Almost nothing about T. R. Reid's Seattle Arts & Lectures talk on health care last night was what I expected. His book The Healing of America is in paperback now ($10.88 from Amazon), and remains the gold standard for the non-wonk citizen curious how the rest of the world pulls off universal health coverage at about half the cost of the U.S.
The unexpected? Without exception, everyone who learned I was going to a health care talk used--in some variation--the word "snooze." Actually, Reid, a veteran Washington Post correspondent, had the audience laughing throughout much of the night ("You owe me big-time"), and always engaged ("You get me?" is Reid's guy-at-the-bar underlining of key points).
And though brash statements don't usually faze Seattle Arts & Lectures patrons--Jonathan Franzen was just in town--sustained murmuring rose from the crowd when Reid closed by saying he thinks there's a good chance Obamacare will fail: either because of legal challenges or political intransigence. Then, universal health care might be put back on the table, possibly by a moderate, fiscally conservative Republican.
("As I look down the road I know America is good at heart..." goes a line from John Adams' Nixon in China.)
The thesis of Reid's book, which surveys health care systems around the world, is that universal health care is a fundamentally a moral and ethical decision. Moral because countries decide whether, through inaction, they're willing to let someone die. Ethical, because universal health care speaks to fairness--everyone participates.
Reid disparaged the Obama administration's health care reform, saying they did a "lousy job" of selling the plan to Americans. It was on the one hand a landmark reform and on the other we were told, "If you're happy with your current health care, nothing will change." This proposition underscored, for Reid, the selfish basis of the appeal. Universal health care will never gain support because it doesn't affect you personally--it gains support because it's an expression of deeply felt values.
"I don't think we've made that moral commitment," said Reid. "But if we Americans can find the will, other nations can show us the way." Didn't we just find the will? Nine years into Obamacare, said Reid, 25 million of our current 50 million uninsured will still be without coverage.
Reid believes one reason that commitment is yet to be made is because--despite some 25,000 to 44,000 people dying annually from lack of health care--the vast majority of Americans already believe no one is refused treatment. But there's a real gulf between access to emergency care and good health.
People with chronic diseases will get progressively worse and die if their only treatment is from an emergency room. Cancers that could have been treated if caught in time are fatal when they are large enough to make someone risk their life savings by seeking treatment. (Every year, some 800,000 Americans file for bankruptcy because of medical costs.)
But, most Americans believe we have health care for all. Most Americans also believe we have the best health care in the world. And if what we have already costs everyone and arm and a leg, runs the thinking, how could adding 50 million uninsured to the coverage pool do anything but bankrupt all of us?
It's counterintuitive, but universal health care costs less. It doesn't have to be "socialized medicine," or single-payer, but it does work best when a country goes all in. Reid singled out two drivers of lower cost: simplicity and prevention. The simplicity comes from everyone using the same regulated system--but that doesn't mean fewer choices.
Tiny Switzerland requires universal participation in health care, but the Swiss have 70 different insurers to choose from, and those insurers average about 4.5 percent administrative costs, as opposed to here in the U.S., where administrative costs can suck up to 40 cents from every dollar you pay for health care. Japan has 3,200 insurers and they flock to the doctor's office, with an average of 15 visits per year, and an average hospital stay of 20 days. Yet Japan averages $3,400 per person for health care; the U.S. over twice that.
A McKinsey study claims that if we adopted the high-tech, streamlined French health care system the U.S. would save some $600 billion per year in administrative costs. In this analysis, it's the people who refuse to countenance universal coverage because it gives slackers a "free ride" who are actually reaching into everyone's pocket. (In another instance of pay-less-now-or-pay-more later, French doctors get a government-sponsored education, which means they can work for about $65,000 per year, not having over a hundred thousand dollars in school loans to repay.)
Preventative medicine is also much, much less expensive than letting conditions go until they become life-threatening. Reid mentioned that walking down the street in London, he'd see young women dressed as cheerleaders (which the English don't really have, they've picked up the look from Friday Night Lights, he surmises). "They think it's a sexy look--I always do, too," chuckled Reid. The cheerleaders get the attention of passers-by, and then hit them up to get a flu shot.
(Reid also compared our Surgeon General's cigarette pack warning to to this one: "85 percent of lung cancers are caused by smoking. 80 percent of lung cancers kill within three years. You will die.")
There's a third way to keep costs low in medicine, which tends to generate a lot of heat on these shores from people who imagine their care isn't rationed due to cost. (These are likely the same people who thought when they bought an "unlimited" AT&T data plan that it meant unlimited data, rather than whatever amount AT&T deems reasonable.) You don't have to trust the government if you don't want to, but if you trust your private insurance provider more, then you have not been paying attention.
"All countries ration health care," noted Reid, in one way or another. The difference is that some countries employ a floor--a promise that you will get basic health care no matter what--along with a ceiling, to rein in expensive surgeries and treatments. In the U.S., we have no floor, and our ceiling is strictly dependent on the premium we can afford and our private insurer's willingness to pay.
In Seattle, Reid implied, we're spoiled for choice. "I don't know if you are aware," he said, "but this area is famous as a hotbed of health policy and innovation." Washington ranks among the lowest of all states in health care cost per patient. We are 50th out of 50 in hospital beds, not because we're short on beds, but because our population is so healthy we don't need as many as other states. He name-checked Swedish Medical Center (where he'd delivered a talk earlier) and Group Health as two local leaders in delivering top care competitively.
(He could have also mentioned boutique basic-health provider Qliance, who provide primary care for a monthly fee that's less than a digital cable package.)
When Reid was making a presentation for Senator Baucus, prior to the health care reform's passage, he was peppered with questions by Washington Senator Maria Cantwell. "She got it," Reid said admiringly. But, unsure that the American public supported universal coverage, the Obama administration put full coverage on the table, and it was compromised away, along with, Reid believes, universal health care's moral mandate.
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