A Good Book on Health Care Debate

I’m reading a book by T.R. Reid titled “The Healing of America”, in which the author looks at health care systems in Britain, France, Germany, Japan, Taiwan, Switzerland, Canada, and the United States.

The author traveled to these countries inquiring about treatment for his shoulder, which he injured many years ago, leaving him with limited use of his arm and constant discomfort.  At the same time, he studied the organization and principles of these countries’ national health care systems and he compares them to the United States.

What Mr. Reid learned from his study was that every developed country – except the United States – has based their health care system on the notion that health care is a right and not a privilege, and that all citizens, whether rich or poor, should have the same access to a certain level of health care.

France, Germany, Taiwan, and Switzerland have insurance companies (or something like insurance companies) as part of their health care system. But the insurance companies are not-for-profits. In all of the countries Reid studied, the idea of making a profit from health insurance or health care is viewed as a very bad idea.

In Switzerland, Germany and France, most people get health insurance through their job.  But if they lose their job, they do not lose their insurance. Everyone must participate in their country’s health insurance system, generally through payroll taxes or general taxes – there is no opting out (except for the richest Germans, who are allowed).

In the countries Reid studied, all doctors and hospitals participate in the national system, and people can go to any doctor in the country.  There are no “network” limitations as is the case with most American health insurance. By law, providers must be paid within a week for their services.

In these countries, the cost of health care services is set by the government, and the government (or some council) decides what services are covered. In the U.S., each insurance company negotiates a different price for services with providers, and it is the insurance company that decides what is covered. An MRI in the U.S. costs between $1,000 and $1,400.  In Japan the cost of an MRI is $105.

The common theme for doctors in these countries is that they earn much less money than American physicians, but most make at least $150,000 per year.  Another common theme is that the education of doctors is mostly paid for by the government. The idea of a new doctor owing hundreds of thousands of dollars in education loans is unheard of.

In the United States,  with most health care being for-profit, we spend about twice as much per per person on health care than France. Yet France and all of the countries Reid studied have much better outcomes than the U.S. for infant mortality rates, curing people of diseases, and keeping people healthy and living longer.

The book came out last fall amidst the heated debate over our American health care legislation, and I can see some ideas from other countries that may have been incorporated into the “new” American health care system.  I’ll write about those next.

“The Healing of America” is an easy read with stories of Mr. Reid’s own experiences with doctors in the U.K. and Japan, where he worked and lived with his family. The stories are entertaining and even funny. Throughout the book, Reid compares treatment suggestions for his shoulder he received from doctors in each country – a revealing look at very different philosophies about how to treat ailments.

PS:  Mr. Reid does write about the negatives of the British and Canadian systems where there are not enough doctors and people must wait months for non-emergency procedures.

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