The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care

by T.R. Reid

EACH NATION’S HEALTH CARE SYSTEM IS A REFLECTION OF its history, politics, economy, and national values.

the two purest examples of the Beveridge Model—or “socialized medicine”—are both found in the Western Hemisphere: Cuba and the U.S. Department of Veterans Affairs. In both of those systems, all the health care professionals work for the government in government-owned facilities, and patients generally receive no bills.

How many people go bankrupt because of medical bills? In Britain, zero. In France, zero. In Japan, Germany, the Netherlands, Canada, Switzerland: zero. In the United States, according to a joint study by Harvard Law School and Harvard Medical School, the annual figure is around 700,000.3

minimal.Texas passed the toughest malpractice controls in the country, but health care costs in Texas have risen faster than the national average, despite that law.

The United States is the only developed country that relies on profit-making health insurance companies to pay for essential and elective care.

The United States is the only developed country that allows insurance companies to refuse coverage to people for fear that they might get sick.

The second major anomaly of the U.S. system——the flaw that forces us to spend more than any other country on health—is sheer complexity. We have developed, more or less by accident, the most fragmented health care system in the developed world, with “providers” sending bills to a vast array of different payers.

The presence of countless different payers and fee schedules drives another unique feature of American health care: the cost shift. Medical providers—doctors, hospitals, labs—naturally try to shift costs toward the highest payer.

The U.S. Government Accountability Office concluded that if the country could get the administrative costs of its medical system down to the Canadian level, the money saved would be enough to pay for health care for all the Americans who are uninsured.

France spends about $3,165 per capita each year for a health insurance system that covers everybody; the United States spends more than $7,000 per capita and leaves tens of millions without coverage.

Leading health economists complain that this amounts to “making health care policy through strikes.” This charge is accurate. But then, a lot of policy disputes in France are resolved through strikes.

This carte vitale—the “vital card,” or the “card of life”—contains the patient’s entire medical record, back to 1998. Embedded in the gold metallic square just left of center is a digital record of every doctor visit, referral, injection, operation, X-ray, diagnostic test, prescription, warning, etc., together with a report on how much the doctor billed for each visit and how much was paid, by the insurance funds and by the patient.

Automatic payment also makes French hospitals, public and private, dramatically cheaper to run than any U.S. hospital. Although French hospitals generally have more doctors and nurses per patient than an American establishment, they have 67 percent fewer administrative personnel to keep track of paperwork and billing.

A rich society must care for the poor.”

Everyone in Japan is required to sign up with a health insurance plan. This is what’s known as an “individual mandate,” a concept that has sparked furious debate in the United States. But every nation that relies on health insurance has that requirement—it’s necessary to ensure a viable risk pool for the insurance companies—and in Japan the mandate is not controversial at all. “It’s considered an element of personal responsibility, that you insure yourself against health care costs,” Dr. Ikegami told me. “And who can be against personal responsibility?”

In America, drug companies and medical device makers argue that they have to charge high prices to fund their research and development. But Japanese experience shows that tough cost controls tend to drive innovation, not stifle it.

THE BIG LOSERS in the Japanese health care system, the people who come out worst, are the providers of health care—doctors, nurses, therapists, and hospitals.

With government doctors in government clinics dispensing government drugs (and no bills for the patients to pay), the U.S. Department ofVeterans Affairs is one of the purest examples anywhere of the Beveridge Model at work. If this is un-American, why did we choose it for America’s military veterans?

It’s not really part of the Canadian psyche to feel superior to anybody,” Marcus Davies, an official with a Canadian medical society, told me.“But there are two areas where we enjoy feeling smugly superior to the United States: hockey and health care.”

If people see that we can provide health care to all, free at the point of service, so that any person, rich or poor, can get the medical treatment he needs—if people elsewhere see that, they’ll want it, too.”

Hsiao’s famous textbook, Getting Health Reform Right, is required reading among health officials anywhere on earth who are trying to fix a health care system in an era of skyrocketing costs.

Both countries decided that society has an ethical obligation—as a matter of justice, of fairness, of solidarity—to assure everybody access to medical care when it’s needed. The advocates of reform in both countries clarified and emphasized that moral issue much more than the nuts and bolts of the proposed reform plans. As a result, the national debate was waged largely around ideals like “equal treatment for everybody,” “we’re all in this together,” and “fundamental rights” rather than on the commercial implications for the health care industry.

People who are Uninsured (PU) are 25 percent more likely to die of treatable diseases than People of the same age cohort who have Insurance (PI).

If Nikki had received the standard treatment regimen for lupus readily available to any American with health insurance, she could have lived a normal life span. If she had been a resident of any other developed nation, she could have lived a normal life span. No other rich country would have tolerated the inequality that left Nikki White dead.

For the law-abiding, health care in the United States is a product, something that Americans are expected to buy if they can afford it.

For people over sixty-five, we’ve adopted the Canadian model (we even use the name for it that was coined by the socialist who invented the Canadian system: Medicare).

Universal coverage is an essential tool to control costs and maintain the overall quality of a nation’s health.

Every nation’s health care system reflects that nation’s basic moral values,” he taught us. “Once a nation decides that it has a moral obligation to provide health care for everybody, then it can build a system to meet that obligation.”