Tuesday, September 1, 2009

Explaining foreign health systems

Explaining foreign health systems


Campaign Desk -- August 28, 2009

Laurel to T.R.Reid


For extraordinary clarity in explaining foreign health systems


By Trudy Lieberman




As I have posted many times on Campaign Desk, the

media, for the most part, has hardly touched how health

care works in the rest of the developed world. Special

interests, instead, have filled in the blanks with

shrill and false advertising about socialized medicine

and rationing. The public discussion has become so

polarized and virulently nasty that it's nearly

impossible for any lessons from abroad to gain traction.


In last Sunday's Washington Post, T.R. Reid, a former

Post reporter and would-have-been host of Frontline's

"Sick Around America" last March, busts five myths

about foreign health care, in an article based on

reporting for his new book, The Healing of America: a

Global Quest for Better, Cheaper, and Fairer Health

Care. What's remarkable about this piece is not that he

challenges commonly held beliefs about how bad things

are in England or Germany (other groups have tried to

do that), but that he does it with clarity, simplicity,

and honesty--three attributes that have been missing

from much of this year's health care reportage.


Myth one: It's all socialized medicine out there. No,

says Reid. Some countries, like Britain and Cuba,

provide health care in government hospitals with the

government paying the bills. But in other countries,

like Canada, private-sector providers give the care

that is paid for under their national health systems.

"In some ways, health care is less socialized overseas

than in the United States," he writes.


Myth two: Overseas care is rationed through limited

choices or long lines. Generally not, Reid points out.

In most places, patients can go to any doctor or have

choices of providers. There are no limits like we have

in the U.S.--no lists of in-network doctors and

pre-authorization forms. In Canada, he acknowledges,

some people wait for non-emergency care, but Britain,

Germany, and Austria outperform the U.S. when it comes

to waiting times for appointments and elective

surgeries. Waiting times are so short in Japan, most

people don't bother making appointments. I know from my

own reporting in Japan that people simply walk into any

hospital, and pronto, they are seen.


Myth three: Foreign-health care systems are

inefficient, bloated bureaucracies. All other payment

systems are more efficient than ours, Reid writes. U.S.

health insurers have the highest administrative costs

in the world, spending about twenty cents of every

dollar for paperwork, marketing, and claims review.

Japan controls costs better than any other country,

even though its population uses more services than

Americans use. Quality is high, and life expectancy and

recovery rates for major illnesses are better than in the U.S.


Myth four: Cost controls stifle innovation. That

assertion is just plain false, Reid says. While

groundbreaking research comes from the U.S., it also

comes from other countries with much lower cost

structures--like France, where hip and knee replacements

were invented, or Canada, where the breakthrough in

deep-brain stimulation to treat depression was made.


Myth five: Health insurance has to be cruel. In

America, insurance companies routinely reject

applicants with preexisting medical conditions, and

rescind policies of those who accumulate big medical

bills. That doesn't happen in other countries, where

all the national insurance schemes must accept everyone

and pay all the bills that citizens present. Reid

observes that the key difference between the U.S. and

other systems is that foreign health plans exist only

to pay medical bills; they aren't in business to make a profit.


The most persistent myth of all, says Reid, is that

"America has the finest health care in the world. We

don't." When you compare results, most other

industrialized countries have much better statistics.

For awhile at the beginning of the presidential

campaign, advocacy groups and politicians talked about

the under-performing U.S. health care system. But that

was before Celinda Lake advised Democrats not to

mention statistics like how America ranks

thirty-seventh in the world in health outcomes. When

spokespeople and politicans stopped talking about

America's bad showing, so did the media.


Reid reminds us why we need to keep reminding audiences

how and why America falls short, and he offers a fine

template for reporters needing help breaking down

health bill complexities, misinformation, and the

half-truths that will keep floating around. We urge

readers of Campaign Desk who are not journalism

professionals to see what Reid has to say. Apparently

Post readers are already doing that: Post ombudsman

Andy Alexander told me that Reid's story was the most

widely viewed story on the paper's Web site Sunday and Monday.




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