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T.R. Reid: Elsewhere, Heathcare for Everyone is a Moral Issue

An internationally prominent writer on healthcare presented a comprehensive review of the wide range of national systems around the developed world Monday, and combined it with a discussion of the singular conditions and practices in this country. Though he pledged to be objective at the outset, T. R. Reid’s address amounted to a detailed outline of the severe deficiencies in American healthcare.

Reid appeared as the keynote speaker at the Sixth Annual Conference of the P2 Collaborative, an area Robert Wood Johnson-funded planning and consultancy organization, at the Buffalo-Niagara Convention Center. Reid, an erstwhile lawyer, has also been a national and foreign correspondent for the Washington Post, a documentary filmmaker, and an NPR and PBS commentator. He is the author of a widely read study of international healthcare, “The Healing of America.”

Beginning in a casual, even breezy mode (“Did I mention I have a book?”), he moved on to a short catalogue of what he took to be the four major modes of public healthcare models in the world: The Beveridge Model, the Bismarck, the Douglas-Canadian, and the out-of-pocket.

The first, named for Britain’s Lord Wilham Beveridge, was begun in Britain just after the Second World War, and involves government-run hospitals and publicly employed medical personnel. “Is this socialism?” Reid asked the audience of around 150, before saying, “The answer is yes.” And “it works pretty well,” he continued. Americans, Reid said, are famously ignorant of Britain’s system, and its efficient, humane operation. “We know it’s bad, but we don’t know what it is,” he quipped.

Named for Germany’s 19th-century Iron Chancellor Otto Von Bismarck, this model keeps private providers but mandates citizen coverage, paid for with employee-employer withholding taxes, much like in this country’s Medicare. Reid noted two related ironies: Americans are unaware of the German influence on this popular program, and Bismarck was an autocratic rightist, but one who valued social cohesion and a healthy populace.

In Canada’s program, devised by Saskatchewan’s socialist premier Tommy Douglas in the early 1940s, the government pays private providers from citizens’ monthly premiums. “Does it sound like a tax?” Reid said in another of his rhetorical questions. Well, it is, he responded.

The fourth model is scarcely one, and found in scores of poor nations. “It’s simple and brutal,” he said. “You pay if you can, or you may die.”

The US, he said, doesn’t fit into any of these. It has a crudely inefficient, ill-fitting, gap-interrupted amalgam of the four models, with the result that at least 48.6 million of us don’t have coverage. (He didn’t mention it, but millions more are underinsured.) All of the other advanced nations, from Japan to Switzerland, have much lower costs, and better health outcomes. The National Institute of Medicine estimates that 22,000 Americans die each year from lack of affordable care, he observed. Annually, 30,000 expectant mothers show up in hospital emergency rooms without having had previous contact with a nurse or doctor. And yet, Medicare, the Veterans Administration, and the Indian health service all provide public “socialized” medicine that’s cheaper, and sometimes better, than private provision.

Obamacare, Reid conceded in a question period, will hardly correct America’s inadequacies. It’s only supposed to cover about 32 million people, and half of those would be dumped into state Medicaid program, which are, he argued, “programs for the poor” that are “poor programs.” Even if Obamacare works as the president claims it will, by 2019 there will be at least 23-24 million uninsured Americans, Reid said.

Finally, he noted, he had to move from the realm of “objective journalism.” “The insurance companies,” he said, “are doing fine.” What Americans haven’t faced up to, Reid said, is the moral issue. In other countries, there’s a moral tradition of healthcare provision for everyone. If Americans had the political will, he said, other countries could show them the way.

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