San Francisco
Anyone put off by the poster that paints President Obama as a “socialist joker” might take a look at the typical American in the mirror. We already combine the worst features of both socialism and market forces in healthcare, because we can’t seem to learn from the best examples in other countries.
It’s time we did – because that’s where the real choices are. And eventually, we’ll have to choose.
On the (fully) socialized side, US Medicare and Medicaid consume 8 percent of our national income – about the same share as socialist European systems. Except that theirs cover everyone, not just the elderly. And we’ve only just begun to pay for our own collectivism, since the bulk of our boomers haven’t retired yet. When that gray wave crashes on our status quo shores, it’ll wipe away trillions in national wealth.
Then we pile on uniquely American layers of private-sector “innovation” in healthcare, forcing us to spend double what other rich countries do:
•Reimbursement rates disproportionately enrich specialists, who are better rewarded for being “partialists” doing procedures and heroic interventions. We scarcely reward outcomes or results – most of our incentives actually preempt prevention.
•Primary care doctors are quitting front-line healthcare to join boutique practices in gated community medicine – because good primary care has become nearly impossible in practice.
•Insurance and pharmaceutical lobbyists have written fat profit subsidies and price supports into federal legislation, particularly the Medicare drug benefit, inflating costs unsustainably.
Add the cost of our elderly socialized systems to what employers and families spend for coverage with private insurers – when they can afford it, which tens of millions of our citizens can’t – and Americans burn more than $7,000 each year on healthcare. That’s more than twice the average for other rich nations.
For all of that money, we get better quality – right? Well, no. Our health system ranks 37th on the list of wealthy nations, on a definitive range of outcomes, according to the World Health Organization.
Enter T.R. Reid’s new book, “The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care.” It makes a critically important contribution to the conversation about reform, by taking a clear-eyed look at what is actually working in other countries.
While the right feeds culture-war flames of indignation about so-called death panels that would euthanize the elderly, and the left berates Mr. Obama for backing down on an opaquely defined and unaffordable “public option,” Mr. Reid starts our interview with a bracing statistic that frames the debate in simple moral terms.
He points out that some 18,000 Americans die each year, simply because they don’t have access to the basic medical treatment that would save their lives, according to the Institute of Medicine.
Now consider the lucky among us: Even among those with access, another 200,000 perish from preventable medical errors and avoidable hospital infections. Overall, our failure to structure and deliver effective healthcare is 70 times more lethal to our citizens, every year, than the September 11 attacks.
We can do better. “What I saw in all the other developed countries,” Reid says, “is that they decided that a rich society has an obligation to see to it that anybody who’s sick can see a doctor. All of the rich countries have agreed on this except one. The United States has never made that basic moral commitment.”
Reid, a veteran foreign correspondent, spotlights three paths that other countries have taken to walk their talk. A “Bismarck” system of private insurers and providers – financed through payroll deductions, but universal and portable – works for Germany, Japan, and Switzerland. Britain runs a “Beveridge” system (similar to what the US provides military veterans). Taiwan, France, and Canada run national single-payer health plans funded by government through taxes (like Medicare, which we currently provide to 36 million of our own elderly).
What America can’t continue to do forever is operate a mishmash of market and government systems that has become the worst of both worlds. Reform will be as simple – and as difficult – as deciding on one approach and executing it.
Notably, once citizens in other nations have agreed that healthcare is a moral imperative and a right, they’ve found ways to summon an equal measure of individual responsibility for healthcare that sounds … well, pretty conservative.
“In Britain,” Reid says, “if some fat guy is sitting at the bar with a pint and a plate of chips, a complete stranger will walk over to him and say, “Hey, mate – go easy on all that. I’m not paying for your heart attack.” What true conservative would choose a fat tax over the simple stigma of a snack attack?
Reid wonders aloud whether Britain’s peer pressure amounts to a “nanny state.” But the effect seems the opposite, and far more effective: a health system where choices are made by individuals held accountable to family and community. Where the irresponsible, rather than being policed by bureaucrats, make a direct impression on fellow citizens, right where it hurts – in their wallets. Sounds more like a “neighbor state.”
“I want to see us get this done,” Reid says, well after midnight. “If we could find the political will to cover everybody, the other countries can show us the way. They’ve all done it, for a lot less money than we spend. And they’re getting far better health outcomes.”
Among all of the issues Americans are struggling with right now, healthcare reform is generating a fearful focus inward.
Let’s just take a deep breath, turn our heads, and learn. It won’t hurt a bit.
Originally published in the The Christian Science Monitor on September 1, 2009.
