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Health care myths should not control debate

A unified national health care system does not mean a government takeover or higher costs.

 

Our older daughter, Carrie, visited last weekend from her home in Seattle. She works as an independent contractor without health insurance. Over the past year or so, Carrie has been bothered by chronic stomach issues.

She has addressed this problem by lots of visits to the medical Internet site Web MD and occasional visits to a naturopathic medicine school or her local clinic.

This is hardly the way for Carrie to get the care and treatment she needs to be healthy. She has no way of sustaining the kind of doctor-patient relationship that would allow a proper diagnosis and course of treatment.

Only America, of all developed countries, puts its citizens in the kind of situation Carrie faces. Most of you will be familiar with the statistics. We spend 16 percent of our GDP on health care, twice as much as any other country, yet we don't cover everyone, nor do we have good health outcomes. The United States ranks 47th in the world in life expectancy – that's 47th, just ahead of Cyprus and behind Bosnia.

This is why the debate on health care reform being played out in such an excruciating way in Washington is so important, yet it also is complex and confusing.

A recent book by the journalist T.R. Reid called "The Healing of America" has helped clarify much of this debate for me.

Reid visited seven countries in the developed world that provide better health care at (much) lower cost than the United States. What he learned punctures several myths we in this country hold about health care systems in the rest of the world:

Myth No. 1: "It's all socialized medicine." It turns out that most wealthy countries rely on private-sector mechanisms to provide and/or pay for health care. Countries such as France, rated No. 1 in the world, Germany and Switzerland offer universal coverage using private providers and private insurance plans.

Myth No. 2: "They ration care with waiting lists and limited choices." In many developed countries, people have quicker access to care and more choice than Americans do. Waiting times in Japan are so short that most people don't make appointments to see a doctor.

Myth No. 3: "They are wasteful systems run by bloated bureaucracies." In fact, America's for-profit health insurance companies have the highest administrative costs in the world, averaging 20 percent. France's private (but nonprofit) health insurance industry spends 5 percent, Canada only 6 percent.

Myth No. 4: "Those systems are too foreign to work in the United States." Reid points out that we already use elements of the approaches of other developed countries' systems in our own. For those over 65 we have adopted the Canadian model (Medicare), and for working people with insurance through their employers we are like Germany. For active-duty military and veterans we use the British model.

In fact, what distinguishes us is that we are the only developed country that tries to use more than one system. All other countries have one unified system that applies to all.

A single system is easier and cheaper to administer and a powerful lever for cost control. A single health care system has significant bargaining power. Reid notes that this is why an MRI scan in Denver costs $1,200 and only $98 in Tokyo.

Moreover, a unified health care system doesn't necessarily equate to a single-payer system (the Canadian approach).

Countries like France, Germany and Japan have several insurance plans, but they are guided by a clear set of rules and policies that ensure all patients are treated the same and all providers' fees adhere to a unified payment schedule.

The bills we are seeing coming from the House and Senate do not take the fundamental step of giving the nation a unified health care system.

The insurance lobby and the American Medical Association have once again overpowered Congress on this issue. In addition, the Republican Party has given up all pretext of being a constructive force in the policy debate.

The best we can hope for is a plan that addresses two major defects in our country's health care system: providing coverage to all Americans, and forcing insurance companies to cover all citizens regardless of pre-existing conditions.

These modest gains will simply be layered on our torturously complex system. Nonetheless, we must do something to address the moral question: How can the world's richest country not provide basic health care to all of its citizens?

Let us get this done. Then let us step back and address the corrosive effect of big money on our political system, now the single greatest threat to American democracy.

It is not al-Qaida that should keep you awake at night. It is the fact that your political representatives are spending 80 percent of their time begging for dollars for the next campaign. Only in America.