- T. R. Reid talks at Town Hall at 7:30 p.m. Tuesday, September 8. Tickets are $5 at the door. The Washington Post correspondent and NPR commentator has a new book out, The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care.
T. R. Reid argues that lack of universal health care is primarily a moral question, not an economic one. It's estimated that each year we do not offer universal health care, 20,000 U.S. citizens die who did not have to. To my ears, the debate sounds Abrahamic:
24What if there are fifty uninsured people in the country? Will You really let them fall ill and not spare the lives of the fifty uninsured people? 25Far be it from You to do such a thing–to kill the uninsured with the terminally ill, treating the uninsured and the terminally ill alike. Far be it from You! Will not the Judge of all the earth do right?”
I can't pretend not to be biased here--I've been a proponent of health care reform since reading of Harry S Truman's attempts at reform in the mid-1940s. Said Truman, "I do not understand a mind which sees a gracious beneficence in spending money to slay and maim human beings in almost unimaginable numbers and deprecates the expenditure of a smaller sum to patch up the ills of mankind."
But that said, one thing we need to agree on is that we can't afford not to reform health care. Even when throwing the poor and uninsurable under the wheels, even when allowing insurance companies to decide if they feel like paying or not, costs have ballooned out of control. Not because of runaway malpractice settlements (everything associated with malpractice adds only about one percent to our total health care bill) but because of runaway administrative overhead.
"Contrary to conventional American wisdom," writes Reid, "most developed countries manage health care without resorting to 'socialized medicine.'" And unlike many outraged shouters, he can speak with personal authority, having been a foreign correspondent dependent on the health care systems of other countries.
He goes on to explore the varying health care models at work in France, Germany, Japan, the United Kingdom, and Canada. It's notable that every country on that list offers a form of universal coverage and spends less money on health care (as a proportion of GDP) than the U.S. All that spending gets the U.S. ranked 37th in the world in terms of health care quality by the World Health Organization.
"There are four basic arrangements," instructs Reid. Under the Bismarck model (Germany, Japan, France), private insurers pay for private health care--the difference is simply that the insurers "are basically charities. They cover everyone and don't make a profit." If you're a working person under 65, this is your model, except your insurance company makes a whopping profit. The NCHC says, "The cumulative increase in employer-sponsored health insurance premiums have raised at four times the rate of inflation and wage increases during last decade."
Under the Beveridge model (the U.K.), taxes pay for government-run health care. "Medical treatment is a public service, like the fire department or public library." There may still be private doctors and hospitals, but they have to accept what the government decides to pay. If you're in the military or a veteran, this is your model.
The national health insurance model (Canada) is just what it sounds like: the government simply insures its whole population. The citizens pay a monthly fee. This is, essentially, Medicare--the "whole population" is those over 65. Medicare's administrative costs run about three percent, compared to private insurers' 20 percent.
The fourth and most widespread model, outside of wealthier countries, is no model at all. If you can afford health care, you get it. If you work part-time or are unemployed, this is your option.
Reid's investigations of how this all works "on the ground" make for page-turning reading. Nothing about health care is simple in practice, it turns out. Some countries implement a minimal co-pay; some use co-pay, but then refund it when the bill is accepted and paid, on the theory that people don't respect the worth of something that seems free.
All countries are struggling to contain costs, and all of course have their successes and failures. Reid is particularly taken with France's "carte vitale," which is an encrypted smart card that travels with each person, and keeps track of their whole medical history, allowing doctors to dispense with rooms full of file cabinets and even receptionists.
It is heartening to learn we are so tantalizingly close to universal health care--it wouldn't require an enormous overhaul to establish a public insurance option, and exert some Wal-Mart-style downward pressure on private insurance premiums. Or, we could give health insurance non-profit status. But of course this has been true for some time. We have been "so close" since 1945, and have agreed to let the most vulnerable among us suffer and die for the sake of profit every year since.
