Healing of America

"The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care," by T.R. Reid does such a good job of laying out the issues. There's a lot of deliberate confusion about health care options around the globe.

First, he lays out four basic arrangements for health care among the developed nations:

The Bismarck Model is found in Germany, Japan, France, Belgium, and Switzerland (among others). It uses private health insurance plans, usually financed jointly by employers and employees through payroll deductions. But unlike our health insurance industry, these health insurance companies are "basically charities: They cover everybody, and they don't make a profit. The doctor's office is a private business, and many hospitals are privately owned." Moreover, "tight regulation of medical services and fees gives the system much of the cost-control clout..."

The Beveridge Model. Medical care is "a public service, like the fire department or the public library. .... many (sometimes all) hospitals and clinics are owned by the government; some doctors are government employees, but there are also private doctors who collect their fees from the goverment. These systems have low costs per capita, because the government, as the sole payer, controls what doctors can do and what they can charge." Example: the U.S. Department of Veterans Affairs.

The National Health Insurance Model: "providers are private, but the payer is a government run insurance program that every citizen pays into. The national, or provincial, insurance plan collects monthly premiums and pays medical bills." Example: Canada. No marketing, no underwriting offices to deny claims, no profit: so it all tends to be cheaper and simpler than American-style insurance.

The out-of-pocket model. "The rich get medical care; the poor stay sick or die." And "Generally, the world's poorest countries have the highest percentage of out-of-pocket payment for health. In America, with more than 45 million uninsured (before the Affordable Health Care Act), 17% of health care costs are out-of-pocket.

And four issues:

Coverage. People talk about rationing, but it's worth considering that in America we ration health care because we don't cover so many people.

Quality. "The other industrialized countries produce better results, in terms of overall national health and longevity, than American medicine does."

Cost. Other nations pay less per capita than we do.

Choice. In America, you have networks. Great Britian doesn't, France doesn't, Japan doesn't. You can go to any doctor. "The patient, not the insurance plan, decides which doctor to use."

So the next time someone spouts off about about the dangers of socialized medicine, or about how we have the best medical care in the world, ask them if they've actually read anything about it. Then refer them to this book, written by a man who says, "In industry, finance, music, science, arts, academics, athletics, Americans can match or surpass any other country. Why can't we do that when it comes to health care?"