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Opinion

What can America learn from Switzerland and France about healthcare reform?

Quite a lot. T.R. Reid's new book shows that other rich countries have provided quality healthcare to all citizens at a much lower cost.

By Mark Lange / September 1, 2009



San Francisco

Anyone put off by the poster that paints President Obama as a "socialist joker" might take a look at the typical American in the mirror. We already combine the worst features of both socialism and market forces in healthcare, because we can't seem to learn from the best examples in other countries.

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It's time we did – because that's where the real choices are. And eventually, we'll have to choose.

On the (fully) socialized side, US Medicare and Medicaid consume 8 percent of our national income – about the same share as socialist European systems. Except that theirs cover everyone, not just the elderly. And we've only just begun to pay for our own collectivism, since the bulk of our boomers haven't retired yet. When that gray wave crashes on our status quo shores, it'll wipe away trillions in national wealth.

Then we pile on uniquely American layers of private-sector "innovation" in healthcare, forcing us to spend double what other rich countries do:

•Reimbursement rates disproportionately enrich specialists, who are better rewarded for being "partialists" doing procedures and heroic interventions. We scarcely reward outcomes or results – most of our incentives actually preempt prevention.

•Primary care doctors are quitting front-line healthcare to join boutique practices in gated community medicine – because good primary care has become nearly impossible in practice.

•Insurance and pharmaceutical lobbyists have written fat profit subsidies and price supports into federal legislation, particularly the Medicare drug benefit, inflating costs unsustainably.

Add the cost of our elderly socialized systems to what employers and families spend for coverage with private insurers – when they can afford it, which tens of millions of our citizens can't – and Americans burn more than $7,000 each year on healthcare. That's more than twice the average for other rich nations.

For all of that money, we get better quality – right? Well, no. Our health system ranks 37th on the list of wealthy nations, on a definitive range of outcomes, according to the World Health Organization.

Enter T.R. Reid's new book, "The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care." It makes a critically important contribution to the conversation about reform, by taking a clear-eyed look at what is actually working in other countries.

While the right feeds culture-war flames of indignation about so-called death panels that would euthanize the elderly, and the left berates Mr. Obama for backing down on an opaquely defined and unaffordable "public option," Mr. Reid starts our interview with a bracing statistic that frames the debate in simple moral terms.

He points out that some 18,000 Americans die each year, simply because they don't have access to the basic medical treatment that would save their lives, according to the Institute of Medicine.

Now consider the lucky among us: Even among those with access, another 200,000 perish from preventable medical errors and avoidable hospital infections. Overall, our failure to structure and deliver effective healthcare is 70 times more lethal to our citizens, every year, than the September 11 attacks.

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