Amid all the hubbub about death panels and socialism that accompanied the last year's debate over health care reform, a crucial question was often ignored: How does the United States outspend everyone else on health care but still rank behind most wealthy countries on things like life expectancy and survival rates from major diseases?
In The Healing of America, author, commentator and Washington Post journalist T.R. Reid sets out to answer this question by visiting and studying a range of other wealthy democracies. The take-home lesson, repeated frequently during an hour-long conversation with the Independent, boils down basically to this: Provide universal health care, and the rest will follow.
Yes, that might sound paradoxical, but Reid illustrates how France, Germany, Great Britain, Japan, Canada and other countries have all done precisely that without embracing socialism or sending Grandma to an early grave.
Though Reid, 65, now lives in Denver, he remembers the day in 1998 when the idea for the book took root: Having just moved to England, he had to take his 12-year-old daughter to the hospital.
He was astonished by an administrator's response when he tried to pay for the visit: "We don't bill for medical care in our country."
Indy: Were there one or two moments in your travels when you thought, "Wow, this is the way a health care system should be run?"
TRR: The most striking thing was the realization that the other countries cover everybody. That's the most important point: They cover everybody. And then figuring out that universal coverage actually saves money.
This is a point I have not been able to get across to the U.S. Congress, but the fact is, if you provide coverage for everybody, you spend less per capita on health care than an erratic, spotty system like ours.
Indy: In Sicko, Michael Moore makes the case that health care works a whole lot better in other countries than it does here. You argue along similar lines in your book, though obviously in much more detail. What did you think of the movie?
TRR: I think Michael Moore's film was wrong. I think it was OK when he was in America, but when he went overseas, it's just far, far too simplistic.... No system is perfect. They all have horror stories, they all have real problems with cost, and they're definitely not all socialized medicine.
Indy: I have a cousin in England who developed a golf-ball sized lump on his finger, but it took months to get it dealt with. As our health care debate exploded last summer, this kind of fear — that health care will be rationed if reform goes through — kept coming up. How do you respond to those kinds of concerns?
TRR: I'm very tough on Canada's system in my book. My chapter on Canada is called, "Sorry to keep you waiting," because that's what they do. They do have long waiting lines. ... Britain, too, although I think the waiting lists in Britain are much shorter now than they were when I got there in 1998. But, yeah, it's definitely true.
On the other hand, some countries — Germany, Japan, France — have shorter waiting times for just about all medical procedures than the United States. ... So, yeah, some countries keep you waiting, and some countries limit choice, but many countries do better than we do.
For example, Rudy Giuliani said he had prostate cancer and, if he'd lived in Britain he'd be dead because they have a lower recovery rate from prostate cancer. He's right. Prostate cancer and breast cancer, America leads the world in recovery.
Indy: I remember [U.S. Rep.] Doug Lamborn brought that up at a town hall meeting last summer.
TRR: That's right. But virtually all other chronic diseases, in fact most cancers, and all other chronic diseases — let's see, lupus, both kinds of diabetes, chronic arthritis, cardiovascular disease — [for] all those other diseases, Britain has a better recovery rate than we do.
[You] can find two or three examples, there's no question, where we do better ... but on most ... the British have a better recovery rate than we do.
Look, all the other industrialized democracies have a longer life expectancy than we do. All of the other industrialized countries have a longer life expectancy at age 60 than we do.
Indy: When Barack Obama was elected president, health care reform seemed imminent. Now, that agenda has hit some major bumps. ... Do you think we're closer now or further away from fixing the system?
TRR: I think in some ways we are further away, and here's why: All the other countries have made the decision to cover everybody. There are a lot of reasons for doing that, as I said — better health, lower cost — but the major reason they did it was they made a moral decision that they are going to provide health care for everybody who needs it. ...
Universal coverage is quite often seen as the equivalent of big government, nanny state, big-expense, trillion-dollar government takeover of medicine. It doesn't have to be that way ... but I think that is the feeling now. I think if you said now, "I believe that all Americans should have health care," they'd call you a big government, socialist, lefto guy, you know? I think that's a setback for the argument.
Indy: Do you think our political system is equipped to solve this problem?
TRR: Absolutely. ... Our political system can definitely make change if somebody leads us there. ... I don't think it's the political system, I think it was a failure of leadership.
Indy: With a health care summit scheduled for Feb. 25, do you think there's any prospect for moving forward with reform?
TRR: I think you could define a compromise plan that could work. It would involve Democrats agreeing to limits on malpractice awards, because that's important to Republicans. It's a legitimate issue. And it would involve some means of expanding coverage.
Indy: Suppose Congress and the President turned to you and said, "Mr. Reid, redesign our health care system." What would you do?
TRR: The first thing I'd do is say, "Let's cover everybody. Everybody in our country is going to have coverage." That's the destination, and that's the most important thing. ... You could do it through Medicare for all. That would work. You could do it through private insurance for everybody. ...
The thing I would tell the President — and have told many members of Congress — is, you first have to commit to cover everybody.