The Isolationism of Health Reform
Why won't Congress consider how other countries do it?
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The health care debate is, within mainstream political discourse, isolationism's last refuge.
Every day Washington's leaders tell us that we live in an interdependent world with a globalized economy. A butterfly beats its wings in Guangdong province, and four Wal-Marts materialize in Duluth. The peso plunges, and 30 Honda workers get laid off in Marysville. A coal-fired power plant belches carbon dioxide in Prague, and Lohachara Island sinks into the Bay of Bengal.
But change the subject to reform of the health care system, and the community of nations abruptly vanishes. No France, no Canada, no Germany, no Japan. Let there be no mention of any industrialized democracy save that of the United States, which is proud to claim 37th place in the World Health Organization's rankings of the world's health systems and 15th in the Commonwealth Fund's ranking by avoidable mortality of 19 industrialized countries (the highest rank indicates the fewest such deaths). To achieve a better score would be unpatriotic!
The political establishment's hubristic refusal to consider how other countries manage health care is encapsulated in the cliché "uniquely American," which is what Sen. Max Baucus, D-Mont., the lead legislator on health care reform, says he wishes his bill to be. It therefore goes without saying that the finance committee Baucus chairs could find no place in this year's exhaustive health care hearings for a single expert on how other countries achieve better health outcomes for their populations while typically spending, on a per capita basis, half what we do. When the finance committee releases its draft bill this week, it will be almost completely free of foreign influence.
Given this circumstance, I am sorry to report that T.R. Reid's superb new book, The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care, won't hit bookstores until August, by which time the Obama White House and Congress hope to be finishing up their work on health reform. In the meantime, I would urge Penguin Press to sprinkle advance copies liberally throughout Congress, the White House, and the Health and Human Services department.
Ignore the title (which, apart from being Sunday-schoolish, was used 12 years ago by New Age spiritualist Marianne Williamson); a better one would be Sick Around the World, which is what Reid called the excellent Frontline documentary he hosted on this topic last year. Even better: Around the World With My Bum Shoulder. Engagingly, Reid frames his inquiry by seeking relief for his aching right shoulder, which he injured while serving in the Navy in 1972. A surgeon at Bethesda Naval Hospital fixed it by inserting a stainless-steel screw into his clavicle, but three decades later Reid could no longer swing a golf club and could only just barely replace a hanging light bulb. In a show of the same sunny resourcefulness he displayed as a foreign correspondent for the Washington Post, Reid uses his ailment as a vehicle to explore the world's health systems.
Reid helpfully divides health care systems into four models:
Bismarck. As the name suggests, the Bismarck model is found in Germany—and also in Japan, France, Belgium, Austria, and, "to a degree," in Latin America. Doctors, hospitals, and insurers are all private, and insurance is funded jointly by employers and employees, as it is in the United States. But the insurance companies are nonprofit, and coverage, fees, and medical services are all tightly regulated by the state.
Beveridge. Named for Lord William Beveridge, who with Aneurin Bevan created Britain's National Health Service. Also found in Spain, Italy, Hong Kong, and much of Scandinavia. Instead of private insurers, the government pays all medical bills. Hospitals are typically owned by the government, and doctors are usually (though not always) salaried government employees.
National Health Insurance. A blend of Bismarck and Beveridge found in Canada, Taiwan, and South Korea. Hospitals and doctors are private, but the government pays.
Timothy Noah is a former Slate staffer. His book about income inequality is The Great Divergence.