January 08, 2010 | Allison Graff

T.R. Reid to speak at January Series

Author and journalist T.R. Reid opened the January Series Wednesday, January 6, 2010 with a discussion about health care in the United States.

In "The Healing of America: A Global Quest for Better, Cheaper and Fairer Health Care," Reid shared insights learned from his travels to a wide range of countries, from Canada and Great Britain to India and Japan.

Using a sore shoulder to get himself in to doctors' offices, hospitals and even an Ayurvedic healing center in India, Reid investigated each country's health care system first hand. He probed government officials, doctors and health care consumers to find out how each system works (or doesn't work). He also studied how each industrialized nation managed to provide all its citizens (and even visitors, like Reid) with health care.

Four models of health care

Four basic models of health care emerged as Reid traveled the world:

  1. The Lord Beveridge model of health care, used in Great Britain, is essentially a socialized health care system. The government both provides and pays for health care in this system.
  2. The Bismarck model (named for German chancellor Otto von Bismarck, who created it), is a health care system administrated privately. In Germany, this privatized, not-for-profit system provides health insurance for all Germans at a reasonable cost.
  3. The national health insurance model, used in Canada and called "Medicare," organizes payment for private health care through one national insurance system. Canadians each pay a premium tax to pay for this system.
  4. The out-of-pocket model, seen in most of the developing world, provides health care to only those who are able to pay for it.

Multiple systems in U.S.

Health care in the United States operates using all four systems:

  • Veterans and Native Americans receive care through a socialized health care system administrated and paid for by the U.S. government.
  • Those on Medicare use a Canadian-type system to receive private care.
  • About 150 million Americans buy into a German-type privatized health insurance system.
  • The uninsured, numbering at least 40 million, operate under the out-of-pocket system used in most developing nations.

Reid said that this multi-model approach to health care creates huge inefficiencies that make the system difficult to fix. It's also far more expensive; countries that use one approach are able to provide health care to all because administrative costs are so much lower. The multi-model approach, said Reid, stifles incentive within systems, or individual insurance companies, to focus on cost-saving preventative health measures; people are seldom insured by the same company or organization long enough for preventative health measures to be profitable.

A moral question

Approximately 22,000 people die in the United States each year from treatable diseases because they lack health insurance, Reid said, adding that these people are seldom the poorest citizens who have access to free clinics and other programs, but rather the working poor unable to afford insurance premiums. Additionally, some studies suggest that between 700,000 and 800,000 people each year face bankruptcy because they are unable to pay medical bills, Reid said.

This creates a moral dilemma, Reid said, for the world's richest nation.

"The design of any country's health care system is a moral question—it's a political and economic question too—but it's first and foremost a moral question," he said.

In the end, Reid said that that the health care bills currently passing through Congress don't do enough to fix the expensive, inefficient multi-model approach to health care in the United States. A switch to a single-model system is what is needed to ensure that all receive the health care they need.

"If we can find the political will to provide universal health coverage, the other rich countries can show us the way," he said.

Learn more

Listen to T.R. Reid speaking about health care on NPR.

Read more about T.R. Reid at the January Series Web site.

Learn more about the four basic models of health care systems.

Watch a PBS-produced documentary from T.R. Reid's travels.

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