Grand Rapids Institute for Information Democracy

T. R. Reid, author of the book The Healing of America: A Global Quest for Better, Cheaper, and Fairer Healthcare opened the 23^rd annual Calvin College January Series Wednesday, Jan. 6 with a recap of his ten-country tour of healthcare systems, all which do a better job of caring for their citizens than the United States.

Reid opened with the question, “How is it that Americans pay so much more but get so much less than people of other industrialized nations?”

He surmised that current bills before congress render the idea that of universal access to affordable healthcare a hopeless goal, even though other countries recognized as “free market democracies” provide health coverage for all while spending half as much money in the process.  “I went around the world to figure out how they do it . . .  It’s not a secret. You can go there and ask them.”

Reid found that the answer wasn’t always socialized medicine. Many countries successfully providing universal healthcare have private doctors, private hospitals and private insurance companies. Single-payer systems weren’t the common denominator either. Germany has 220 payers, Switzerland 70 and Japan, 3,000.

Reid went on to classify the different healthcare systems he saw at work into four models.

1. The Beveridge model. At his government’s request, twentieth century British social reformer, William Beveridge, put this model into practice near end of World War II. A national health service takes care of people’s health in the same way that their firemen put out fires or libraries lend out books. National health service taking care of peoples’ health is the government’s  job.  Healthcare is free, paid for by taxes. The government owns the hospitals, employs the doctors, and runs the medical labs. “97% of people in Britain never have a doctor or hospital bill. Government provides the care, pays for the care,” Reid said. “It’s socialized medicine–we know it’s bad bit we don’t know what it means.”

Spain, Italy, New Zealand, Cuba and Scandinavian countries successfully follow this model.

2. The Bismarck model. When the first chancellor of Germany wanted to woo the people of the countries assimilated into the new Deutschland in the late nineteenth century, he invented the old age pension (1871), workman’s compensation (1873) and the first national healthcare system (1883). Providers and payers are private, but government pays the bill. “You can have universal coverage in a private system,” Reid said. “Switzerland, France, the Netherlands, Japan and 150 million Americans have this kind of healthcare coverage.”

3. The national health insurance model. Used in Canada since 1944, this model has private providers paid by government insurance. People pay their premiums through tax withholding.  Taiwan, South Korea, Australia, Mexico and, soon, Malaysia also run healthcare on this model.

When asked that perennial question about Canadians having to wait so long for some modalities of care, Reid replied that the long waits are “not a function of the system. They’ve done this to save money. Taiwan has same model and has shorter waiting times than the U.S. However, the rich Canadian and the poor Canadian wait the same amount of time.”

4. The out-of-pocket model. The most common model, found here in the U.S. and in poverty stricken, developing countries, this model, simply put, means if you have money, you get treated. If you don’t have money, you don’t get treated.

Reid, however, asserts that the U.S. has all four models. If you are a veteran or Native American, you live in Britain. If you are a senior on Medicare, you live in Canada . . .  If you buy private insurance through your job, you live in Germany. If you are one of the 45 million with no insurance, those people live in Angola or Afghanistan.”

Reid observed that a main difference between the U.S. and those industrial countries with successful universal healthcare was that those countries stick to one model, whereas the U.S. uses all four. Reid outlined three reasons why following one model makes universal coverage viable.

• It’s simpler and, therefore, “vastly cheaper in administrative terms,” Reid said. “You have one set of rules, one set of forms, one set of prices. You spend vastly less on paperwork.” He gave the example of a 900-bed hospital in Canada that employs two people part-time to handle billing. In a U.S. hospital of that size, 200 full time people would need to be employed to do the billing

• Having one model provides incentive to invest in preventive medicine. The average American stays with an insurer for 5.8 years. The insurer has no incentive to cover preventive care that won’t pay off until the client is insured by someone else.

• It’s fairer. Other countries believe that everyone having the same access to the same healthcare is the fairer, just, decent, ethical thing to do.  “The design of any country’s healthcare system is a moral question. Do you want to be a society where everybody who gets sick has access to a doctor? If you make that commitment, you can do it. All the other countries are doing it . . . The U.S. has never made that moral commitment.”

Reid concluded his presentation by asking, “Do we want to be a nation where everybody has access to healthcare? Because we are not, 22,000 people die every year from treatable diseases because they cannot afford treatment. The poorest can get some treatment, but people who had a job, got sick, who didn’t qualify for public health but have too little to pay don’t. 700,000 to 800,000 people go bankrupt because of medical bills. 60 % of all bankruptcies are due to medical bills. It’s appalling. How many in Canada went bankrupt? Zero.”

At the conclusion of the presentation, a few minutes remained for audience questions. The first was whether partisan politics were what prevented the U.S. from attaining universal healthcare access. Reid answered, “Our political structure has caused us to lose sight of the fundamental issues. Healthcare is a huge business, $l 2.3 trillion dollars last year. That means hundred of companies making more than billion dollars a year. They are doing great off our current system.”

Then, Reid was asked if he had opportunity to present his findings to Congress. He answered that he had made a presentation to 16 members of a Congress committee on healthcare—and that the 16 congressman “recoiled in horror.” He explained, “In other countries they have private insurance but they are nonprofit. Insurance companies don’t make a profit. How would we convince the insurance companies to give up their profits? In Switzerland in 1994 . . . they passed a law, and said insurance could no longer make a profit.”

Another audience member asked if it wasn’t really malpractice suits that were driving up our healthcare costs. Reid replied that all the countries he visited had malpractice issues and these costs are not the source of our skyrocketing medical costs. As an example, Reid cited the State of Texas, where medical costs soared after malpractice suits were limited

In answer to a question about costs associated with Medicare and Medicaid fraud, Reid pointed out that all countries have similar problems with medical fraud, even Japan, which has a reputation as a very law abiding country.

The next question fielded asked if universal healthcare was impossible in the U.S. because Americans are so individualistic. Reid pointed out that Germans and British share this quality and that U.S. government run medical programs are very popular with those who make use of them, e.g. Medicare and the V.A.

Last of all, Reid was asked if the problem wasn’t that Americans want everything—and that a universal plan would mean rationing healthcare. Reid stated,  “The U.S. rations healthcare every day . . . No country can pay for everything that modern medicine can do.  (In other countries) there is a basic floor of care. In the U.S., some people have no ceiling but tens of millions never even get in the door. That’s the harshest form of rationing.”