I had the privilege of representing MLA at the Midcontinental Chapter/MLA annual meeting last week (Sept. 23-24) in Breckenridge, Colorado. It was a great conference. I enjoyed meeting so many members I had not met before, and visiting with many I know but had not seen for a while. I even got to see a little bit of snow while there, which was a treat since I don’t see much snow in central Arkansas.

The program for the Midcontinental meeting was excellent, but one presentation really stands out in my mind. It is the presentation given by T.R. Reid, a former reporter for the Washington Post. During the past several years, Mr. Reid traveled around the world to study different health care systems. His book entitled The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care was published about four weeks ago, and it is already on the best seller list. Mr. Reid gave one of the most succinct and clear presentations I’ve hear related to the current debate on health care reform. I thought his presentation was so enlightening that I decided to share my notes from the presentation with the MLA membership.

Mr. Reid said that the existing health care systems found throughout the world fall into one of four general categories.

  • Beverage model – Public Payer/Public Provider. Providing health care is the government’s job, and the government pays for the health care through taxes and provides health care. The government owns the hospitals, labs, etc. and pays for health professionals’ salaries and for drugs. Britain, Spain, Italy, New Zealand, Hong Kong and Scandinavia have variations of this system.
  • Bismarck model – Private Payer/Private Provider.Bismarck was the German Chancellor who united Germany in 1871. In 1883 he developed a health care system, but he didn’t want to raise taxes. In this system, everyone must carry health insurance through their employers and split the cost with them. Insurance companies, hospitals and doctors are private, but insurance companies are non-profit (Mr. Reid said that health care insurance companies in the US make a huge profit. The main reason they try to stall and get others to pay claims, or they try to deny claims is to maximize their profits.) Since the insurance companies in Germany are non-profit, they compete by providing more preventive services and keeping people healthier, which makes insurance costs lower and improves the citizens’ quality of life.
  • National Health Insurance model – Public Payer/Private Provider. In this model, health professionals, hospitals, and labs are private, but the payment is public (based on monthly taxes). The number of specialists is limited, and elective procedures are put on a waiting list. Canada invented the model in 1944. Canada, Australia, Taiwan, and S. Korea currently use this system, and Mexico (which has ¼ as much per capita income as the US) is implementing this plan next year.
  • No Health Care System model – This is also known as the Out of Pocket model, which basically means that those with money can purchase health care, and those without money get no health care unless they barter for it. Most of the countries not listed above have this “brutal” system.

Mr. Reid says that the US has all four models. The US VA and Indian Health Service systems are the beverage model (public payer/public provider), 59% of Americans are under model #2 (workers share health insurance costs with employers), Americans over 65 have model #3 (public payer/private provider) in the form of Medicare, and the 40 million Americans without insurance have #4 (pay out of pocket or get no health care). All other countries have one system for everyone, which he says is much more efficient and inexpensive than having a combination of systems.

Three major reasons Mr. Reid gives for having one system:

  1. Cost – In the US, administrative costs make up 20% of the total cost of health care, while France is at 4%, the UK at 5%, Japan at 5.5% and Canada at 6%. Lowering our administrative costs would save billions of dollars.
  2. Preventive care – Having everyone in the same system would provide a much stronger incentive for preventive care, which cuts costs, reduces illnesses, and saves lives. We don’t have incentives for prevention in our current system, and insurance companies try to shift the costs to each other or the public. The “world champion” in preventive medicine is the UK, because preventive care is more economical than treating sick people (and it improves quality of life)
  3. Fairness – It’s fairer to have one system which covers everyone. These are subjective and moral judgments, but the design of a health care system is a moral issue. Without the moral commitment to fairness, we will probably continue to have our current system that doesn’t cover everyone.

Mr. Reid said that the question facing the US is a moral one – Are we going to provide a fair system that includes health care for everyone? He said that until we get a consensus on this question, we’ll have a difficult time improving our health care system.

Health care is a $2.4 trillion business, there are many companies that would benefit from the preservation of the status quo, and they have strong lobbyists in Congress.

The US economy is based on the ideology that the free enterprise system is best, but that ideology is not always true.

The US is the only developed country in the world that does not provide health care for all of its citizens. If we can find the political will to provide universal health care coverage, other developed countries can show us the way because they are already doing it. I ordered Mr. Reid’s book when I got home from the Midcontinental meeting, and am looking forward to reading it.

I extend my thanks to the Midcontinental chapter LAC and program committees for providing an excellent meeting, and I thank the Midcontinental chapter members for their wonderful hospitality!

Mary Ryan