Tuesday, August 25, 2009


For an informative and interesting explanation of health care around the world, read the transcript or listen to the recorded interview of T.R. Reid by Terry Gross in Monday's "Fresh Air."

Reid, formerly a reporter for the Washington Post, is the author of The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care, published just last week. After describing health care models in various developed countries, he says that in the United States we have four models operating simultaneously: Britain, Germany, Canada, and Malawi. The Neffs are currently enrolled in the German model, will be in the Canadian model in about four years, and hope the publishing industry remains strong enough to allow them to avoid the Malawian model in the meantime.

Reid also had an excellent article in Sunday's Washington Post: "Five Myths About Health Care Around the World." It should be required reading for every American who thinks our system is better than all the others.

Three of Reid's important points (the quotations are from his book):

1. “The primary issue for any health care system is a moral one." If we believe no one should die for want of access to health care, we can find a way to provide care for all. If we believe health care is a commodity like TVs and automobiles, we can continue to exclude those who can't pay. “All the developed countries I looked at provide health coverage for every resident, old or young, rich or poor. This is the underlying moral principle of the health care system in every rich country—every one, that is, except the United States.”

2. It is possible to improve health care and save money at the same time. Hey, those other rich nations that provide health care to everybody spend about half as much per capita as the United States spends, and their citizens also live longer and enjoy better health. If we are willing to study the ways other developed nations handle health care, we're smart enough to devise an approach that suits our needs.

And by the way, we don't need to fear "socialized medicine," whatever that may be. As Reid points out, "the term was popularized by a public relations firm working for the American Medical Association in 1947 to disparage President Truman’s proposal for a national health care system. It was a label, at the dawn of the cold war, meant to suggest that anybody advocating universal access to health care must be a communist.” In fact, successful health-care systems in other countries have widely varying approaches, ranging from public funding and public health-care provision (Britain) to private insurance and private providers (Germany, Japan, France, Belgium, Switzerland, Japan). In fact, some European systems are considerably more private than ours.

Nor do we need to fear loss of choice: almost all developed nations allow more choice of provider than our insurance companies currently permit, and some also have more insurance companies to choose among.

3. The biggest source of waste in American health care comes from our approach to insurance: “20 cents of every dollar people pay in premiums for health insurance doesn’t buy any health care.” Insurance per se isn't the problem. Many developed countries, like the United States, rely on competing private insurance companies to pay health-care bills. There is just one major difference between their systems and ours: most of our private insurance is for-profit, and all of their insurance that pays for basic health care is not-for profit.

Reid does not discuss the army of lobbyists currently working feverishly to sway public opinion and persuade Congress to veto any significant reform, nor does he mention the enormous contributions made by health-care lobbyists over the last five years to key Senators and members of Congress. His book was completed before Wendell Potter, former head of corporate communications at CIGNA, blew the whistle on common unfair industry practices, so he doesn't mention Potter either. Likewise, he is silent about possibly excessive executive compensation at health insurance companies.

Reid is not concerned with abuse and corruption in the health-care industry so much as with flaws in the system itself. Even operating at its best and most honest, a for-profit insurance system cannot provide health care for everybody as cheaply as a not-for-profit private company or a public system. This is counter-intuitive to free-market advocates, but Reid backs up his assertions with figures: contrast 20% administrative costs in America with 6% in Canada, 5% in France and Britain, less than 2% in Taiwan.

1. again (this is Reid's most important point): “The primary issue for any health care system is a moral one." If we have the will to care for all our people, we will find a way. I was thinking about that Sunday while listening to the day's readings from the Revised Common Lectionary:
The rich and the poor have this in common
the LORD is the maker of them all.
Whoever sows injustice will reap calamity,
and the rod of anger will fail.
Those who are generous are blessed,
for they share their bread with the poor.
Do not rob the poor because they are poor,
or crush the afflicted at the gate;
for the LORD pleads their cause
and despoils of life those who despoil them.
--from Proverbs 22

Listen, my beloved brothers and sisters. Has not God chosen the poor in the world to be rich in faith and to be heirs of the kingdom that he has promised to those who love him? But you have dishonored the poor. Is it not the rich who oppress you? Is it not they who drag you into court? Is it not they who blaspheme the excellent name that was invoked over you? ... If a brother or sister is naked and lacks daily food, and one of you says to them, "Go in peace; keep warm and eat your fill," and yet you do not supply their bodily needs, what is the good of that?
--from James 2


  1. Thanks, LaVonne, for directing me to Reid's article in the Washington Post! If anyone is interested in more from Reid, there is a Frontline program he did in 2008 called "Sick Around the World." The Wheaton Public Library owns the dvd. Check with your library!

  2. I am a fairly new reader of your blog and enjoying it immensely.

    Thank you for your recent posts on the healthcare debate. You have pointed me to some thoughtful articles. I appreciate it.

    I also enjoy your book reviews. After reading of your interest in medieval mysteries, I went to the library and checked out several. I was not familiar with that genre before. Thank you for that recommendation as well.