Foreign models for US health care

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KATY CLARK: Washington Post journalist T.R. Reid covered Senator Kennedy through the years. He got to know him during Mr. Kennedy's 1980 run for the Democratic presidential nomination, visiting all 50 states with the Senator. T.R. Reid also has a new book out on a topic that was very close to Kennedy's heart, healthcare reform. The book is called 'The Healing of America: A Global Quest for Better, Cheaper and Fairer Healthcare.' It looks to other countries to see what lessons can be applied to the healthcare system here in the U.S. T.R. Reid, you had many discussions with Ted Kennedy about healthcare reform. How did you see his stance on this issue evolve over the last few decades?

T.R. REID: He loved this issue; he absolutely felt that America had an obligation to provide healthcare to everybody who needs it. And in the early years he was a purist. We were going to have government-run single-payer healthcare, that's it, that's what other countries, many of them do, he thought. And he moved off the purist position and just moved to whatever he could get that would get more people covered. He endorsed the Massachusetts State Plan, which brought many more people into coverage but didn't do anything about costs, and he was a player in the plans in America this summer, which also look like they're not going to cover everybody -- they might improve things, but we're not going to get all the way. So yeah, he evolved from a purist to what would you call it, a realist?

KATY CLARK: Ted Kennedy wanted to know why we didn't have universal health coverage here in the U.S. like other wealthy nations do. In your new book you went around the world

seeking medical treatment for an old shoulder injury in order to find out how other countries actually do provide universal coverage. What did you find?

T.R. REID: Yeah, my question was a pretty important question for Americans. All the other developed democracies manage to cover everybody with high-quality care and still spend half as much as we do. How do they do that? And I found out it's not all the same. It's not all socialized medicine; a lot of them cover everybody with private docs, private hospital and private insurance. It can be done; America could do that too. But along the way of trying to figure out how they do it, it dawned on me that the more important question was why did they do it? Why would a country commit to provide healthcare for everybody who needs it? I think I answered that question in the book too, but then that raises a third question, why doesn't the richest country in the world provide healthcare for everybody? And I really struggle with that one in the book. Why is it that we don't do that?

KATY CLARK: And let's be clear here about why you were comparing U.S. healthcare with other countries is because when you look at the rankings, we just don't come out very high, do we, despite the money we spend on healthcare?

T.R. REID: Yeah, that's right. In terms of cost, we're the most expensive. In terms of fairness, we leave tens of millions of people uncovered, while all the other rich countries cover everybody.

And what really was kind of stunning to me was in terms of healthcare outcomes, America ranks at the bottom among all the rich nations on many important rankings. We're pretty low on life expectancy, we're low on recovery rates from many major diseases, and we're worst in all the rich countries in the world in infant mortality.

KATY CLARK: You do a lot of myth busting in your book about some of the conventional wisdom that's been floating around in this country about how healthcare in other places works. And you say a lot of what we actually know about other nations' approaches to healthcare is simply a myth. What exactly are you referring to?

T.R. REID: Well, for example, as we all know, in other countries everybody is kept waiting for months to get treatment. Guess what, in a lot of rich countries waiting time for an appointment, waiting time for elective surgery is shorter than it is in America. They don't have choice, they limit choice, they ration care. In France, Germany, Japan you can go to any doctor in the country. You don't have to ask your insurance company beforehand. There's no in-network because everybody's in the network. You go to any doctor and insurance has to pay. In most countries the health insurance has to pay in a matter of days. In Switzerland if they don't pay your claim in five days your next month's premium is free. You know, no American has that quality of health insurance.

KATY CLARK: How do countries, though, manage the costs? Is there some limiting of care for people? I mean, kind of give us a summary of what you found and what might apply to our system.

T.R. REID: Oh, you're raising that dreaded word, 'rationing of care.' Yeah --

KATY CLARK: Is that one of those myths?

T.R. REID: Here's the truth. No, every country rations healthcare; nobody can afford to pay for everything. The point is, though, America rations care too. We just do it differently. In the other rich countries, they have a basic floor of care that everybody has access to, and therefore nobody dies for lack of a doctor. In the United States, for some people the sky is the limit. They get the greatest care in the world with no waiting, but tens of millions of people don't have access to that care. Now that's rationing of care; we just do it in a harsher, crueler way than other countries.

KATY CLARK: I'm curious about your shoulder. The ailment that you carried with you around the world in doing research for this book was a bum shoulder going back many, many years. How is that shoulder doing and where did you get the best care for it?

T.R. REID: My shoulder is definitely better. That's the nice thing about this book. I came away confident that we could fix American healthcare, and I came away with a better shoulder, more movement and less pain. Strikingly, the best result I got was not in a rich country, but in India, where I did this 3,000 year-old Ayurvedac medicine, and that's a form of treatment that's herbal and laying on of hands. And here's what you do in Ayurveda: You lie on this dark neemwood table and six guys massage you with warm oil. I did that for five weeks. It was really sweet and guess what? The hotel suite, all my meals and three massages a day cost $42 bucks a day. It wasn't bad. And I got more movement and less pain. I mean, it definitely improved me.

KATY CLARK: But interestingly when you took your shoulder injury to a doctor in Britain you were basically told, "Tough it out; go home and deal with the pain."

T.R. REID: Stop winjing [ph], yes. "Stop complaining; go home," and it's true. I'm living my life. You know, I ski, I ride a bike. It's not terrible. Yeah, so the Brits said, "We don't want to spend money on that. You know, so go home and live with it." That was the least sympathetic care I got. Well, the other, the worst was Canada, where they said, "Yeah, you'd better go see an orthopedic surgeon, and you'll have to wait 10 months to get an appointment," because in Canada they do have long waiting lines. But, you know, France, Germany, Japan, Taiwan, they were willing to give me a variety of care and it either would have been free or quite cheap.

KATY CLARK: Journalist T.R. Reid's new book is, 'The Healing of America: A Global Quest for Better, Cheaper and Fairer Healthcare.' Thank you so much for talking with us.

T.R. REID: Thank you.