In 2009, ahead of the 2010 passage of the Affordable Care Act, the country was in the midst of an animated conversation about the future of health care. T.R. Reid was right in the middle of it.
Reid, an author, correspondent for The Washington Post and former chief of its Tokyo and London bureaus, as well as a commentator for National Public Radio, chose 2009 to release his book, The Healing of America: A Global Quest for Better, Cheaper and Fairer Health Care. The book takes readers around the world, exploring health care systems in France, Germany, Japan, the United Kingdom and Canada. It points to the weaknesses, strengths and differences among their systems, but ultimately fixates on a single point: Despite their faults, health care systems that control costs while covering everyone — generally single-payer systems — work better than the American version of health care.
Reid notes that the World Health Organization, in "The World Health Report 2000," studied the health systems of 191 member states. France was rated as having the best overall system. Other high-ranking countries included Italy, Spain, Oman, Austria and Japan. The United States was ranked 37th. The study also looked at different parts of the health system. Most interesting to Reid was its judgment of "fairness." The United States ranked 54th on "Fairness of financial contribution to health systems in all Member States, WHO index, estimates for 1997," ahead of Chad and Rwanda, but behind Bangladesh and the Maldives. Not exactly a ringing endorsement for the richest country in the world.
Reid, 72, lives in Denver and is a major supporter of Colorado's proposed Amendment 69, known as ColoradoCare. Ultimately, Reid says he wants to see the entire country go to a single-payer system, but he says ColoradoCare is an important first step.
"A lot of important ideas — let's see free public education, female suffrage, child labor laws, interracial marriage, recreational marijuana — started in one state and the rest of the nation copied it," he says. "That's why I say, this is a chance for Colorado to be the leader. We can lead our country to a place we should have gotten long ago, which is high-quality health care, at a reasonable cost, for everybody."
We spoke with Reid about health care around the world, ColoradoCare, and how change happens in America.
Tell me about your book.
"It asks a simple question: How come all the other countries like us, advanced democracies, can provide health care for everybody and spend half as much? And I think it answers that question."
I remember that when I was reading this book years ago, a lot of the systems were really different. Some had private and public components, others were totally public systems.
"Yes, thank you for remembering that. So, my basic contention is, it's pretty simple: A decent ethical democracy ought to provide health care for everybody. And in fact, as my book shows, all of them do, except the U.S. We're the only industrialized democracy that doesn't cover everybody. I think we should, and I say we could, because all the other countries like us already do it, and in the process, they spend half as much and they all have better health outcomes. I mean when you look at comparative health statistics, it's embarrassing to be an American.
For example, the Commonwealth Fund in New York does comparative studies, it's an independent charity in New York. [Commonwealth Fund describes itself as a private foundation that promotes a high-performing health care system with better access for all, especially the vulnerable.] ... On neonatal mortality — that is keeping newborn babies alive till their first birthday — the U.S. ranks 23rd out of 23 richest countries. And what I discovered is, it's not because there's any problem with our OBGYNs or our hospitals ... The issue is all the people who don't get care ... Obamacare expanded coverage in the U.S., but, according to the Congressional Budget Office, there are 33 million people without health care in the United States today — 370,000 people in Colorado don't have health insurance. [According to the Colorado Health Institute 2015 Survey it's actually 353,000.] And it's uninsured moms who have the babies that we fight like hell to keep alive, and then they die before their first birthday. It's shameful."
What spurred your interest in this subject?
"You know, I was a foreign correspondent. I worked for The Washington Post ... We stayed overseas about 16 years, and you know, the kids got sick [Reid had three young children at the time] ... and we had to go to the doctor. And at first we were kind of worried about this. You know, we're Americans. Everybody knows America does everything best.
And it turns out, the care was great, the facilities [in Japan] were fine, we didn't have to wait very long, and their prices were minute — one-tenth as much as you would pay, one-twentieth ... So, I just got interested in this as a reporter: How the hell do they do this?
... And then in the process of reporting on the "how they do it" I got into the other question, which is "why." ... I thought I was going to write a pretty mechanical book, here's how Germany does it, here's how Taiwan does it, and it turned out there was a very strong moral overlay to that book, because I think we've made the wrong moral decision. And I think we have an obligation as human beings to care for our neighbors when they're sick, and we don't do it."
What system does ColoradoCare most closely resemble of the various single-payer systems you've examined?
"It closely resembles Medicare, which is the U.S. system for seniors, in that the insurance scheme is public, funded by taxes, just like Medicare. But the providers, the docs, the hospitals, the labs, etc. are private ... So the closest model for what we're doing is Medicare, which has two great advantages: It's the most popular health insurance in America, it has the highest rates of satisfaction and it has the lowest costs because it's highly efficient." [Debate has raged about whether comparisons of Medicare's administrative costs to private insurers are truly fair, due to a number of complicating factors.]
Now obviously, we now have the Affordable Care Act. A recent report found that the number of uninsured has reduced drastically, and in Colorado only 6 percent of people are uninsured. So why change the system?
"Thank you for asking that. So, 6 percent means 360,000 to 370,000 people with no health insurance. And guess what? Those 370,000 people still get cancer. They still get hit by trucks. They still fall off roofs. And we treat them. We don't leave them to bleed to death in the street. They go to the emergency room. They're treated free because they have no health insurance and we all get to pay for them.
So, 6 percent uninsured is nothing to be proud of ... Premiums are going up at 10 times the rate of inflation. Last year in Colorado, inflation was 1 percent. The average premium went up 9.86 percent."
What would happen to all the people who work in insurance, and work in industries associated with our current health care system, should we come up with a new one?
"... In the 1950s ... half of the staff [of Denver's children's hospital] worked in the polio ward. And then the polio vaccine came along and all those people lost their jobs. Now is that a bad thing? My answer is no.
A resilient and innovative society replaces needless jobs with useful jobs. So the people whose job now is to deny your claim — which is not needed at all — can provide health care ... Some people will switch to other jobs, probably more useful jobs ... So yeah, I think that's a terrible argument. Nobody's making buggy whips in the United States anymore."