exercises in compound storytelling

Thursday, September 24, 2009

Summary of T. R. Reid at Commonwealth Club

SAN FRANCISCO - SEPTEMBER 22:  A supporter of ...Image by Getty Images via Daylife

T. R. Reid is a journalist and author of The Healing of America; here's a summary of his prepared remarks at Commonwealth Club of California (mp3):

Reid went and visited a bunch of countries and looked at how they fund health care.
  1. Not every modern country uses a socialist scheme: private health care works in other rich democracies.
  2. Not every modern country is single-payer; e.g. Japan has 3000 payers, Germany 220, Switzerland has 70.
  3. Not all developed countries do the same things.
Of 190 countries there are four basic models; they can be broken down by asking who is the provider and who is the payer:
  1. The Beverage model (UK): taxes are high, but they pay half of the what the U.S. does; government owns hospitals, pays doctors, and pays bills. This is real socialized medicine.
  2. The Bismarck model (Germany): premiums are split between employers and employees; private insurance purchased through employer. Private doctors/hospitals/insurance.
  3. National Health Insurance model (Canada): private providers; government pays. Premiums are paid to provincial governments (Reid did not deal with the question of whether people opt out). Model for Johnson/Medicare plan. Popular in newly-rich countries. Reid singled this approach out for criticism because Canada has limited numbers of specialists and advanced equipment; "lots of waiting" for non-emergency care. A gatekeeper system.
  4. Out of pocket model (much of the world). Patient pays at point of service; for some reason Reid spent a lot of time talking about people paying with potatoes.
All four models are in effect in the United States: the military has the Beverage model, the elderly have the NHI model, many employed people have the Bismarck model, and about forty-million Americans pay out of pocket. This differs from much of the rest of the world: most countries have just one model.

Why do most countries have one model? Reid chose to examine Switzerland:
  1. It's simpler and cheaper to administer; Reid says in the U.S. we spend 18-25% of our health care dollars on administrative costs.
  2. They have a strong incentive for preventive health care; cited many anecdotes from the UK.
  3. It is "fairer" to have everyone have the same access to the same health care at the same cost. Reid ended his remarks here by admitting this is a subjective assessment of a moral question and fundamentally reflects a moral value.
During the Q&A Reid said he expects the US to move to a Canadian model.

Reblog this post [with Zemanta]

No comments: