Checking In With T.R. Reid: 'It Doesn't Have To Be Single Payer'

Aug 26, 2009

Laurie McGinley: Good day. I’m Laurie McGinley with Kaiser Health News. Today we are interviewing journalist and author TR Reid, whose latest book, "The Healing of America, A Global Quest For Better, Cheaper And Fairer Health Care," provides a world tour of various health care systems, as well as prescriptions for the U.S. system. It’s very timely and we appreciate you joining us, T.R. Could you tell us a little bit about what set you off on your journey – it was a combination of your interest in different kinds of health care systems and having a sore shoulder.

T.R. Reid: A combination is exactly right. So, here’s the deal. All of the other industrialized democracies provide high quality coverage to everybody and still spend half as much as we do on health care. How do they do that? That’s what I set out to figure. And I figured since I was going to some very good health care systems, I’d take my bum shoulder, which I injured in the Navy eons ago, and see if I could get it fixed. And that way as both an analyst and a patient.

LM: And who gave you the best care and the best advice on your shoulder?

TRR: Well, as you can imagine, in America, they wanted to do the high-tech, most aggressive, most expensive thing. They wanted to cut out my shoulder and put in a piece of titanium. It was about a $50,000 operation.

In France, Germany, and Japan, they would have done that, and it would have cost me $5,000 in France, but those doctors suggested other things: cortisone shots, physical therapy. In Japan, they gave me acupuncture; they gave me traditional Chinese manipulation. None of which helped. And then in India, I got this ancient Ayurvedic medicine; really sweet. Six guys massage you with warm oil every day. I did it for five weeks; it was great.

LM: What did you learn in your travels, and did you discover that some of the stereotypical views that Americans hold of different systems possibly aren’t all accurate?

TRR: Yes, it’s amazing the mythology that we labor under in our country. Look, it’s not all socialized medicine overseas. A lot of rich democracies cover everybody with private docs, private hospitals, and private insurance. In fact, a lot of countries - Germany, Switzerland, Netherlands – people stay with the private insurer cradle to grave. There’s no Medicare for old people; there’s no Medicaid for poor people. There’s less government involvement in those countries than there is in the U.S.

It doesn’t have to be single-payer. Japan has 3,000 payers. Switzerland has 70. Germany has 200. So, a lot of the myths that we hear - big government, nanny state, single-payer – no, it’s not true. And in a lot of rich countries, people have much more choice than Americans do. In France, you can go to any doctor or hospital in the whole European Union without asking your insurance company for any kind of authorization, and insurance has to pay, they have to pay you within two weeks.

LM: But TR, you also found a lot of problems in the other systems as well. France, you wrote in the book, is having a lot of financial problems with the system. Canada does have the kind of waiting times that many people hear about. In Britain, they really just told you to go away. So, these are not perfect systems either, and they’re all having trouble controlling costs, as we are here in the United States. So, what do you conclude from that?

waiting times

TRR: Every country has the same problems we do. Aging populations. Health care is much more technical, it’s much better, it saves lives, but it costs a lot of money, and every country has serious cost control problems. The main thing I learned is: the other countries, whatever, whether they do it through socialized medicine, or through private, or through a blend of the two, they put everybody in one system. They just decided that it’s cheaper and easier and fairer if everybody in their country has the same access to the same care at the same price.

Whereas in our country, we have one system for veterans, one for members of Congress, one for Native Americas, one for 16 year olds with 120 percent of poverty – like that. We have 19 different systems; it’s very expensive, they overlap, the administrative costs are five, six times higher than any other country.

LM: Do you think it’s important, if everyone is put in the same public system, that there also be a smaller, parallel, private system for people who actually want to spend more of their resources on health care?

TRR: I think that’s fine, but you know, the single system doesn’t have to be public. Japan is a unified system, but it’s 3,000 different insurance companies, most of them are private. Japan has more private hospitals than the United States does. Germany has all private insurance companies. They don’t make a profit, but they’re private charities; they’re not run by government.

LM: When you look at the spectrum of systems out there, which ones do you think are close enough to the US that might provide realistic lessons, considering that Americans are very conservative in wanting to change the health care system we have?


TRR: Well, my family of five Americans lived in Britain. It was great – the doctor comes to your house, she gives your kid a shot, the kid feels better, and then she walks out the door, there’s no bill. In Britain, there’s no co-pay, there’s no insurance payment, there’s no deductible, there’s nothing. I really liked that; as a patient, as a father, as a husband - it worked for us. But you’re right; it’s probably too Big Government to work in America. They use that system in Britain, Spain, Italy, New Zealand, and several other countries.

But if you look at the system that was created in Germany - which I call the Bismarck Model, created in the 1880s in Germany - Germany, Switzerland, France and Japan have that system: private doctors, private hospitals, private insurance – we can do that. What they have that we don’t do is, they put everybody in one system. One unified system. Japan has one set of prices for the same procedure all over the country.

And they have really strict regulation of these private insurance companies. The companies have to cover everybody; they have to pay every claim; unusually they have to pay every claim within two or three days; and once you’re in the plan, they can’t cut you off. So, people like their insurance companies in these other countries, unlike Americans.

LM: Thank you very much, TR.

TRR: Delighted.

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