ASHE PDC: The Global Quest for Better, Cheaper, and Fairer Healthcare
In a well-attended and well-received opening keynote address at the 2012 ASHE PDC Summit in Phoenix, Arizona, on Monday, March 5, NPR and PBS reporter and author of The Healing of America T. R. Reid delivered a talk that revealed many insights of his "world tour" spent searching for the ideal healthcare system. While in the end, Reid discovered that there is, in fact, no totally ideal system, his findings shed a lot of light on the myths behind the term "socialized medicine" and some of the reasons why other industrialized countries have been able to deliver better, more affordable, fairer healthcare.
Reid began his keynote by making sure not to offend the audience of American healthcare architects, engineers, planners, and designers with the caveat that "the best hospitals are in the U.S., but it is not the best healthcare system." Throughout his speech, Reid maintained that from a design perspective, the buildings that the ASHE PDC crowd are responsible for are second-to-none in his worldwide comparison. However, in looking at the roughly 45 "rich" countries of the world, literally all of the other countries manage to cover their entire populations and yet spend half as much (or less) than the United States does on healthcare. What followed were his findings and comparisons of the rest of the industrialized world's healthcare systems, but he started by establishing that, "there is no perfect system. Every country is struggling with what to cover and how to pay for it."
Reid then began outlining the three major models used worldwide for healthcare systems. First up was the Beveridge Model, popularized in the United Kingdom, wherein the government owns the health facilities, employs specialists, and GPs are private but bill the government, and there is no premium, co-pay, or bill for the citizens. However, the tax rates are rather high (about 20% sales tax) to pay for this universal coverage. Reid was very impressed with the way the system worked and noted that England was by far the most proactive country, dubbing it the “champion of preventive care” because keeping people healthy is in the system’s best interest.
Next was the Bismarck Model, started in Germany when in 1883, Bismarck decided that a rich country like Germany should provide healthcare for all its people and proceeded to make it so. This model of private healthcare where business owners and employees share in the expenses of healthcare is shared by France, Japan, and many of the other rich nations. Finally came the Douglas Model, originating in Canada and named for a prominent politician who promised healthcare to all and wound up winning the election. This model featured private doctors, private (or charity run) hospitals, and public payments was soon named “Medicare” and in 1944, the United States adapted this model into its own healthcare system. The rest of the world, Reid pointed out, essentially uses the Out-of-Pocket Model, in which if you can pay, you can get care, and if you can’t pay, you don’t.
In comparing these systems to the United States, Reid made the key point that the U.S. uses all of these systems—and that perhaps that is a large part of what leads to all of the problems we encounter here, as we are the only country that does this. Those in the VA system are essentially using the Beveridge Model; if you are a senior on Medicare, you are using the Douglas Model; if you share your healthcare expenses with your employer, you are using the Bismarck Model; and of course the nation’s 49-plus million uninsured use the Out-of-Pocket Model.
Reid reasoned that under a single, unified system—which one it might be—everything would be exponentially simpler and cheaper than our current operating model. We pay more and get less in the United States because the system is so complicated here, with too many moving parts and fingers in the pie. He concluded that it is fairer if everyone is given the same care at the same price, and that the decision to do this or not do this is essentially a moral and ethical judgment, as is the design of any country’s healthcare system. If you fail to even make that judgment, you wind up with the U.S. healthcare system. “If we had the will,” Reid explained, “the other rich countries could show us the way.”
With healthcare costs rising at 2 to 3 times the rate of inflation and a Presidential election coming in the fall, Reid’s findings and the debate over the U.S. healthcare system (and how to fix it) are sure to be a topic of debate for some time to come. Reid is optimistic that change can and will happen, however, summarizing his sunny outlook with a zinger: “If France can do it, the United States can do it.”