TR Reid at Town Hall

TR Reid, the Washington Post journalist and NPR commentator, spoke tonight at Town Hall, on his findings on health care around the world, made after 2 years traveling to different countries. This was one of the highlights of the health care reform debate! TR Reid's book should be required reading for everyone who has the slightest interest in what to do about health care in this country.

Reid says there are basically 4 different health care systems in the world:

1. The Beveridge Model, named after Lord Beveridge in England. This is what is used in the UK, among others, and if you're going to call any model socialist, this is it. It's single payer, universal coverage, with the government being the payer AND the provider of health care services, meaning the doctors and the hospitals are government owned. Does the US have this model? You bet. Check out the VA.

2. The Bismarck Model. Yes, that's Bismarck as in Chancellor Otto Bismarck from Germany. This is an employer-based system, with private health insurance paid through employers, often with employees and sometimes the government sharing the cost with the employers. Germany and France, among others, use this. So do those of us in the US who get their health insurance through their employers. The differences between the US version of this model and everyone else's version are (1) in other countries, the insurers, while private, are by law nonprofit; and (2) there is universal coverage in other countries, and (3) in other countries, EVERYONE is on the same system, instead of veterans in VA, seniors in Medicare, etc.

3. The Canadian Model. This is a single payer, universal coverage system, except that unlike in England, the doctors and the hospitals are not employed by or owned by the government. Do we have this system in the US? Yes, it's called Medicare. Do the Canadians have long waits for service? Not for emergencies or other life threatening problems, but yes, for elective care. But that's only because the Canadians elected to limit the number of the doctors and especially the number of specialists.

4. Fee for Service Model. Used in most of the undeveloped world, this simply means if you have the money to pay for a doctor or a hospital, you get health care. If you don't have the money, you don't. Do we have this system in the US? Yes, indeed! The 45 million American who are uninsured have this system.

Next January, Mexico will be offering universal health coverage to its citizens. Singapore tried a consumer-based health care system for a while. This is the type of system favored by a lot of free marketers--if only we as consumers had enough information, market forces would make the health care system work! It didn't work in Singapore, which has an educated population, excellent doctors, and plenty of money.

Why is health care so expensive in the US? Part of the reason is that instead of having just one system for everyone, we use all four systems. That's inefficient! And we know that within the private health insurance system, each insurance company has its own forms, computer programs, and different policies, requiring health care providers to hire several people to just keep track of it all.

Can we learn something about how to structure our health care system from the other industrialized countries in the world? Yes, we can. We just need the political will to do it. Why is the richest,most generous country in the world so lacking in the political will to make sure that all its citizens have access to health care? Mr. Reid said that that was the most baffling question.