Reid: U.S. Unique in lack of health care system

By Richard Haugh

The world offers four distinct models for providing and funding health care, all of which work — or don’t — to varying degrees and any of which could be adopted as a model in the United States.

The problem, T.R. Reid told about 400 businesspeople, political leaders and health care executives Tuesday, is that the United States is trying to make all four work simultaneously.

T.R. Reid, a former newspaper foreign correspondent and author of The Healing of America, delivers the keynote address at the Denver Metro Chamber of Commerce’s annual Health Care Policy Breakfast.

Reid delivered the keynote address at the Denver Metro Chamber of Commerce’s annual Health Care Policy Breakfast, held at the Donald R. Seawell Ballroom at the Denver Center for the Performing Arts complex.

Reid is a Denver-based commentator for National Public Radio, a former foreign correspondent for the Washington Post and the author of nine books, including The Healing of America, set for summer publication.

In researching his new book, Reid traveled the world to see what the United States can learn from health care systems in other developed nations. The fundamental difference, he said, is that all other countries have decided on one system that covers everyone.

“No one else has this crazy quilt of coverage that we have here,” he said.

There are 200 countries on the planet, and Reid said their ways of providing health care to their citizens can be distilled into four basic systems:

• The Beveridge model, such as Britain’s National Health Service, in which most hospitals and clinics are owned by the government, most doctors are government employees and health care is free to all who receive it. The system is financed through taxes, much like a public utility.

• The Bismarck model, as in Germany and Japan, where insurance is funded jointly by employers and employees through payroll deductions. Everyone is covered, doctors and hospitals are private, and insurance companies are nonprofit.

• National health insurance, exemplified by Canada. Providers are private, but care is paid by a government insurance program that every citizen pays into. Costs are low, but largely because the government limits services or makes patients wait for nonurgent treatment.

• Out-of-pocket model. This covers the three-quarters of the world’s countries that are too poor or disorganized to offer a health care system, such as parts of Africa, China, India and South America. Its premise is simple: the rich get medical care, and the poor do not.

“The interesting thing about these models is you don’t have to travel the world to find them,” Reid said. “They’re all here in the United States.”

Military veterans receive free care through government programs similar to Great Britain’s, Reid said. For people 65 and older, there’s Medicare, delivered in a fashion similar to Canada’s. (In fact, Reid said, President Lyndon Johnson used Canada’s name for its health care system when he proposed the creation of the Medicare program in the 1960s.) The working population receives care under an employer-employee insurance system like Germany’s. And the uninsured receive care — or not — just as they do — or don’t — in impoverished countries.

Reid didn’t promote a specific model, but said other countries have created successful single-model systems that provide coverage for everyone. The advantages of such a system include simplified administration, greatly reduced overhead costs and an economic incentive to keep people healthy.

But the biggest benefit of a single health care system, Reid said, is that it’s inherently fair.

“The most important distinction between the United States and other countries is that they’ve made the moral decision to cover everybody,” he said. “If we can find the will to cover everybody, the rest of the world can show us the way.”