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T.R. Reid: Looking Overseas For 'Healing Of America'

TERRY GROSS, host:

This is FRESH AIR. I’m Terry Gross.

It’s proving awfully difficult to change our health care system and provide
care for people currently uninsured. Yet, as T.R. Reid points out in his new
book, all the developed countries except the U.S. have decided that every human
being has a basic right to health care.

Reid says we can bring about fundamental change by borrowing ideas from foreign
models of health care. His conclusion comes from personal experience. He spent
years as a foreign correspondent for the Washington Post and lived with his
family in three continents.

For his new book, he went on a global quest, searching for solutions to two
health care problems: the first, our nation’s health care system; the second,
his bad shoulder.

He took his shoulder to doctors around the world, seeking alternatives to the
risky surgery that was recommended for him the U.S. T.R. Reid’s new book is
called “The Healing of America: A Global Quest for Better, Cheaper, and Fairer
Health Care.”

T.R. Reid, welcome back to FRESH AIR. One of the main arguments that we’re
hearing from critics of reform is that this would be socialized medicine. You
point out in your book that that argument was actually created by a PR firm in
the 1940s. Can you describe what happened then?

Mr. T.R. REID (Author, “The Healing of America: A Global Quest for Better,
Cheaper, and Fairer Health Care”): Yeah. Harry Truman wanted to provide
universal health care in 1947. The American Medical Association, the doctors,
hired a PR firm, who invented the term socialized medicine. Nobody knew what it
meant, but I think the idea was if you wanted to provide health care to your
sick neighbor, you were a commie, and you know, during the Cold War, that was a
powerful argument.

The amazing thing is it’s still a powerful argument. I don’t know that anybody
can define socialize medicine, but nobody seems to like it, except, Terry, when
Americans get government-run medicine, they really like it.

The VA, the Native American Health Service and Medicare are the three most
popular health care systems in America, all run by government.

GROSS: Now, you’ve broken down Western health care systems into four different
categories. I think it would be really helpful for all of us to understand what
some of the options are out there, how other countries do it. Let’s talk about
those systems.

Let’s start with what is often called the William Beveridge Model because he’s
the person who inspired the British National Health Service, and you describe
the British National Health Service as probably what’s closest to what
Americans have in mind when they talk about socialized medicine. So give us an
overview of that system.

Mr. REID: Yeah, well in the Beveridge Model, taking care of people’s health is
government’s job just like picking up the trash or putting out fires or running
the public library. When you need the service, you get it, and you don’t pay
there. You pay for it in taxes. It’s a government service.

About 97 percent of the people in Britain and Spain, Italy, New Zealand - those
are also Beveridge-Model countries - never get a doctor bill in their life.
They go their whole life and never get a hospital bill. How do you do that? You
assume that it’s government’s job to keep people healthy.

I would say that’s socialized medicine. Government owns the hospitals. It
employs a lot of the doctors and nurses, and government buys the pills,
government pays the bills. Yeah, I’d say that’s socialized medicine. But you
know, you get a lot of benefits out it.

For one thing, it’s so simple administratively. You know, the billing office of
a British hospital with 900 beds, and I said to the guy, where’s the billing
office? Oh, yeah, it’s one drawer in my secretary’s desk over there, which she
opens once a month to send some record to the government.

It’s just so much simpler. There’s one set of rules. So those systems really
work. And you know, our family lived in Britain, and guess what happens, Terry?
Your kid has an earache. The doctor comes to your house. She goes back and sees
your child. She says, I believe it’s otitis media. I gave her a penicillin jab.
Your kid feels better, the parent feels better, and then guess what? She walks
out the door. No bill, no three-month, then, fight with the insurance company
over who’s going to pay the bill. So I found a lot to like in Britain. For our
family, it worked well.

GROSS: Are there insurance companies in England?

Mr. REID: Yeah, because the NHS covers almost everything.

GROSS: NHS is the National Health Service.

Mr. REID: The National Health Service, I’m sorry. Yeah, the free service. There
are private insurance plans that will cover things they don’t cover, like Botox
or breast enlargement. Private health insurance will get you to the top of the
waiting list faster - although now, because Tony Blair spent so much money -
the waiting lists are a lot shorter. It’ll get you a private room in the
hospital.

About 10 percent of the people in Britain have private insurance, but it only
accounts for about three percent of the money spent on health care. When
anything serious has to happen - this is interesting - people go to the public
hospital.

I had a really good friend who had a baby. She had private insurance, and I
said, well, are you going to go to a private doctor? Oh, no, no, no, no, no.
For my baby, that’s too important. I’m trusting the NHS.

GROSS: So what about the question of choice. Can you go to any doctor you want
to? Can you see a specialist if you want to?

Mr. REID: Britain has a gatekeeper system. You have to go to the general
practitioner first, just like in a lot of American insurance plans. You can go
to any GP in the country, but most people pick they guy who’s right down the
street. Our doctor was two blocks away.

So when we called her, she could get down to our house in an hour. But if you
want to go to an orthopedist or a cardiac surgeon, then you have to go to the
GP first and get a recommendation. And when we lived there - well, we came
home, what, four years ago - there was still some waiting lines to see
specialists. It was tough, but I think those waiting lists are way down, as I
said, because Blair and Brown have spent a lot of money.

GROSS: On the health insurance system.

Mr. REID: Yeah, yeah. One of the ways – you know, they have that thing on
Britain on Wednesday where the prime minister stands up in parliament, and the
other party insults him and shouts questions at him. And one of the most-
standard questions is: A woman in my constituency has been waiting four weeks
to see a doctor. This is outrageous. And that happens, and then the answer that
the prime minister always gives is, well, obviously, the gentleman opposite
wants to see us institute for-profit, American-style corporate medicine. This
we will never do. You know? And they never will.

GROSS: Is that the worst thing that you can say, we’re going to institute
American-style corporate medicine?

Mr. REID: All over the world, people say that. If you complain about health
care, they say well, you want to move to America? You think that’s better?

Everywhere I went, people had this kind of smug superiority. They know. They
know that we let people die and go bankrupt by the thousands in our health care
system, and they don’t do that, so they feel better.

A person in the Health Ministry in Canada - you know, they’re kind of
understated people in Canada - said to me, you know, we don’t go around
chanting we’re number one like some countries I know, but there are two areas
where we’re better than the states: hockey and health care.

(Soundbite of laughter)

GROSS: Now, what about the question of choice? You quote the British health
minister as saying we cover everybody, but we don’t cover everything. So what
are some of the things that the British National Health Service won’t cover?

Mr. REID: Well, I’m a man of a certain age, and in America, a man like me would
get a prostate cancer test, a blood test for prostate cancer. And I was really
friendly with my GP in Britain and said to him, hey, I should get this test. I
get it at least once a year in America. He said no, no, we don’t think it’s
cost effective.

So I’m thinking hey, if it finds cancer in me, it’s pretty cost effective. I
like that. But they were thinking of an entire society, and of course, as we
now know, the American researchers, too, have now concluded that that’s not a
useful test.

GROSS: Is there anything that you would describe as rationing, the kind of
rationing that Americans are really afraid of?

Mr. REID: Every country rations health care, Terry. There’s no question about
that. And yeah, they do some of it at the end of life. They limit some of the
procedures. They limit this drug, Herceptin, for breast cancer. They only allow
that in certain cases.

That’s certainly true in Britain, but it’s true everywhere. Every country
rations health care. This is not a nice thing to say, but the United States
rations health care. The distinction is we ration differently from everybody
else. I think this is important.

In the other countries, they have sort of a basic floor of care that everybody
has access to, and the result is nobody dies for lack of a doctor. In America,
some people get everything. The ceiling is the sky, you know, kind of thing,
and get it right away with no waiting, but a lot of people don’t have access to
care. So that’s how we ration. We ration by cutting off access for tens of
millions of people, and no other country rations health care that way.

GROSS: Okay, and here’s another question about the British National Health
Service. You mentioned that there is kind of rationing at the end of life. So
what are some of the procedures or some of the things that are, you know,
typically done at the end of life in the United States that wouldn’t be done
under the National Health Service in England?

Mr. REID: That’s really hard to say. I think there’s an age cutoff in Britain,
and it’s kind of hard to figure out what that is, I think it varies by region,
after which they won’t give you kidney dialysis. That’s a fairly expensive and
intrusive procedure, and at age 89, 90 or something, they won’t do it, but
that’s true in some plans in America, too.

So this business about throwing grandma off the cliff I think, frankly, is
bologna, and I’ll tell you why. There’s a standard statistic, Terry, in health
care: healthy life expectancy at age 60. How long are you going to live on the
day you turn 60?

All the other rich democracies have a longer life expectancy at age 60 than 60-
year-old Americans have. So they can’t be throwing seniors off the cliff over
there. They’re keeping them alive longer than ours are.

GROSS: If you’re just joining us, my guest is T.R. Reid. We’re talking about
his new book, “The Healing of America: A Global Quest for Better, Cheaper, and
Fairer Health Care.” Let’s take a short break here, and then we’ll look at
other countries around the world and how they do their health care and what we
can learn from that. This is FRESH AIR.

(Soundbite of music)

GROSS: If you’re just joining us, my guest is T.R. Reid. And we’re talking
about his new book, “The Healing of America: A Global Quest for Better,
Cheaper, and Fairer Health Care,” and it’s based on his travels around the
world, looking at health care systems in other countries.

We’ve talked a little bit about the British National Health Service model.
Let’s look at what’s often called the Bismarck model. This is a model that was
developed in Germany that’s used in several other countries, including Japan,
France, Belgium, Switzerland. Let’s look at the French model because you seem
particularly interested in the French system, and I think that was rated the
number one health care system by the World Health Organization study that
ranked countries around the world. So…

Mr. REID: Yeah, everybody in France knows this. They’re thrilled about this.
The World Health Organization did rate them number one, and you know, I went
there. I can see why. It’s a very good health care system. But in contrast, do
you remember we said the British system, the government provides the care, and
the government pays for the care? These Bismarck models on the continent of
Europe and in Japan, they’re all private. They’re private docs, private
hospitals and mainly private insurance plans.

GROSS: So are these insurance companies in this model that France has, are they
for-profit companies like our for-profit insurance companies?

Mr. REID: No. No country that has insurance companies lets insurance companies
make a profit on basic health insurance, and they have pretty strict rules. I
mean, this is nice insurance. In Germany, for example, there are about 200
insurance companies. It’s not single-payer. I want to make that point, 200
insurance companies. Anybody in Germany can buy any of the 200 (foreign
language spoken) plans. If you don’t like your insurance, guess what: You can
drop it, shift to the next guy, and the new guy can’t raise your premium. Now,
that’s, you know, more choice than anybody in America has. These companies have
to cover everybody. They have to pay every claim. They don’t have all those
people going through, saying sorry, we don’t cover that.

In many countries, if you’re stressed, and the doctor says you need a weekend
at the spa, the insurance has to pay for that. That’s in the law. Generally,
they have to pay in a short period of time. In France, the doctor has to be
paid within three days. Get this: In Switzerland, if the insurance company
doesn’t pay your claim in five days, your next month’s premium is free.

GROSS: Wow.

(Soundbite of laughter)

Mr. REID: That’s pretty good health insurance.

GROSS: That’s amazing.

Mr. REID: Yeah, exactly. People actually like their health insurance companies
in those countries. And you know, this business in America where we have the
in-network deal, or you have to get pre-authorization, in France - this is true
in Germany, in Japan - any doctor, any clinic, any chiropractor, anybody in the
entire country, you choose them, you go, and insurance has to pay the bill
within two weeks or so. Pretty good insurance.

GROSS: I’m trying to understand how a nonprofit insurance company would
operate. I think there’s some of them in the United States, but for the most
part, we in the United States think of insurance companies as companies that
kind of bet against you in a way.

(Soundbite of laughter)

GROSS: They’re betting that they’re going to make money off of you because your
health is going to be good or not so bad or whatever. And if the odds are
against you, they’re going to try to drop you or not insure you in the first
place, but it’s a gamble. The whole insurance industry in America, it’s
gambling, and you sometimes lose - as the insured - you lose the gamble. So
what’s the different between a for-profit, American-style insurance company and
a French, nonprofit-style insurance company?

Mr. REID: Well, all over the world, health insurance is nonprofit except the
U.S.,. And as a matter of fact, when health insurance started in the U.S., the
original Blue Cross and Blue Shields in every state were nonprofit, and they
operated fine. The concept is more like the taxes you pay to operate the fire
department in your town. Most people will never have a fire at their house, and
therefore, the fire department makes enough money from everybody to put out the
ones that do happen.

In those countries, the insurance companies are basically charities. They’re
community organizations, and they have one goal in life, and that is to keep
people healthy. That’s what they’re for, and the reason for that is those
countries have all decided that there’s a basic conflict between making a
profit for investors and covering people’s health.

The last country, as I say in the book, that allowed health-insurance companies
to make a profit on the basic coverage was Switzerland. And guess what: In the
mid-‘90s, the Swiss companies were copying our companies. They finally decided,
well, why should we sell a policy to anybody who’s sick? They might make a
claim and cost us money. So they started turning people down for pre-existing
conditions. Switzerland got the point - and fasten your seatbelt, Terry - five
percent of the people in Switzerland couldn’t get insurance, and that was a
scandal. That was unthinkable. Well, we’re at 16 percent today, but that was
not acceptable in Switzerland. So they had a national referendum, took the
profit out of insurance and said that everybody has to have a policy.

GROSS: So in the model that we’re talking about that France and Germany,
Belgium, Switzerland and some other countries follow, do you have your choice
of insurance companies, or is there just one national company that you buy
from?

Mr. REID: In some countries, like France and Japan, you get the insurance that
applies to your industry or your company or your region, and that’s it. But
some countries - Germany, Switzerland - Germans can choose any of 200 health
insurance plans, and the plans do compete, even though they can’t make a
profit. Now why do they do that? Well, one reason is the more members, the more
customers they plan has, the more money its executives make. So that’s a reason
to compete.

In Switzerland, it’s interesting. The same company that sells the nonprofit,
basic health insurance plan also sells life insurance and fire insurance. And
they sell this kind of supplemental insurance to cover breast enlargement or
hair replacement. So they try to win you by being really good, nonprofit
health-insurance companies, and then you say oh, that’s good. I’ll buy my fire
insurance there, too. And they’re all making more money because they use the
basic health insurance as a way to bring in customers.

GROSS: When you say they’re making more money, do you think that the salaries
of insurance executives in the countries you’re talking about now compare to
the multi-multi-million-dollar salaries of insurance CEOs in the United States?

Mr. REID: Oh, no. But nobody makes American-insurance-CEO kind of salaries.

GROSS: One of the things I loved about your description of the French health
care system is the health care card that everybody carries. Why don’t you
describe what makes that so special?

Mr. REID: The Carte Vitale, yeah. French doctors don’t make a lot. They do
fine. You know, they’re good, middle-class people, but they’re not rich, and
their offices are Spartan, you know. They don’t have National Geographic
sitting on the table. There’s just a plain, white waiting room and then the
doctor’s office - but what’s missing in all doctors’ offices in France is the
files and files of patient records, and there’s no billing office.

And I said to this doc I spent some time with, where’s your billing office? He
said, oh, this would be ridiculous. I don’t make enough to pay somebody to do
the billing, but he doesn’t have to. Here’s what happens: The patient comes in.
Out of her pocket, she pulls this green credit card. It’s called the Carte
Vitale. He puts that in a reader on his desk, and her entire medical record
shows up on the screen. And he chats with her about her problem. He’s typing
down what she’s got wrong, and he says to her well, I think I’m going to
prescribe a course of antibiotic, and I want you to take two a day for two
weeks. And he’s typing all that up.

And then he’s finished with her. He turns to me, and he says Monsieur Reid,
please watch. He hits one key on his computer, and the entire bill has gone to
her insurance company. He’s going to be paid in three days, and she’s going to
get her co-pay back from the insurance company within two weeks, done. No
paper.

GROSS: And the next time she goes to a different doctor, he can put her card in
the reader and see what this doctor had prescribed and what this doctor
thought.

Mr. REID: That’s right. He’ll say oh, did that other antibiotic work for this
condition when you had it two years ago? Yeah, it’s perfect. They find you. And
your record - you can actually see on this card. There’s a little gold chip, as
you saw in the book, where your health records are. So doesn’t this raise
privacy problems? And I asked that in the health ministry, but he says they’ve
never had a problem with identity theft or people stealing records because this
is encrypted. And I guess the encryption’s pretty good.

GROSS: Now, Japan has borrowed this model that France has. And you say that in
Japan, there’s good access to fine doctors and lots of choice, but the system
is overstretched, and it’s pinching pennies. So how does that affect the health
care of Japanese people?

Mr. REID: Well, their health care is fabulous. They have the longest lived and
the healthiest population in the world. They have much better recovery rates
from every major disease than Americans do. It’s just a marvelous health care
system, and they love going to the doctor in Japan. In Japan, on average,
people go to the doctor 15 times a year. We go about 4.3 times per year in
America. The average hospital stay in Japan is 36 nights. Ours is six nights.

So they’re big consumers of medicine - very, very good results, but the
Japanese spend less than half as much per capita as we do. How do they do that?
The answer is they’re stingy. They have the stingiest pay scale of all the rich
countries. Docs and hospitals just don’t make much money. And the result is a
lot of hospitals in Japan are now borrowing money from banks just to operate.
It’s really, they’re under severe strain. The solution: They spend eight
percent of GDP on health care - we spend about 17 percent. If they raised that
to nine percent, they could pay all their doctors and hospitals a better wage,
but so far, they’ve tried to resist that. But they’re going to have to do it.

GROSS: So that would mean just raising the taxes a little bit.

Mr. REID: Yeah, or maybe raising the insurance premium or something.

GROSS: Journalist T.R. Reid will be back in the second half of the show. His
new book is called “The Healing of America: A Global Quest for Better, Cheaper,
and Fairer Health Care.” I’m Terry Gross, and this is FRESH AIR.

(Soundbite of music)

GROSS: This is FRESH AIR. I'm Terry Gross back with journalist T.R. Reid. We're
talking about what the U.S. could learn about health care reform by looking at
other developed country systems that are based on the premise that every human
being has a basic right to health care. Reid is a former Washington Post
foreign correspondent and has lived on three continents. He travelled around
the world researching his new book which is called "The Healing of America: A
Global Quest for Better, Cheaper, and Fairer Health Care."

We’ve talked a little about Britain's National Health Service. We’ve looked at
the French model, which is used in Germany, and Japan, and several other
countries. Let's look at the model in Canada, which you describe as the
National Health Insurance model. What's the basics of that model?

Mr. REID: You remember in Britain, government provides the care and government
pays for the care. And in Germany the providers and the payers are private. The
Canadian model is a blend. They have private docs and private hospitals but the
payment system is public. It's one big government system - actually it's 14.
There's one for each province. Everybody pays. In some provinces it’s a tax, in
some provinces it's called a premium. You pay in every month, just like we pay
Social Security tax and Medicare tax. You go to the doctor and it’s free. And
this really works pretty well. The docs are private and they just bill the
government. You just - you don’t get a bill and this means anybody can go. It
means nobody with an acute condition in Canada dies for lack of health care as
happens in America.

The flaw with the Canadian system is, to save money they’ve cut back sharply on
the number of specialists, on operating rooms, on scanning machines. So if it's
anything that's not acute they keep you waiting. I mean they keep you waiting
weeks or months.

You know, I have this bum shoulder and I said to this wonderful doctor I was
with in Canada, I got a bum shoulder. It really hurts me. He said yeah, I
better send you an orthopedist. How long would it take? He said oh, 10 or 12
months.

GROSS: Whoa.

Mr. REID: Twelve months?

(Soundbite of laughter)

Mr. REID: Twelve months. It hurts. It hurts every morning when I wake up and I
got to wait 12 months to get treatment? This guy says, oh I didn’t say
treatment. No. It would be 10 months or so to get a consultation. If he wants
to do anything it'll be six more months before an operating room comes up.

So this is just the choice they made. It's not a function of their system
because other countries that have the same system don’t have waiting times. But
it's absolutely true that Canada keeps people waiting. They did it to save
money.

GROSS: Can you get supplemental insurance and, through that, jump ahead of the
line?

Mr. REID: Ha. That's up in the air at the moment. The Canadians are so
egalitarian - the Swedes did this too, they first said no, no. We have a very
good health care system here and that's where you’re going to get your health
care. Obviously some people in Canada could go south to America and buy health
care without waiting in the line. The number of people who do that seems to be
pretty small. It's not as big as you hear in the argument in America, but some
do that.

But three years ago - was it? The Canadian Supreme Court ruled that they can't
bar you from buying private insurance and going to private doctors. And this
created all sorts of concern in Canada because their big bugaboo, you know how
we're all worried about socialized medicine? Their equivalent to that term, the
thing they all hate is two-tier medicine. They definitely don’t want a system
where rich people get better care than poor people. That would be un-Canadian.

And so what they did is they tried to step up the spending on the system they
have so that people can get care. And as it turns out, there are a few places
in Canada where a doctor can operate privately, but not many, because the rule
is if you operate in the Medicare system, in the national system, then you
can't also treat people privately. So you got to be a doc in a pretty rich
neighborhood to have enough private customers to make a living.

GROSS: Let's look briefly at the fourth model that you write - the fourth and
final model that you write about in your book "The Healing of America," and
this is the out-of-pocket model which you can sum up pretty quickly.

(Soundbite of laughter)

Mr. REID: Yeah. And that's the most common model in the world because it's only
the 40 or 50 richest countries that really have a health care system. In all
the other countries in the world, maybe 150 countries, here’s the rule: If you
can pay your doctor out-of-pocket, you get treated. If you can't pay, you stay
sick or you die. That's it. Brutal, simple, it's a fact of life in most
countries.

Some Third World countries have a big hospital in the capital city where people
can line up, but out in the villages, no care. So people, if they have money
they pay in money, if - they pay in potatoes, they weave a rug. In some
countries the woman brings her child in and serves as a wet nurse for the
doctor's baby to pay. But basically this is a brutal system and if you don’t
have the money, tough.

GROSS: Okay. So we looked at four models and three of the four models - and
these are the three models that most Westernized countries use, everybody is
guaranteed health care. Now, you write that in America we have aspects of all
four of the models. The three models where people are guaranteed health care
and the fourth model is if you don’t have the money you don't get the
treatment. So explain how we have aspects of each of those models.

Mr. REID: Yeah, so look, please don’t tell my publisher because I spent a lot
of their money. I went all around the world for three years looking at these
different models of health care.

(Soundbite of laughter)

Mr. REID: Turns out we have them all right here in the United States. If you’re
a Native American or a veteran you live in Britain. They get government health
care and government hospitals from government doctors and they never get a
bill.

If you’re an employed person sharing your health insurance premium with your
employer, you live in Germany. That's the Bismarck model that was invented in
Germany and used in many countries.

If you’re a senior and you buy Medicare insurance from the government and go to
private doctors, you live in Canada. That's the Canadian model. As a matter of
fact, the Canadian health care system is called Medicare, and when Lyndon
Johnson provided it for our seniors in 1965 he borrowed both the model and the
name from Canada.

And if you’re one of the tens of millions of Americans who can't get health
insurance, well, you live in Malawi or Madagascar or Mali or something, because
if you can pay for health insurance you get it, or maybe you can line up at the
free hospital sometime.

We’ve got them all and that's really the most important difference. All the
other countries have decided that it's cheaper and fairer to provide one model
so that everybody has the same access to the same care at the same price.

GROSS: But it's not just a sense egalitarianism that underlines your criticism
of our multi-tiered health care system, it's also really an expensive system to
maintain because there's so many different systems within it. There's so many
different forms of billing. There's so many different prices. Give us an
example of why that really both complicates things for doctors and patients and
also makes it much more expensive.

Mr. REID: Well, just think about it. It's just vastly simpler if there's one
set of rules and one set of forms and one price or one regional price for the
whole country. You know, you go to the doctor in France and that doctor, by
law, is required to post on the wall the price she's going to charge you for
the hundred most common procedures that she does. And then the next column says
how much insurance is going to pay you back. And the next column says how many
days before the insurance pays you. No doctor in America could do that because
they don’t know what they're getting paid. They get 30 different fees for the
same procedure in the same week because of all the different plans.

The result is enormous administrative complexity. The American health insurance
industry - you know, it's free enterprise, it's competitive, those guys, as we
said, make huge salaries - it's the least efficient payment system in the
world. They spend 18 to 20 percent of every premium dollar on administration
costs.

You think of France, Terry, as a model of management efficiency? The French
insurance industry spends four percent on administration. Germany, five
percent, Japan about five percent. So we are just pouring tons of money into
stuff that doesn’t buy anybody health care largely because we have this hugely
complicated overlapping set of systems and that's one of the reasons all the
other countries went to a single system.

Another reason is if everybody's in the same system - and it doesn’t have to be
a single-payer. Japan has 3,000 payers but it's a coordinated system with one
set of rules. If everybody's in it then they have an economic incentive to pay
for preventive care.

Preventive medicine works but it costs some money up front. And, you know, in
our system your insurance company's probably only going to cover you for five
or six years until you move to the next job. It's not in their interest to
spend money to keep you healthy. By the time you get sick, you’re somebody
else's problem.

GROSS: My guest is journalist T.R. Reid and his new book is about health care
systems around the world and what we can learn from them. The book is called
"The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health
Care."

Let's take a short break here and then we'll come back and talk about your
shoulder...

(Soundbite of laughter)

GROSS: ...and how it was treated under health care systems around the world.
This is FRESH AIR.

(Soundbite of music)

GROSS: My guest is journalist T.R. Reid and we're talking about his new book
which is called "The Healing of America: A Global Quest for Better, Cheaper,
and Fairer Health Care" and about his travels around the world looking at
different health care systems and trying to figure out what we can learn from
them.

Now, one of the reasons why you undertook this travelogue around the world
looking at health care systems is that you have a bum shoulder.

Mr. REID: Yes.

GROSS: And tell us briefly what's wrong with your shoulder.

Mr. REID: I fell and broke my shoulder in the U.S. Navy 30-some years ago and
the Navy fixed it at Bethesda Naval Hospital. They basically, literally screwed
my shoulder back together. There's a big stainless steel screw in there you can
see in the x-rays. And I'm getting old now and it's freezing up. I can't swing
a golf club anymore. It hurts when I wake up in the morning.

So my major quest in this book was to see if we could find a better way to do
health care in America. But let's admit it. I also had the selfish reason -
maybe I could get good care for my shoulder too, so I set out to see what I
could do.

GROSS: Now in America the doctor you saw recommended a very challenging...

(Soundbite of laughter)

Mr. REID: Exactly. Yeah.

GROSS: ...surgical operation for you which would’ve been what?

Mr. REID: Well he's an orthopedic surgeon and they're confident guys. I showed
him my sore shoulder and he comes in the room with this little red metal box,
and he opens it up and said, okay here’s your new shoulder. He's going to cut
out the shoulder that God gave me with a saw and put in this piece of titanium
and Teflon and that's going to replace my shoulder. It'll work fine he says.
He's a good guy. I like this doctor. Well what could go wrong? And he said
well, you know, it's major surgery. There are always some problems. Like what?
And he says well, you know, death, paralysis, disease.

(Soundbite of laughter)

Mr. REID: So I said, well, maybe I’ll go look around.

GROSS: Okay. So let's start with England. You took your shoulder to England...

(Soundbite of laughter)

GROSS: ...and what was the advice you got there?

Mr. REID: In Britain that's, you know, where they invented the stiff upper lip,
and to be blunt about it, my GP in Britain said live with it. It's not
destroying my life that much. I got another hand that I can reach up and change
light bulbs with, you know. So he said I could send you to the orthopedic
surgeon, he'd look at it, he'd say no not serious enough. We're not going to do
the operation and you could come back to me, we could send you to another
surgeon, he'd say no. He says I'll tell you what, the NHS, the National Health
Service, we'll give you physio - that's physical therapy, and that'll help
some. That'll reduce some pain but go home and live with it. That's the advice
he gave me.

GROSS: Okay. Was that satisfying to you?

Mr. REID: You know, it helped a little. It helped a little. It's not that bad
and rather than sit around and moan about it, just live your life and you can
kind of forget that your shoulder hurts. Yeah, it wasn't bad.

GROSS: Okay. You went to France. What kind of advice did you get there?

Mr. REID: The guy, the orthopod in France loved me because he threw my x-ray on
that light machine they have, you know, big smile on his face because he saw
that stainless steel screw I got at Bethesda Naval Hospital. That operation was
invented in France, it's called the Latarjet Procedure, and this guy was so
thrilled that I had French operation on my American shoulder, so we did just
fine. And he said that he too could cut out my shoulder and give me an
artificial one. And that would cost, it would only cost about six thousand
bucks in France - a real bargain by American standards. He didn’t think that
was recommended either. He thought physical therapy and maybe some pain shots
would handle me fine. If I wanted the operation I could get it in France
because they have a lot choice, but he didn’t think it made sense.

GROSS: He was recommended cortisone shots?

Mr. REID: Yeah. Like I think it was a steroid. But, yeah, that's right.

GROSS: Okay. Okay. You went to Japan. What did they tell you?

Mr. REID: That was the most interesting doctor. For one thing, he was the only
doctor I went to who called up my condition on a computer and read about it
while I was in the room just to make sure he was right. He said in Japan they
would definitely do that surgery if I wanted it, you know, replace my shoulder.
He suggested monthly or bi-monthly steroid shots. He said I think you’re going
to get a lot of elimination of pain with that and guess what: It worked and it
was really cheap.

He suggested traditional Chinese medicine, herbal medications, and he suggested
physical therapy. And he gave me the longest, widest range of anybody and all
of it was covered by Japanese insurance. And I tried. I tried the traditional
Chinese medicine. I had acupuncture and I know a lot of people get good results
from acupuncture. I got nothing. I mean it didn’t hurt. It was kind of
interesting to do it, but I got no gain. But Japanese insurance would pay for
that too.

GROSS: I should mention that the cortisone shots and the physical therapy that
the Japanese doctor recommended, you could have gotten same advice from a lot
of America doctors and had your health insurance company in America pay for it,
too.

Mr. REID: I think that’s absolutely right, yeah. I mean, I went to an
orthopedic surgeon and, you know, they want to orthopedically surge, that’s
what they want to do. But - and he’s a good one. I mean, I’m sure it would’ve
helped.

GROSS: Okay. You had a very interesting experience in India.

Mr. REID: Yeah. In India, we went to an Ayurvedic clinic - that’s a 3,000-year-
old Indian form of medicine. And it’s herbal and it’s all about getting the
prana - the flow of power in your body to flow correctly. And the way they do
it, Terry, is marvelous.

You lie on this dark neem wood table and six people massage you with warm oil.
I mean it was fabulous. I did this for five weeks. I made a movie about it for
PBS “Frontline,” called “A Second Opinion.” After the massage, then the guy
would take me to the shower and these same strong masseuses would take this
soap made out of green beans and wash the oil off my body. That felt great too.
It was just great.

And after I made that movie, you know, trying to get my shoulder better, people
would come up to me on the street and they would say one of two things: how’s
your shoulder, or I saw you naked.

(Soundbite of laughter)

GROSS: So, how is your shoulder? Did that massaging helped?

Mr. REID: It definitely improved. I did not believe in this Ayurveda. It comes
out of a Hindu religion. So, while I was being treated, they made me go over to
the temple and walk three times around Dhanwantari, the god of healing,
clockwise - had to be clockwise. They made a person from the Ahdjnapathy(ph)
department - that’s astronomy - come in and read my star chart before they
would treat me. I didn’t buy any of this. And guess what? I got much more
movement and much less pain. It definitely worked.

GROSS: Well, I’m glad your shoulder is improved and I hope it stays that way.
We’re having a lot of political obstacles in the United States that are slowing
or preventing health care reform. You went to two countries that recently did
remake their systems – Taiwan and Switzerland. And you see in both countries
liberal political parties stepped up the pressure for change to such a level
that the conservative parties were unwilling to resist. Would you elaborate on
what happened in those countries politically that enabled major health care
reform?

Mr. REID: Yeah. Taiwan is one of these new Asian tigers, you know. It’s a
country that got very rich. They went from about a hundredth in the world in
GDP per capita to 20th in the world in about 15 years. And once they got there
in the mid-‘90s, they said, well, we ought to have a rich country’s health care
system. So, they did what I did in the book. They went around the world and
looked at all the health care systems, including ours, and ended up choosing
the Canadian model. And then they had this political fight to put it into
effect. And the argument that the liberal parties took was, we’re a rich
country now and rich countries have a moral obligation to provide health care
for everybody. The pro-business party in power resisted that for a while. And
then decided no, actually that’s right. We think we do have a moral obligation
as a rich country to cover everybody. So then the conservative party grabbed
onto the idea and they put it into effect before the liberals could win the
next elections - pretty interesting development. And that’s just…

GROSS: You mean, it was so popular - reform became so popular that the
conservatives decided they wanted to take credit for it?

Mr. REID: Yes, I think that’s exactly right. They saw they couldn’t stop it.
Taiwan felt that they were a rich country, as important as any country in
Europe or in the Americas. And rich countries have health care systems that
care for everybody, which is true for all the rich countries except us.

GROSS: I should mention that doctors in a lot of the countries you went to get
paid much less than doctors here. But as you point out, they don’t have to go
as deep into debt to get their medical education as American doctors do.

Mr. REID: Yeah, most of them go to medical school for free or for almost
nothing. And their malpractice insurance premiums are much lower than in the
United States.

But I think a lot of it is expectation. They don’t expect to make $45,000 a
year and drive a Lexus to the country club. They expect to be comfortable,
middle-class people who are helping their patients and getting satisfaction in
their life that way. And, frankly, a lot of American doctors have that same set
of expectations. They don’t want to particularly be rich. They just want to
treat their patients and help their community. And, of course, they see this
ridiculous system we have getting in the way. So, I don’t think that’s such a
big obstacle. I think - I talk to medical societies a lot and those docs
definitely would accept a system with lower payments if they had an easier way
to treat their patients.

GROSS: T.R. Reid, thank you so much for talking with us.

Mr. REID: Thanks.

GROSS: T.R. Reid is the author of the new book, “The Healing of America: A
Global Quest for Better, Cheaper, and Fairer Health Care.”

Coming up, Ken Tucker reviews a new CD by the band Deer Tick, whose music is
inspired by early rock and roll, rockabilly, and country music. This is FRESH
AIR.
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Deer Tick’s ‘Born On Flag Day’

TERRY GROSS, host:

Deer Tick is a Providence, Rhode Island, act that began as a solo project for
its leader, John McCauley. Now, he’s gathered three more musicians to form a
Deer Tick quartet. Rock critic Ken Tucker says Deer Tick’s music remains
focused on its founder’s obsession.

(Soundbite of song, “Hell on Earth”)

Mr. JOHN McCAULEY (Singer): (Singing) Life is beautiful, but beauty is a dying
art. Life is wonderful, there’s only so much you can wonder about. Before life
drives you mad, and before nobody care, before life drives you mad, and before
nobody care, there are only words…

KEN TUCKER: Deer Tick is an interesting work in progress. The lead singer who
formed the band, John McCauley, is in his early 20s. He’s precocious. He
released his first album a couple of years ago. It was called “War Elephant,”
and he played every instrument himself. Now, he’s put together a real Deer Tick
band to flesh out his sketches of loneliness and fond self-regard.

(Soundbite of song, “Smith Hill”)

Mr. McCAULEY: (Singing) Elbows on the window sill, my head against the pane.
You’ve seen so many grow and die, but you forgot most of their names. So I fire
that arrow into the great big sky, and hope that it never comes down. Unless
you’re coming with it, it’s better with you around. I could drink myself to
death tonight, or I could stand and give a toast. To those who made it out
alive, it’s you I’ll miss the most. But tonight I’ll see my sweetheart…

TUCKER: John McCauley sings in a constipated croon as though it pains him to
try and make his voice actually hit the notes of the melodies he writes. It’s a
voice that carries its own inherent form of resentment, which is why the best
songs on this new album, “Born On Flag Day,” frequently sound both angry and
weary. It’s an effort to find the right way to express his alienation.

(Soundbite of song, “Song About a Man”)

Mr. MCCAULEY: (Singing) How can a man feel anything when all he’s ever got was
sympathy? Take both your hands and put them around my neck, you’re a fool for
wanting everything. It couldn’t be much fun being…

TUCKER: There are strong elements of folk and country music in Deer Tick’s
music, but the attitude is classic rock and roll bratty. McCauley frequently
goes on about how he feels best when he’s in the most miserable part of town.
He’s at his best when he keeps his lyrics conversational and at his weakest,
when he’s straining for a hardboiled image. When he describes, quote, “a curse
like a knife,” it’s a phrase that could have come from a thousand other songs
or a thousand detective novels. Yet despite and because of all this, McCauley’s
country folk has a stubborn orneriness that keeps you listening.

(Soundbite of song, “Houston, TX”)

Mr. MCCAULEY: (Singing) I’ll walk with the moon tonight, and cut through the
air with a curse like a knife. And it can float around and I can do what I
like. There’s no good place in town, but I feel all right. All right. I ain’t
gonna talk like your…

TUCKER: Deer Tick can actually be pretty charming and enduring, especially when
the band tries to approximate the half century old rock, country and rockabilly
that McCauley clearly loves and rips off with his much brazen gusto as he can
muster.

(Soundbite of song, “Straight Into a Storm”)

Mr. MCCAULEY: (Singing) Is it wrong to think that it ain’t no fun to be
anything but second to none when I’m second to him every time that I come
around? Tell me baby, how long till we’re gonna get down? I’m a stranger now in
my own house. I’m a brand new man watching her undo her blouse. I see my mama
of a princess, though she herself was never a queen. So now I’m heading out
West and I’m gonna get this body clean. Throw it out, make some noise…

TUCKER: I suspect that if John McCauley really wants to make a go of this Deer
Tick thing, he’ll have to come up with a subject other than his own discontent.
The music is already there and solid, a frequently fierce melding of the Hank
Williams-era country music he loves un-ironically. Even better is his own
original take on how folk rock should sound in these hard times.

If he takes more firm control over his wayward talent for narrative, I’ll bet
the next Deer Tick album will shake off the doldrums and take off like a
rocket.

GROSS: Ken Tucker reviewed the new album by Deer Tick, which is called “Born On
Flag Day.” You can download podcasts of our show on our Web site,
freshair.npr.org.

I’m Terry Gross.
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Transcripts are created on a rush deadline, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of Fresh Air interviews and reviews are the audio recordings of each segment.