Terry Gross | National Public Radio | August 24, 2009
Original radio program available here.
This is FRESH AIR. I’m Terry Gross.
It’s proving awfully difficult to change our health care system and provide care for people currently uninsured. Yet, as T.R. Reid points out in his new book, all the developed countries except the U.S. have decided that every human being has a basic right to health care.
Reid says we can bring about fundamental change by borrowing ideas from foreign models of health care. His conclusion comes from personal experience. He spent years as a foreign correspondent for the Washington Post and lived with his family in three continents.
For his new book, he went on a global quest, searching for solutions to two health care problems: the first, our nation’s health care system; the second, his bad shoulder.
He took his shoulder to doctors around the world, seeking alternatives to the risky surgery that was recommended for him the U.S. T.R. Reid’s new book is called “The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care.”
T.R. Reid, welcome back to FRESH AIR. One of the main arguments that we’re hearing from critics of reform is that this would be socialized medicine. You point out in your book that that argument was actually created by a PR firm in the 1940s. Can you describe what happened then?
Mr. T.R. REID (Author, “The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care”): Yeah. Harry Truman wanted to provide universal health care in 1947. The American Medical Association, the doctors, hired a PR firm, who invented the term socialized medicine. Nobody knew what it meant, but I think the idea was if you wanted to provide health care to your sick neighbor, you were a commie, and you know, during the Cold War, that was a powerful argument.
The amazing thing is it’s still a powerful argument. I don’t know that anybody can define socialize medicine, but nobody seems to like it, except, Terry, when Americans get government-run medicine, they really like it.
The VA, the Native American Health Service and Medicare are the three most popular health care systems in America, all run by government.
GROSS: Now, you’ve broken down Western health care systems into four different categories. I think it would be really helpful for all of us to understand what some of the options are out there, how other countries do it. Let’s talk about those systems.
Let’s start with what is often called the William Beveridge Model because he’s the person who inspired the British National Health Service, and you describe the British National Health Service as probably what’s closest to what Americans have in mind when they talk about socialized medicine. So give us an overview of that system.
Mr. REID: Yeah, well in the Beveridge Model, taking care of people’s health is government’s job just like picking up the trash or putting out fires or running the public library. When you need the service, you get it, and you don’t pay there. You pay for it in taxes. It’s a government service.
About 97 percent of the people in Britain and Spain, Italy, New Zealand – those are also Beveridge-Model countries – never get a doctor bill in their life. They go their whole life and never get a hospital bill. How do you do that? You assume that it’s government’s job to keep people healthy.
I would say that’s socialized medicine. Government owns the hospitals. It employs a lot of the doctors and nurses, and government buys the pills, government pays the bills. Yeah, I’d say that’s socialized medicine. But you know, you get a lot of benefits out it.
For one thing, it’s so simple administratively. You know, the billing office of a British hospital with 900 beds, and I said to the guy, where’s the billing office? Oh, yeah, it’s one drawer in my secretary’s desk over there, which she opens once a month to send some record to the government.
It’s just so much simpler. There’s one set of rules. So those systems really work. And you know, our family lived in Britain, and guess what happens, Terry? Your kid has an earache. The doctor comes to your house. She goes back and sees your child. She says, I believe it’s otitis media. I gave her a penicillin jab. Your kid feels better, the parent feels better, and then guess what? She walks out the door. No bill, no three-month, then, fight with the insurance company over who’s going to pay the bill. So I found a lot to like in Britain. For our family, it worked well.
GROSS: Are there insurance companies in England?
Mr. REID: Yeah, because the NHS covers almost everything.
GROSS: NHS is the National Health Service.
Mr. REID: The National Health Service, I’m sorry. Yeah, the free service. There are private insurance plans that will cover things they don’t cover, like Botox or breast enlargement. Private health insurance will get you to the top of the waiting list faster – although now, because Tony Blair spent so much money -the waiting lists are a lot shorter. It’ll get you a private room in the hospital.
About 10 percent of the people in Britain have private insurance, but it only accounts for about three percent of the money spent on health care. When anything serious has to happen – this is interesting – people go to the public hospital.
I had a really good friend who had a baby. She had private insurance, and I said, well, are you going to go to a private doctor? Oh, no, no, no, no, no. For my baby, that’s too important. I’m trusting the NHS.
GROSS: So what about the question of choice. Can you go to any doctor you want to? Can you see a specialist if you want to?
Mr. REID: Britain has a gatekeeper system. You have to go to the general practitioner first, just like in a lot of American insurance plans. You can go to any GP in the country, but most people pick they guy who’s right down the street. Our doctor was two blocks away.
So when we called her, she could get down to our house in an hour. But if you want to go to an orthopedist or a cardiac surgeon, then you have to go to the GP first and get a recommendation. And when we lived there – well, we came home, what, four years ago – there was still some waiting lines to see specialists. It was tough, but I think those waiting lists are way down, as I said, because Blair and Brown have spent a lot of money.
GROSS: On the health insurance system.
Mr. REID: Yeah, yeah. One of the ways – you know, they have that thing on Britain on Wednesday where the prime minister stands up in parliament, and the other party insults him and shouts questions at him. And one of the most-standard questions is: A woman in my constituency has been waiting four weeks to see a doctor. This is outrageous. And that happens, and then the answer that the prime minister always gives is, well, obviously, the gentleman opposite wants to see us institute for-profit, American-style corporate medicine. This we will never do. You know? And they never will.
GROSS: Is that the worst thing that you can say, we’re going to institute American-style corporate medicine?
Mr. REID: All over the world, people say that. If you complain about health care, they say well, you want to move to America? You think that’s better?
Everywhere I went, people had this kind of smug superiority. They know. They know that we let people die and go bankrupt by the thousands in our health care system, and they don’t do that, so they feel better.
A person in the Health Ministry in Canada – you know, they’re kind of understated people in Canada – said to me, you know, we don’t go around chanting we’re number one like some countries I know, but there are two areas where we’re better than the states: hockey and health care.
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GROSS: Now, what about the question of choice? You quote the British health minister as saying we cover everybody, but we don’t cover everything. So what are some of the things that the British National Health Service won’t cover?
Mr. REID: Well, I’m a man of a certain age, and in America, a man like me would get a prostate cancer test, a blood test for prostate cancer. And I was really friendly with my GP in Britain and said to him, hey, I should get this test. I get it at least once a year in America. He said no, no, we don’t think it’s cost effective.
So I’m thinking hey, if it finds cancer in me, it’s pretty cost effective. I like that. But they were thinking of an entire society, and of course, as we now know, the American researchers, too, have now concluded that that’s not a useful test.
GROSS: Is there anything that you would describe as rationing, the kind of rationing that Americans are really afraid of?
Mr. REID: Every country rations health care, Terry. There’s no question about that. And yeah, they do some of it at the end of life. They limit some of the procedures. They limit this drug, Herceptin, for breast cancer. They only allow that in certain cases.
That’s certainly true in Britain, but it’s true everywhere. Every country rations health care. This is not a nice thing to say, but the United States rations health care. The distinction is we ration differently from everybody else. I think this is important.
In the other countries, they have sort of a basic floor of care that everybody has access to, and the result is nobody dies for lack of a doctor. In America, some people get everything. The ceiling is the sky, you know, kind of thing, and get it right away with no waiting, but a lot of people don’t have access to care. So that’s how we ration. We ration by cutting off access for tens of millions of people, and no other country rations health care that way.
GROSS: Okay, and here’s another question about the British National Health Service. You mentioned that there is kind of rationing at the end of life. So what are some of the procedures or some of the things that are, you know, typically done at the end of life in the United States that wouldn’t be done under the National Health Service in England?
Mr. REID: That’s really hard to say. I think there’s an age cutoff in Britain, and it’s kind of hard to figure out what that is, I think it varies by region, after which they won’t give you kidney dialysis. That’s a fairly expensive and intrusive procedure, and at age 89, 90 or something, they won’t do it, but that’s true in some plans in America, too.
So this business about throwing grandma off the cliff I think, frankly, is bologna, and I’ll tell you why. There’s a standard statistic, Terry, in health care: healthy life expectancy at age 60. How long are you going to live on the day you turn 60?
All the other rich democracies have a longer life expectancy at age 60 than 60-year-old Americans have. So they can’t be throwing seniors off the cliff over there. They’re keeping them alive longer than ours are.
GROSS: If you’re just joining us, my guest is T.R. Reid. We’re talking about his new book, “The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care.” Let’s take a short break here, and then we’ll look at other countries around the world and how they do their health care and what we can learn from that. This is FRESH AIR.
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GROSS: If you’re just joining us, my guest is T.R. Reid. And we’re talking about his new book, “The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care,” and it’s based on his travels around the world, looking at health care systems in other countries.
We’ve talked a little bit about the British National Health Service model. Let’s look at what’s often called the Bismarck model. This is a model that was developed in Germany that’s used in several other countries, including Japan, France, Belgium, Switzerland. Let’s look at the French model because you seem particularly interested in the French system, and I think that was rated the number one health care system by the World Health Organization study that ranked countries around the world. So…
Mr. REID: Yeah, everybody in France knows this. They’re thrilled about this. The World Health Organization did rate them number one, and you know, I went there. I can see why. It’s a very good health care system. But in contrast, do you remember we said the British system, the government provides the care, and the government pays for the care? These Bismarck models on the continent of Europe and in Japan, they’re all private. They’re private docs, private hospitals and mainly private insurance plans.
GROSS: So are these insurance companies in this model that France has, are they for-profit companies like our for-profit insurance companies?
Mr. REID: No. No country that has insurance companies lets insurance companies make a profit on basic health insurance, and they have pretty strict rules. I mean, this is nice insurance. In Germany, for example, there are about 200 insurance companies. It’s not single-payer. I want to make that point, 200 insurance companies. Anybody in Germany can buy any of the 200 (foreign language spoken) plans. If you don’t like your insurance, guess what: You can drop it, shift to the next guy, and the new guy can’t raise your premium. Now, that’s, you know, more choice than anybody in America has. These companies have to cover everybody. They have to pay every claim. They don’t have all those people going through, saying sorry, we don’t cover that.
In many countries, if you’re stressed, and the doctor says you need a weekend at the spa, the insurance has to pay for that. That’s in the law. Generally, they have to pay in a short period of time. In France, the doctor has to be paid within three days. Get this: In Switzerland, if the insurance company doesn’t pay your claim in five days, your next month’s premium is free.
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Mr. REID: That’s pretty good health insurance.
GROSS: That’s amazing.
Mr. REID: Yeah, exactly. People actually like their health insurance companies in those countries. And you know, this business in America where we have the in-network deal, or you have to get pre-authorization, in France – this is true in Germany, in Japan – any doctor, any clinic, any chiropractor, anybody in the entire country, you choose them, you go, and insurance has to pay the bill within two weeks or so. Pretty good insurance.
GROSS: I’m trying to understand how a nonprofit insurance company would operate. I think there’s some of them in the United States, but for the most part, we in the United States think of insurance companies as companies that kind of bet against you in a way.
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GROSS: They’re betting that they’re going to make money off of you because your health is going to be good or not so bad or whatever. And if the odds are against you, they’re going to try to drop you or not insure you in the first place, but it’s a gamble. The whole insurance industry in America, it’s gambling, and you sometimes lose – as the insured – you lose the gamble. So what’s the different between a for-profit, American-style insurance company and a French, nonprofit-style insurance company?
Mr. REID: Well, all over the world, health insurance is nonprofit except the U.S.,. And as a matter of fact, when health insurance started in the U.S., the original Blue Cross and Blue Shields in every state were nonprofit, and they operated fine. The concept is more like the taxes you pay to operate the fire department in your town. Most people will never have a fire at their house, and therefore, the fire department makes enough money from everybody to put out the ones that do happen.
In those countries, the insurance companies are basically charities. They’re community organizations, and they have one goal in life, and that is to keep people healthy. That’s what they’re for, and the reason for that is those countries have all decided that there’s a basic conflict between making a profit for investors and covering people’s health.
The last country, as I say in the book, that allowed health-insurance companies to make a profit on the basic coverage was Switzerland. And guess what: In the mid-’90s, the Swiss companies were copying our companies. They finally decided, well, why should we sell a policy to anybody who’s sick? They might make a claim and cost us money. So they started turning people down for pre-existing conditions. Switzerland got the point – and fasten your seatbelt, Terry – five percent of the people in Switzerland couldn’t get insurance, and that was a scandal. That was unthinkable. Well, we’re at 16 percent today, but that was not acceptable in Switzerland. So they had a national referendum, took the profit out of insurance and said that everybody has to have a policy.
GROSS: So in the model that we’re talking about that France and Germany, Belgium, Switzerland and some other countries follow, do you have your choice of insurance companies, or is there just one national company that you buy from?
Mr. REID: In some countries, like France and Japan, you get the insurance that applies to your industry or your company or your region, and that’s it. But some countries – Germany, Switzerland – Germans can choose any of 200 health insurance plans, and the plans do compete, even though they can’t make a profit. Now why do they do that? Well, one reason is the more members, the more customers they plan has, the more money its executives make. So that’s a reason to compete.
In Switzerland, it’s interesting. The same company that sells the nonprofit, basic health insurance plan also sells life insurance and fire insurance. And they sell this kind of supplemental insurance to cover breast enlargement or hair replacement. So they try to win you by being really good, nonprofit health-insurance companies, and then you say oh, that’s good. I’ll buy my fire insurance there, too. And they’re all making more money because they use the basic health insurance as a way to bring in customers.
GROSS: When you say they’re making more money, do you think that the salaries of insurance executives in the countries you’re talking about now compare to the multi-multi-million-dollar salaries of insurance CEOs in the United States?
Mr. REID: Oh, no. But nobody makes American-insurance-CEO kind of salaries.
GROSS: One of the things I loved about your description of the French health care system is the health care card that everybody carries. Why don’t you describe what makes that so special?
Mr. REID: The Carte Vitale, yeah. French doctors don’t make a lot. They do fine. You know, they’re good, middle-class people, but they’re not rich, and their offices are Spartan, you know. They don’t have National Geographic sitting on the table. There’s just a plain, white waiting room and then the doctor’s office – but what’s missing in all doctors’ offices in France is the files and files of patient records, and there’s no billing office.
And I said to this doc I spent some time with, where’s your billing office? He said, oh, this would be ridiculous. I don’t make enough to pay somebody to do the billing, but he doesn’t have to. Here’s what happens: The patient comes in. Out of her pocket, she pulls this green credit card. It’s called the Carte Vitale. He puts that in a reader on his desk, and her entire medical record shows up on the screen. And he chats with her about her problem. He’s typing down what she’s got wrong, and he says to her well, I think I’m going to prescribe a course of antibiotic, and I want you to take two a day for two weeks. And he’s typing all that up.
And then he’s finished with her. He turns to me, and he says Monsieur Reid, please watch. He hits one key on his computer, and the entire bill has gone to her insurance company. He’s going to be paid in three days, and she’s going to get her co-pay back from the insurance company within two weeks, done. No paper.
GROSS: And the next time she goes to a different doctor, he can put her card in the reader and see what this doctor had prescribed and what this doctor thought.
Mr. REID: That’s right. He’ll say oh, did that other antibiotic work for this condition when you had it two years ago? Yeah, it’s perfect. They find you. And your record – you can actually see on this card. There’s a little gold chip, as you saw in the book, where your health records are. So doesn’t this raise privacy problems? And I asked that in the health ministry, but he says they’ve never had a problem with identity theft or people stealing records because this is encrypted. And I guess the encryption’s pretty good.
GROSS: Now, Japan has borrowed this model that France has. And you say that in Japan, there’s good access to fine doctors and lots of choice, but the system is overstretched, and it’s pinching pennies. So how does that affect the health care of Japanese people?
Mr. REID: Well, their health care is fabulous. They have the longest lived and the healthiest population in the world. They have much better recovery rates from every major disease than Americans do. It’s just a marvelous health care system, and they love going to the doctor in Japan. In Japan, on average, people go to the doctor 15 times a year. We go about 4.3 times per year in America. The average hospital stay in Japan is 36 nights. Ours is six nights.
So they’re big consumers of medicine – very, very good results, but the Japanese spend less than half as much per capita as we do. How do they do that? The answer is they’re stingy. They have the stingiest pay scale of all the rich countries. Docs and hospitals just don’t make much money. And the result is a lot of hospitals in Japan are now borrowing money from banks just to operate. It’s really, they’re under severe strain. The solution: They spend eight percent of GDP on health care – we spend about 17 percent. If they raised that to nine percent, they could pay all their doctors and hospitals a better wage, but so far, they’ve tried to resist that. But they’re going to have to do it.
GROSS: So that would mean just raising the taxes a little bit.
Mr. REID: Yeah, or maybe raising the insurance premium or something.
GROSS: Journalist T.R. Reid will be back in the second half of the show. His new book is called “The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care.” I’m Terry Gross, and this is FRESH AIR.
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GROSS: This is FRESH AIR. I’m Terry Gross back with journalist T.R. Reid. We’re talking about what the U.S. could learn about health care reform by looking at other developed country systems that are based on the premise that every human being has a basic right to health care. Reid is a former Washington Post foreign correspondent and has lived on three continents. He travelled around the world researching his new book which is called “The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care.”
We’ve talked a little about Britain’s National Health Service. We’ve looked at the French model, which is used in Germany, and Japan, and several other countries. Let’s look at the model in Canada, which you describe as the National Health Insurance model. What’s the basics of that model?
Mr. REID: You remember in Britain, government provides the care and government pays for the care. And in Germany the providers and the payers are private. The Canadian model is a blend. They have private docs and private hospitals but the payment system is public. It’s one big government system – actually it’s 14. There’s one for each province. Everybody pays. In some provinces it’s a tax, in some provinces it’s called a premium. You pay in every month, just like we pay Social Security tax and Medicare tax. You go to the doctor and it’s free. And this really works pretty well. The docs are private and they just bill the government. You just – you don’t get a bill and this means anybody can go. It means nobody with an acute condition in Canada dies for lack of health care as happens in America.
The flaw with the Canadian system is, to save money they’ve cut back sharply on the number of specialists, on operating rooms, on scanning machines. So if it’s anything that’s not acute they keep you waiting. I mean they keep you waiting weeks or months.
You know, I have this bum shoulder and I said to this wonderful doctor I was with in Canada, I got a bum shoulder. It really hurts me. He said yeah, I better send you an orthopedist. How long would it take? He said oh, 10 or 12 months.
Mr. REID: Twelve months?
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Mr. REID: Twelve months. It hurts. It hurts every morning when I wake up and I got to wait 12 months to get treatment? This guy says, oh I didn’t say treatment. No. It would be 10 months or so to get a consultation. If he wants to do anything it’ll be six more months before an operating room comes up.
So this is just the choice they made. It’s not a function of their system because other countries that have the same system don’t have waiting times. But it’s absolutely true that Canada keeps people waiting. They did it to save money.
GROSS: Can you get supplemental insurance and, through that, jump ahead of the line?
Mr. REID: Ha. That’s up in the air at the moment. The Canadians are so egalitarian – the Swedes did this too, they first said no, no. We have a very good health care system here and that’s where you’re going to get your health care. Obviously some people in Canada could go south to America and buy health care without waiting in the line. The number of people who do that seems to be pretty small. It’s not as big as you hear in the argument in America, but some do that.
But three years ago – was it? The Canadian Supreme Court ruled that they can’t bar you from buying private insurance and going to private doctors. And this created all sorts of concern in Canada because their big bugaboo, you know how we’re all worried about socialized medicine? Their equivalent to that term, the thing they all hate is two-tier medicine. They definitely don’t want a system where rich people get better care than poor people. That would be un-Canadian.
And so what they did is they tried to step up the spending on the system they have so that people can get care. And as it turns out, there are a few places in Canada where a doctor can operate privately, but not many, because the rule is if you operate in the Medicare system, in the national system, then you can’t also treat people privately. So you got to be a doc in a pretty rich neighborhood to have enough private customers to make a living.
GROSS: Let’s look briefly at the fourth model that you write – the fourth and final model that you write about in your book “The Healing of America,” and this is the out-of-pocket model which you can sum up pretty quickly.
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Mr. REID: Yeah. And that’s the most common model in the world because it’s only the 40 or 50 richest countries that really have a health care system. In all the other countries in the world, maybe 150 countries, here’s the rule: If you can pay your doctor out-of-pocket, you get treated. If you can’t pay, you stay sick or you die. That’s it. Brutal, simple, it’s a fact of life in most countries.
Some Third World countries have a big hospital in the capital city where people can line up, but out in the villages, no care. So people, if they have money they pay in money, if – they pay in potatoes, they weave a rug. In some countries the woman brings her child in and serves as a wet nurse for the doctor’s baby to pay. But basically this is a brutal system and if you don’t have the money, tough.
GROSS: Okay. So we looked at four models and three of the four models – and these are the three models that most Westernized countries use, everybody is guaranteed health care. Now, you write that in America we have aspects of all four of the models. The three models where people are guaranteed health care and the fourth model is if you don’t have the money you don’t get the treatment. So explain how we have aspects of each of those models.
Mr. REID: Yeah, so look, please don’t tell my publisher because I spent a lot of their money. I went all around the world for three years looking at these different models of health care.
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Mr. REID: Turns out we have them all right here in the United States. If you’re a Native American or a veteran you live in Britain. They get government health care and government hospitals from government doctors and they never get a bill.
If you’re an employed person sharing your health insurance premium with your employer, you live in Germany. That’s the Bismarck model that was invented in Germany and used in many countries.
If you’re a senior and you buy Medicare insurance from the government and go to private doctors, you live in Canada. That’s the Canadian model. As a matter of fact, the Canadian health care system is called Medicare, and when Lyndon Johnson provided it for our seniors in 1965 he borrowed both the model and the name from Canada.
And if you’re one of the tens of millions of Americans who can’t get health insurance, well, you live in Malawi or Madagascar or Mali or something, because if you can pay for health insurance you get it, or maybe you can line up at the free hospital sometime.
We’ve got them all and that’s really the most important difference. All the other countries have decided that it’s cheaper and fairer to provide one model so that everybody has the same access to the same care at the same price.
GROSS: But it’s not just a sense egalitarianism that underlines your criticism of our multi-tiered health care system, it’s also really an expensive system to maintain because there’s so many different systems within it. There’s so many different forms of billing. There’s so many different prices. Give us an example of why that really both complicates things for doctors and patients and also makes it much more expensive.
Mr. REID: Well, just think about it. It’s just vastly simpler if there’s one set of rules and one set of forms and one price or one regional price for the whole country. You know, you go to the doctor in France and that doctor, by law, is required to post on the wall the price she’s going to charge you for the hundred most common procedures that she does. And then the next column says how much insurance is going to pay you back. And the next column says how many days before the insurance pays you. No doctor in America could do that because they don’t know what they’re getting paid. They get 30 different fees for the same procedure in the same week because of all the different plans.
The result is enormous administrative complexity. The American health insurance industry – you know, it’s free enterprise, it’s competitive, those guys, as we said, make huge salaries – it’s the least efficient payment system in the world. They spend 18 to 20 percent of every premium dollar on administration costs.
You think of France, Terry, as a model of management efficiency? The French insurance industry spends four percent on administration. Germany, five percent, Japan about five percent. So we are just pouring tons of money into stuff that doesn’t buy anybody health care largely because we have this hugely complicated overlapping set of systems and that’s one of the reasons all the other countries went to a single system.
Another reason is if everybody’s in the same system – and it doesn’t have to be a single-payer. Japan has 3,000 payers but it’s a coordinated system with one set of rules. If everybody’s in it then they have an economic incentive to pay for preventive care.
Preventive medicine works but it costs some money up front. And, you know, in our system your insurance company’s probably only going to cover you for five or six years until you move to the next job. It’s not in their interest to spend money to keep you healthy. By the time you get sick, you’re somebody else’s problem.
GROSS: My guest is journalist T.R. Reid and his new book is about health care systems around the world and what we can learn from them. The book is called “The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care.”
Let’s take a short break here and then we’ll come back and talk about your shoulder…
(Soundbite of laughter)
GROSS: …and how it was treated under health care systems around the world. This is FRESH AIR.
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GROSS: My guest is journalist T.R. Reid and we’re talking about his new book which is called “The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care” and about his travels around the world looking at different health care systems and trying to figure out what we can learn from them.
Now, one of the reasons why you undertook this travelogue around the world looking at health care systems is that you have a bum shoulder.
Mr. REID: Yes.
GROSS: And tell us briefly what’s wrong with your shoulder.
Mr. REID: I fell and broke my shoulder in the U.S. Navy 30-some years ago and the Navy fixed it at Bethesda Naval Hospital. They basically, literally screwed my shoulder back together. There’s a big stainless steel screw in there you can see in the x-rays. And I’m getting old now and it’s freezing up. I can’t swing a golf club anymore. It hurts when I wake up in the morning.
So my major quest in this book was to see if we could find a better way to do health care in America. But let’s admit it. I also had the selfish reason -maybe I could get good care for my shoulder too, so I set out to see what I could do.
GROSS: Now in America the doctor you saw recommended a very challenging…
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Mr. REID: Exactly. Yeah.
GROSS: …surgical operation for you which would’ve been what?
Mr. REID: Well he’s an orthopedic surgeon and they’re confident guys. I showed him my sore shoulder and he comes in the room with this little red metal box, and he opens it up and said, okay here’s your new shoulder. He’s going to cut out the shoulder that God gave me with a saw and put in this piece of titanium and Teflon and that’s going to replace my shoulder. It’ll work fine he says. He’s a good guy. I like this doctor. Well what could go wrong? And he said well, you know, it’s major surgery. There are always some problems. Like what? And he says well, you know, death, paralysis, disease.
(Soundbite of laughter)
Mr. REID: So I said, well, maybe I’ll go look around.
GROSS: Okay. So let’s start with England. You took your shoulder to England…
(Soundbite of laughter)
GROSS: …and what was the advice you got there?
Mr. REID: In Britain that’s, you know, where they invented the stiff upper lip, and to be blunt about it, my GP in Britain said live with it. It’s not destroying my life that much. I got another hand that I can reach up and change light bulbs with, you know. So he said I could send you to the orthopedic surgeon, he’d look at it, he’d say no not serious enough. We’re not going to do the operation and you could come back to me, we could send you to another surgeon, he’d say no. He says I’ll tell you what, the NHS, the National Health Service, we’ll give you physio – that’s physical therapy, and that’ll help some. That’ll reduce some pain but go home and live with it. That’s the advice he gave me.
GROSS: Okay. Was that satisfying to you?
Mr. REID: You know, it helped a little. It helped a little. It’s not that bad and rather than sit around and moan about it, just live your life and you can kind of forget that your shoulder hurts. Yeah, it wasn’t bad.
GROSS: Okay. You went to France. What kind of advice did you get there?
Mr. REID: The guy, the orthopod in France loved me because he threw my x-ray on that light machine they have, you know, big smile on his face because he saw that stainless steel screw I got at Bethesda Naval Hospital. That operation was invented in France, it’s called the Latarjet Procedure, and this guy was so thrilled that I had French operation on my American shoulder, so we did just fine. And he said that he too could cut out my shoulder and give me an artificial one. And that would cost, it would only cost about six thousand bucks in France – a real bargain by American standards. He didn’t think that was recommended either. He thought physical therapy and maybe some pain shots would handle me fine. If I wanted the operation I could get it in France because they have a lot choice, but he didn’t think it made sense.
GROSS: He was recommended cortisone shots?
Mr. REID: Yeah. Like I think it was a steroid. But, yeah, that’s right.
GROSS: Okay. Okay. You went to Japan. What did they tell you?
Mr. REID: That was the most interesting doctor. For one thing, he was the only doctor I went to who called up my condition on a computer and read about it while I was in the room just to make sure he was right. He said in Japan they would definitely do that surgery if I wanted it, you know, replace my shoulder. He suggested monthly or bi-monthly steroid shots. He said I think you’re going to get a lot of elimination of pain with that and guess what: It worked and it was really cheap.
He suggested traditional Chinese medicine, herbal medications, and he suggested physical therapy. And he gave me the longest, widest range of anybody and all of it was covered by Japanese insurance. And I tried. I tried the traditional Chinese medicine. I had acupuncture and I know a lot of people get good results from acupuncture. I got nothing. I mean it didn’t hurt. It was kind of interesting to do it, but I got no gain. But Japanese insurance would pay for that too.
GROSS: I should mention that the cortisone shots and the physical therapy that the Japanese doctor recommended, you could have gotten same advice from a lot of America doctors and had your health insurance company in America pay for it, too.
Mr. REID: I think that’s absolutely right, yeah. I mean, I went to an orthopedic surgeon and, you know, they want to orthopedically surge, that’s what they want to do. But – and he’s a good one. I mean, I’m sure it would’ve helped.
GROSS: Okay. You had a very interesting experience in India.
Mr. REID: Yeah. In India, we went to an Ayurvedic clinic – that’s a 3,000-year-old Indian form of medicine. And it’s herbal and it’s all about getting the prana – the flow of power in your body to flow correctly. And the way they do it, Terry, is marvelous.
You lie on this dark neem wood table and six people massage you with warm oil. I mean it was fabulous. I did this for five weeks. I made a movie about it for PBS “Frontline,” called “A Second Opinion.” After the massage, then the guy would take me to the shower and these same strong masseuses would take this soap made out of green beans and wash the oil off my body. That felt great too. It was just great.
And after I made that movie, you know, trying to get my shoulder better, people would come up to me on the street and they would say one of two things: how’s your shoulder, or I saw you naked.
(Soundbite of laughter)
GROSS: So, how is your shoulder? Did that massaging helped?
Mr. REID: It definitely improved. I did not believe in this Ayurveda. It comes out of a Hindu religion. So, while I was being treated, they made me go over to the temple and walk three times around Dhanwantari, the god of healing, clockwise – had to be clockwise. They made a person from the Ahdjnapathy(ph) department – that’s astronomy – come in and read my star chart before they would treat me. I didn’t buy any of this. And guess what? I got much more movement and much less pain. It definitely worked.
GROSS: Well, I’m glad your shoulder is improved and I hope it stays that way. We’re having a lot of political obstacles in the United States that are slowing or preventing health care reform. You went to two countries that recently did remake their systems – Taiwan and Switzerland. And you see in both countries liberal political parties stepped up the pressure for change to such a level that the conservative parties were unwilling to resist. Would you elaborate on what happened in those countries politically that enabled major health care reform?
Mr. REID: Yeah. Taiwan is one of these new Asian tigers, you know. It’s a country that got very rich. They went from about a hundredth in the world in GDP per capita to 20th in the world in about 15 years. And once they got there in the mid-’90s, they said, well, we ought to have a rich country’s health care system. So, they did what I did in the book. They went around the world and looked at all the health care systems, including ours, and ended up choosing the Canadian model. And then they had this political fight to put it into effect. And the argument that the liberal parties took was, we’re a rich country now and rich countries have a moral obligation to provide health care for everybody. The pro-business party in power resisted that for a while. And then decided no, actually that’s right. We think we do have a moral obligation as a rich country to cover everybody. So then the conservative party grabbed onto the idea and they put it into effect before the liberals could win the next elections – pretty interesting development. And that’s just…
GROSS: You mean, it was so popular – reform became so popular that the conservatives decided they wanted to take credit for it?
Mr. REID: Yes, I think that’s exactly right. They saw they couldn’t stop it. Taiwan felt that they were a rich country, as important as any country in Europe or in the Americas. And rich countries have health care systems that care for everybody, which is true for all the rich countries except us.
GROSS: I should mention that doctors in a lot of the countries you went to get paid much less than doctors here. But as you point out, they don’t have to go as deep into debt to get their medical education as American doctors do.
Mr. REID: Yeah, most of them go to medical school for free or for almost nothing. And their malpractice insurance premiums are much lower than in the United States.
But I think a lot of it is expectation. They don’t expect to make $45,000 a year and drive a Lexus to the country club. They expect to be comfortable, middle-class people who are helping their patients and getting satisfaction in their life that way. And, frankly, a lot of American doctors have that same set of expectations. They don’t want to particularly be rich. They just want to treat their patients and help their community. And, of course, they see this ridiculous system we have getting in the way. So, I don’t think that’s such a big obstacle. I think – I talk to medical societies a lot and those docs definitely would accept a system with lower payments if they had an easier way to treat their patients.
GROSS: T.R. Reid, thank you so much for talking with us.
Mr. REID: Thanks.
GROSS: T.R. Reid is the author of the new book, “The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care.”
Coming up, Ken Tucker reviews a new CD by the band Deer Tick, whose music is inspired by early rock and roll, rockabilly, and country music. This is FRESH AIR.
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