Comparing American Healthcare With Foreign Healthcare

Americans aren't always right, especially when it comes to healthcare. That's why U.S. lawmakers should look to other countries for solutions to healthcare reform, T. R. Reid argues in The Healing of America. Reid, a longtime foreign correspondent for the Washington Post, looks at other wealthy democracies to understand how they've accomplished what the United States has failed to do: provide universal, affordable, and effective healthcare at low costs. He recently chatted with U.S. News about other countries' systems, President Obama, and why healthcare reform prompts a moral question. Excerpts:

Why did you write this book?

I got intrigued with this question: How come all the other developed democracies manage to cover everybody with high-quality care and still spend half as much as we do? And I went around the world trying to figure out how they do it, and you know what? I think I figured out how they do it, but along the way I figured out there's a more important question, and that is why did they do it? Why does a country decide to provide healthcare to everybody who needs it? And if you think about that for two minutes, it raises another question: Why doesn't the richest country in the world guarantee healthcare for everybody?

Why is it important to look to foreign countries?

It's a good way to solve any problem. Whether it's a company or a college or a country, you need to face up to your problems. You can't put them off forever as we've tried to do with healthcare. One way to solve your problems is to see how other places like you have fixed them. Certainly all the other developed democracies have done a better job on healthcare than we do. They cover everybody. They have better results. They live longer. They're healthier, and they spend vastly less. There's a lot to learn there.

To what extent is healthcare a human right?

The other countries feel it is. The other countries, just like we do, they guarantee the right to vote. They guarantee everybody a public education if you want it. They give you legal protection if you are charged with a crime. We do all those things too, but the other countries have also decided that everybody has a right to healthcare when they get sick. The United States has never made that decision.

You say the idea that other countries practice socialized medicine is a myth.

Well, some do. In Britain, for example, the government owns the hospitals. Government employees allot the doctors. Government buys the pills, and government pays all the bills. That's, to me, socialized medicine. But many countries, rich countries, don't. Germany, France, Netherlands, Switzerland, and Japan—in those countries, they provide healthcare with private doctors, private hospitals, and private insurance plans. Many of those countries are less socialized than the United States. In Germany, Switzerland, and Netherlands, they stay with their private insurer cradle to grave. They don't have any government-run Medicare.

Is there something that's not in the Obama healthcare reform plan that you think should be added or something that should be taken out?

If you're going to make private health insurance work, you need much stricter regulation. You need regulation controls over their administrative costs. In other countries, the private insurers have administrative costs of 4 or 5 percent. In the United States, it's 20 percent. In all the other countries, insurance companies have to pay any claim that's certified by a doctor or hospital, and in America, about 30 percent of the claims are turned down. I bet you have had a claim turned down. I certainly have. The other countries have decided that shouldn't be allowed. That's not what health insurance is for.

So you think Obama's healthcare reform package doesn't go far enough?

The problem with talking about the Obama plan is we don't know what the plan is. One of the reasons he's had trouble selling his plan is he doesn't know what's in it. We don't know what this so-called public option would look like. We have no idea how the health co-ops work. We don't know what cost controls he's trying to build in. It appears to me that they're tinkering at the margins of a system that's already the most expensive and the most unfair in the world.

What do you think would surprise Obama most about this book?

Cost controls don't stifle innovations. You can cut cost and still get fabulous innovation. For example, anybody in America who has had a hip or knee replacement is standing on French technology. This deep-brain stimulus that's a huge breakthrough for mental disease, that's Canadian innovation. Even Viagra came from Britain. And those countries have strict cost controls. Second, foreign systems don't limit choice or keep people waiting all the time. Anybody in Germany can buy any one of 200 insurance companies' plans. If you don't like your insurance, you can cancel it; and the next guy has to cover you, and he can't raise your rates. So that's broader choice than anybody in America has. So when Obama is told by our healthcare industry, "Oh, geez, it's very hard to make these changes. We can't offer choices like that. We have to be cruel to people," no, it's not true.