When I wrote about Germany’s health care system two weeks ago, a couple of people referred me to T.R. Reid’s book “The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care.” In fact, it was Reid’s chapter on Germany that inspired that column, and I was remiss in not mentioning that.
Reid, a former foreign correspondent for the Washington Post, was in Spokane last October to discuss his global sojourn, which also resulted in the insightful PBS documentary “Sick Around the World.” He traveled to many countries to study their health care systems and to get advice on how to treat an injured shoulder.
If you feel like you’ve learned all you need to know about foreign health care systems from diatribes about “socialized medicine” or simplistic films like Michael Moore’s “Sicko,” then you can skip Reid’s work. But if you’re interested in the various ways other countries have addressed this problem, then Reid is your man.
As Dr. Tom Schaaf, assistant district medical director for Group Health’s Spokane region, told The Spokesman-Review during Reid’s visit: “I think he has done, really, a pretty good job of de-demonizing the way health care is delivered in other countries.”
In his book, Reid offers a handy way for Americans to think about other countries’ systems. Are you covered by an employer? That’s Germany, France and Japan. Are you retired and at least 65 years old? That’s Canada and Taiwan. Are you a current or former member of the military, a Native American or in prison? That’s the United Kingdom or Cuba. Are you among the tens of millions of people without health care coverage? That’s the Third World.
So what do you get when you toss all of that together? A wilting American salad, with some important caveats.
First, we are alone in using for-profit insurance companies. The employer-based funds offered in Germany, France and Japan are designed for one purpose only: to cover health care costs. To keep costs down, the government sets prices. An MRI scan that costs $1,200 in our country costs $98 in Japan.
Does this mean care is rationed? Well, the Japanese average 14 office visits a year. In France, it’s nine. In the United States, it’s five. U.S. insurance companies place lifetime limits on health care spending (“Obamacare” would repeal this). No such thing exists in other countries.
Does this mean administrative costs are lower? Yes, they are in the single digits in other countries. In the United States, marketing, advertising, billing and high executive pay devour from 20 percent to 30 percent of health care spending (Obamacare would cap this at 20 percent).
Second, unlike Third World countries, we do not let people with emergency health conditions die if they don’t have coverage. However, this means that others do pick up the costs, which leads to another difference. All of the other industrialized countries have a mandate to participate, because their systems would collapse without it.
Third, health care providers in the United States make considerably more money, carry a lot more student debt and face higher malpractice insurance premiums. Governments elsewhere set prices after negotiating with physician associations and unions. Other countries cover most medical school costs. Medical errors and malpractice claims are not handled via an inefficient, high-stakes tort system. Doctors don’t make as much in other countries, but they don’t have to retire debt or ward off legal claims.
Reid’s conclusion is that we can learn a lot from countries that formally established comprehensive health care systems. Our system, such that it is, just sort of evolved into this horribly expensive mishmash.
So there is another key difference. Americans have never had a straightforward conversation on whether we want universal care. That, as Reid notes, is a moral determination. No right to health care exists in our Constitution, but it’s not embedded in the constitutions of other nations either. Yet they have adopted humane, universal systems – at a cheaper price.
We can, too, if we stop chasing imaginary demons and face up to the real ones.