or not) in other countries' health care costs? I'm no Republican, but it seems to me that tort reform does have to play a role in any holistic overhauling of our current system. If litigation contributes significantly to rising health care costs in this country but is not an issue in others, then apple-to-apple comparisons really can't be made.
It doesn't change the facts of Reid's arguments, but it seems to be an issue that the media hasn't done a very evenhanded job of covering. We tend to get polarized views of the issue, and that's not helpful.
#5 Posted by Dan Hutson, CJR on Mon 31 Aug 2009 at 08:14 PM
Friends and relatives in Canada and Britain who are in the health care business (or customers of it) have confirmed the following things to me about their respective systems: a.) health care is not "free" through government programs but instead are paid for by healthy taxation on the individual, b.) health care is essentially "rationed" or even denied in particular for non-emergency "elective" treatments with long waiting periods due to limited funding where remote government bureaucrat committees decide where care for certain ailments are decided not based on medical needs of the patient but on where to dole out the limited budget funds, and c.) such government bureaucracy often gets in the way of the doctor-patient relationship in deciding what is the best medical care for that patient, resulting in denied care (even for critical things like a liver transplant because the government decided the patient was a "chronic abuser of drugs") or physicians going into private practice so they can decide what is best for their patients or those patients simply leaving their country to obtain the needed care in foreign countries (like the U.S.). I listened to a serious, matter-of-fact shortwave radio discussion recently from the ABC (Australia) about starting to limit/ration or even deny medical care in the government public health care system there because of rising costs and the need to stretch limited government budgets that were not keeping up with actual costs. So these are certainly not models for the U.S. which undoubtedly needs some level of reform in health care.
#6 Posted by JHicks, CJR on Mon 31 Aug 2009 at 10:33 PM
I have been in the Canadian health care system for almost 25 years after moving up here from the US. I find it a far better system than the one I left behind.
I also have close connections to people working in health care on both sides of the border and the issue of rationing that JHicks mentions is as much or more so a factor of private systems as it is of the public ones. Private insurance providers will do anything to avoid providing a service.
As for bureaucracy I haven't seen much of it and it is probably no more than in the private system. Granted, in the private system those with money to burn can get almost as much of anything almost anytime that they want, but that is not most of us and we should not build a system that caters to those kind of people.
#7 Posted by JWest, CJR on Mon 31 Aug 2009 at 11:11 PM
RESPONSE TO JHICKS
Friends and relatives in THE US who are in the health care business (or customers of it) have confirmed the following things to me about the US system: a.) health care is not "free" through EMPLOYER-BASED INSURANCE but instead is paid for by healthy OVERPRICED PREMIUMS on the individual, b.) health care is essentially "rationed" or even denied in particular for non-emergency "elective" treatments (AND IN SOME EMERGENCY CASES AS WELL) with long waiting periods due to limited funding where remote INSURANCE CO. bureaucrat committees decide where care for certain ailments are decided not based on medical needs of the patient but on PROFITABILITY FOR INSURANCE COMPANIES and c.) such INSURANCE COMPANY bureaucracy often gets in the way of the doctor-patient relationship in deciding what is the best medical care for that patient, resulting in denied care. AND THIS DOESN'T EVEN ADDRESS THE 40 MILLION AMERICANS WHO HAD NO HEALTH INSURANCE, NOT EVEN THE CRAPPY HEALTH INSURANCE THAT MOST AMERICANS HAVE TO DEAL WITH. So THIS PRIVATE INSURER-BASED SYSTEM, DRIVEN ONLY BY PROFIT MOTIVE, IS CERTAINLY NOT THE MODEL for the U.S. which undoubtedly needs REAL reform in health care.
#8 Posted by mtc, CJR on Tue 1 Sep 2009 at 01:37 AM
The fact that deeply ideological and Europhile urban Americans of the chattering classes - such as Trudy Lieberman, and T. R. Reid (whose journalism consists basically of arguing that foreign tax rates, regulatory processes, and social policies are preferable to and easily transferrable to the culture of the United States, but the opposite is impossible) refuse to acknowledge any trade-offs or down-side to the adoption of a more politically-controlled health care system should alert readers.
I notice Lieberman/Reid do not note the by-products of the Japanese and European models - the demographic nightmare that inflexible entitlement policies guarantee to these aging and risk-averse populations, the dependence on U.S. research and development by these medical systems, the wider issue of the unmistakable stagnation of the Japanese and western European economies over the past generation as resources are poured into present consumption vs. future investment. I know the picture postcards represent real places overseas, but they are not the whole story.
Sometimes these issues turn on cultural differences and expectations of consumers. I'd have more respect for the MSM if it could acknowledge that there are reasons that demanding U.S. consumers might look askance at Canadian or Japanese or western European health care practices. But the advocates of a more left-wing, anti-private approach refuse to acknowledge any possible problems, any at all, even though we have a single-payer system called Medicare that is not a great model right here in the U.S., and even though Massachusetts' universal plan has rehearsed difficulties that a national program would face. And a certain amount of dishonesty has crept into the advocacy of mandatory universal health insurance administered at the federal level; as a small example, Obama's journalistic lobby has backed him up in asserting that services would not be provided to illegal immigrants, without mentioning that the Democrats have struck out verification protocols, rendering the prohibition useless. I'm very skeptical of moralistic approaches to public issues - once one has convinced oneself that one is on the side of the angels, it seems as though a measure of dishonesty (by omission, as above) is acceptable.
#9 Posted by Mark Richard, CJR on Tue 1 Sep 2009 at 12:26 PM
RESPONSE TO DAN HUTSON
Medical malpractice lawsuits both awards and insurance costs, are at the LOWEST levels in recorded history. far less than 1% of medical spending. Even as medical mistakes are way up.
Public Citizen has a report that shows how extremely this false bogeyman on cost has been exaggerated to justify the obscene prices Americans are forced to pay. If anything, we need more people to sue and more people to win.
But its hard to sue when you're dead. It turns out many people's lives aren't worth much, anyway. (Unless you make a lot of money, you are worth more as body parts)
http://www.citizen.org/pressroom/release.cfm?ID=2920
#10 Posted by Brian Katrin, CJR on Wed 2 Sep 2009 at 09:53 AM
Instead of trying to "fix" everything at once, why don't we prioritize the problems with our current health care system and move to make the changes one step at a time?
The idea of trying to swallow the whole elephant in one bite is deflecting the focus because it is so difficult to understand all the issues and their impact.
The argument that something is better than nothing can be more effectively made if reform can be prioritized and implemented step by step.
#11 Posted by Fredric J Bell, CJR on Fri 4 Sep 2009 at 09:02 AM
Asa retired pediatrician, I coldn't agree more with Reid's analysis. He mentions, but does not (to me) sufficiently emphasize, that not only is their a health insurance employee for every physician in the US, but every physician must employ anothe person to interact with that employee of a health insurance company.
Aat one point he repeats the error shared by many authrs, that when life expectancy at birth is 35 or forty years, "average" people die at that age.. Not so.
Half the people die in infancy or early childhood, and helf live to the biblical life expectancy of 70 ("four score years and ten").
#12 Posted by Fred North, CJR on Fri 4 Sep 2009 at 06:11 PM
Sorry to burst your bubble there, Reid, but you're actually talking about disease care and disease insurance. Health care and health insurance doesn't exist yet. The western medical paradigm defines health as the absence of disease. This means there is no "health" without disease and guarantees the presence of disease. Diagnosis in western medicine is merely the labeling of symptoms, and then a feverish attempt is made to eradicate the symptoms without every treating the actual cause of the symptoms. That's called "curing", and it is an event. Healing is a process; something that western medical practitioners no nothing about. It takes a completely different paradigm to understand healing.
I realized early on in my private practice that the business of "health care" was actually the business of disease care. I was searching for the codes to bill a patient's insurance company for acupuncture received. There were no codes for maintaining health. If I didn't treat for a specific symptom, the patient would receive no benefits from the insurance company. Think about this. If you purchased insurance for your car, you pick a policy that covers theft, collision, etc. which pays out when there is theft, or collision. Same with a house. You buy fire, flood or earthquake insurance that pays when there's fire, flood or earthquake. But when you buy "health" insurance, it only pays out when you have "disease". Logically, is should be paying for your health and the maintenance of health. But when "health" is defined as the absence of disease, the insurance is for the disease. If health were defined as harmonization and balance, the western medical paradigm would come crashing down because of the lack of need for it. Don't call it "health care"!
#13 Posted by tribeseeker, CJR on Sun 6 Sep 2009 at 10:24 AM
I recommend that your readers go beyond Reid's summary, to his book, which is illuminating and a real joy to read.
In Chapter 12, on page 212, Professor William Hsiao, a Harvard health economist who helped to design Taiwan's health care system is interviewed: "Before you can set up a health care system for any country, you have to know that country's basic ethical values. The first question is: Do people in your country have a right to health care? If the people believe that health care is a basic right, you design a system that means anybody who is sick can see a doctor. If a society considers medical care to be an economic commodity, then you set up a system that distributes health care based on the ability to pay. And then the poor are pretty much left out. Your ethics, your sense of justice, determines how you distribute goods and services, including health care."
"So the first question has to deal with a country's ethical values."
And the majority of Americans, unlike the majority in those socialist countries of Europe, are church goers who strive to lead a life base on Judeo-Christian values, but ignore the First Question.
#14 Posted by Laurence Lewin, M.D., CJR on Wed 18 Nov 2009 at 12:23 AM