T.R. Reid Takes a World View of Health Care

Sunday's Washington Post carried an excellent look at health insurance systems around the world by foreign correspondent T.R. Reid. In "Five Myths about Health Care Around the World," Reid shares both his experience (as a person who has lived in a lot of countries) and his analysis.

The five myths are:

1. It's all socialized medicine out there.
2. Overseas, care is rationed through limited choices or long lines.
3. Foreign health-care systems are inefficient, bloated bureaucracies.
4. Cost controls stifle innovation.
5. Health insurance has to be cruel.

Some of Reid's best lines:

The world champion at controlling medical costs is Japan, even though its aging population is a profligate consumer of medical care. On average, the Japanese go to the doctor 15 times a year, three times the U.S. rate. They have twice as many MRI scans and X-rays. Quality is high; life expectancy and recovery rates for major diseases are better than in the United States. And yet Japan spends about $3,400 per person annually on health care; the United States spends more than $7,000.

And it's clear from another part of Reid's story that some of that savings comes from MRIs, which cost $98 apiece in Japan (vs. $1,500 apiece in the U.S., and it's not because the cost is regulated in Japan).

In many ways, foreign health-care models are not really "foreign" to America, because our crazy-quilt health-care system uses elements of all of them. For Native Americans or veterans, we're Britain: The government provides health care, funding it through general taxes, and patients get no bills. For people who get insurance through their jobs, we're Germany: Premiums are split between workers and employers, and private insurance plans pay private doctors and hospitals. For people over 65, we're Canada: Everyone pays premiums for an insurance plan run by the government, and the public plan pays private doctors and hospitals according to a set fee schedule. And for the tens of millions without insurance coverage, we're Burundi or Burma: In the world's poor nations, sick people pay out of pocket for medical care; those who can't pay stay sick or die.

This fragmentation is another reason that we spend more than anybody else and still leave millions without coverage. All the other developed countries have settled on one model for health-care delivery and finance; we've blended them all into a costly, confusing bureaucratic mess.

You'd think all the people who get upset about waste in government or corporations would be up in arms about the waste created by our multiple, overlapping, inefficient systems.

In terms of results, almost all advanced countries have better national health statistics than the United States does. In terms of finance, we force 700,000 Americans into bankruptcy each year because of medical bills. In France, the number of medical bankruptcies is zero. Britain: zero. Japan: zero. Germany: zero.

That last paragraph said it all about the brokenness of the American way of doing health care.

T.R. Reid has a forthcoming book to watch for, called The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care. He also produced a Frontline documentary for PBS in 2008 called Sick Around the World. (watch it here).