Changing Healthcare in California and U.S.

This segment on healthcare starts with the news that California has been given a federal waiver to add 500,000 more people to MediCal. Then New York Times bestselling author (The Healing of America") and longtime Washington Post correspondent T.R. Reid tells us that "despite all the rights and privileges and entitlements Americans enjoy today, we have never decided to provide medical care for everybody who needs it…. Other countries like us -- wealthy, technologically advanced, industrialized democracies -- guarantee medical care to anyone who gets sick. Reid talks about what we can learn from other countries -- if we're willing.

Guests: Kenny Goldberg, KPBS Health Reporter

T.R. Reid, Washington Post reporter and author of "The Healing of America."

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Many of the newly elected Republicans who have been elected to Congress have promised to work on if dismantling the affordable public healthcare law. Whether the new GOP can actually do that is yet to be seen. But even if the new healthcare system is fully put into effect, the goal of universal health coverage will still be a dream in America. To tell us why that is and to tell us what we can learn from the rest of the world about healthcare, is my guest, T. R. Reed. Of he's the author of the book, the Healing of America, a global quest for better, cheaper and fairer healthcare. And T. R., welcome to These Days.

T. R. REED: Maureen, it's great to be back on your show. Thanks for calling me.

MAUREEN CAVANAUGH: Now, before we talk about your book and healthcare in the country in general, I'd like to get your reaction to this expansion of Medi-Cal. Kind of getting a foot up on what the rest of the kitchen is gonna be seeing in the next few years. Do you see this as progress or maybe just a drop in the bucket.

T. R. REED: Well, I think it's really smart of California to jump in ahead of everybody else and try to get that money ahead of time and expanding healthcare coverage, it's a good thing. There are a lot of people in America who can't see a doctor until they're sick enough to go to the emergency room. We gotta treat those people earlier. It'd be better for them and cheaper for us. So it's a good yet. But you know, I heard Kenny's report, he's right in every way. But I'm not sure that the $2 billion you're expecting is gonna be there. Because the Republicans have promised they're not gonna appropriate the money to fund Obama care initiatives. That Medicaid expansion is part of Obama care, the Republicans ran against it, they won, I would be surprised if that money comes in much less than you're planning on.

MAUREEN CAVANAUGH: We'll talk a little bit more about the political implications of our recent elections. I would like to start out however with a very moving piece that you start your book on, that is the story of Monique Nicky white. A young woman who contracted lupus, he was uneligible for any public healthcare. Tell us her story.

T. R. REED: He was a 32-year-old college graduate living in Texas, had a good job, and she got lupus, which is a serious disease. But this is a serious disease that modern medicine knows how to manage. There's a drug regime and certain tests you have to get regularly, and lupus sufferers live a normal life. But Nicky lost her job and he lost her health insurance. And she foal into this terrible trap that millions of Americans are in. She had too much money to qualify for Medicaid for welfare. But too little money to pay for the dollars and bills that she needed. And at age 32, she died, in the richest country in the word, she died because she cannot afford medical care. It's a tragedy, but she's not alone. About 25000 of our fellow Americans die every year because they can't afford a doctor. And the point of my book is, if Nicky had lived in any other rich democracy, Germany, Belgium, France, Japan, she would have been alive today, because all of those countries have found ways to treat everybody, to cover everybody, and guess what? They spend half as much as we do on healthcare. So that's the point of the book. I went around the world to figure out how they do it.

MAUREEN CAVANAUGH: What do you find, T. R. Reed, is the fundamental difference between the way we in America approach healthcare and as you say, every other rich industrialized democracy approaches healthcare.

T. R. REED: I cob included at the end of my book is the biggest single difference is all the other countries first decided on the goal. They made a commitment to provide healthcare for everyone who needed it. That's obviously a political decision, it's a medical decision, it's an economic decision, but in the end, that's a moral decision. If a country's moral values say, dog gone it, we want all our neighbors to be able to see a doctor when they're sick. Then you can design a system that gets you there. Of my argument in the book is, unlike the other rich countries issue the U.S. has never made this commitment to cover everybody. And we've never even had the discussion as you just said, even if Obama care takes effect and works, which I think is doubtful now, even under Obama care, ten years from now we're still gonna have 23-million Americans without insurance. And no other rich country lets that happen. And that's what I was looking at in my book.

MAUREEN CAVANAUGH: I'm speaking with T. R. Reed, he is the author of the book, the Healing of America. And you were just speaking about every other rich industrialized democracy has made this moral decision that people should be covered we healthcare. And that need has to be met. And if it's going to be met by government in some way, it's going to be met by government. But you also said something else, that I think really affects people in their pocketbooks. Not only is this a moral decision, but it's a very practical decision for many of the countries of you've travelled the world, you've seen doctors and had treatments in France, Japan, Germany, Britain. Let's focus on a cost comparison that you deal with in your book. Compare the treatment you received and the costs in those nations.

T. R. REED: Yeah, that's pretty striking of they all cover everybody. And they all spend much less on average about half as much in Japan, for example, I'm sure you know this, Maureen, Japan is the oldest population in the world. Of and the healthiest. They're just amazing. Of they live till 78 or 80 before they start getting any diseases at all. So they have really -- that's partly lifestyle, but it's very good healthcare. And they love going to the doctor. Culturally, it's desirable. The Japanese go to the doctor about 15 times a year. We about go five on average. When a baby is born in Japan on average, mother and child stay in the hospital ten days after birth. They real use healthcare. They have three times as many prescriptions per capita, three times as many scans, but they cover everybody and spend $3400 per person per year on health care. We spend $7500 per person per year and leave 50 million people uninsured. So those systems have found ways to do it better, but as I say -- and they all do it different ways. You know, Maureen, the striking thing is it's not all socialized medicine. A lot of countries in my book cover everybody with private docs, private hospitals, and private insurance of the private sector can definitely do this job and it does so in a lot of countries but first you have to make the determination, and as I said, I think it's a moral determination that you want to cover everybody. And we haven't done that.

MAUREEN CAVANAUGH: Tell us a little bit about the countries that do have private insurers as part of their healthcare plan. I think Germany is one of those.

T. R. REED: Germany invented this system. And I think Germany's an interesting model because it's -- it kind of shoots down to, you know, Americans think, oh, gee, universal government, that means big government, nanny state, socialized medicine. No. In germ many, they have 83 million people, 83 million people are covered by the healthcare system, and it's all private docs, private labs, private drug companies and private insurance. They make it work I think because they regulate their insurance companies much more strictly than we do. For example, in all the other countries, let's see, that would be Germany, Belgium, Switzerland, Japan, that have private insurance, the insurers have to pay every claim. I bet some people listening to KPBS this morning have had an insurance claim denied now and then.

MAUREEN CAVANAUGH: I think that's possible.

T. R. REED: Yeah, that can't happen in other countries. If a doctor or hospital sends in the bill, they gotta pay. And get this, they usually have to pay within 2 or 3 days. In Germany -- I'm sorry, in Switzerland, if your insurance company doesn't pay the claim in five days, next month's premium is free. You think anybody in San Diego has that deal?

MAUREEN CAVANAUGH: I haven't heard from them.

T. R. REED: So that's my argument in the book. Look, the private sector works great in these countries. Covers everybody for less money. But to do it, you have to regulate the insurance companies in ways that our insurers have never agreed to.

MAUREEN CAVANAUGH: I'm speaking with Washington post reporter T. R. Reed about his new book, the Healing of America. We're told by people who don't want to see any kind of reform in this country that first of all we have the finest healthcare system in the world and that these reforms will ruin it. And the way that they'll ruin it is because government cost controls will stifle innovation in healthcare and a host of other reasons. I want you, if you could address those two issues, first of all.

T. R. REED: Hey, for some Americans, we have the best healthcare in the world, if you're rich or you have really good insurance in America, you're gonna get the finest care in the finest hospitals in the world with no waiting. There's no doubt about that. The problem with our system is all the people who aren't covered, and as of May, according to the census bureau, that was 50.7 million Americans, if they have some money in their pocket to pay the doctor, they can do it. But you know, you get hit by a truck, even a minor auto accident is $60,000, $100,000. People don't have that in their pocket. And they're stuck. And that's why our statistics are so much lower. Of that's why other countries live longer and have lower infant mortality rates because they cover everybody. We have a great care for some people, but we leave so many people out, and that's why the U.S. doesn't rank very high.

MAUREEN CAVANAUGH: And what about that government cost control stifling innovation?

T. R. REED: I think I shoot that down in my book pretty successfully. Here's the truth. The fact is we have great medical innovation. The United States is really a world leader in drugs and procedures, in research. We're great at this. But guess what? So are the other countries with much lower cost controls. In fact a lot of the stuff that we see as important breakthroughs comes from other countries. If you've ever had an ultrasound when you were pregnant, that's Swedish technology. And they cover everybody for half the cost of ours. Anybody in San Diego's working around on an artificial knee or hip, that's French technology. The biggest selling drug for AstraZeneca are a big American drug company, is Crestor, it's statin for cholesterol, that's licensed from a Japanese company. And get this, one pill of Crestor costs about $0.80 to a dollar in America, the same pill costs $0.06 in Japan. Same pill made in the same factory. So the notion that we have to pay through the nose to finance innovation is nuts. We have good innovation. But so do other countries that pay vastly less.

MAUREEN CAVANAUGH: One of the things that makes the books the Healing of America so engrossing is the fact that you're not just speculating on these things. You talk about being treated in a number of different countries from Japan to Britain, to India, and you compare not only the costs but the quality of that care. Give us sort of an idea of what those treatments were like, and what were the best and the worst.

T. R. REED: Here's the deal, when I was in the U.S. Navy a long time ago, I bashed my shoulder, and I'm getting older now and it's starting to stiffen up and hurt. And I went to doctors and hospitals all over, and said what can you do? And I got a broad range of proposals. Some doctors were -- countries were perfectly willing to give me an artificial shoulder, which is probably what would happen in America. In America, that procedure would cost me around $37,000 through my insurance company. In France exactly the same procedure costs $5,000, in Japan it costs about $4,000. I could have had it. In Britain where they cover everybody, that's a socialized medicine system, it wasn't bad. My family lived there. But my doctor there said no, we're not gonna do that. We're not gonna give you a shoulder because you're doing fine, you're a report, you don't really need that shoulder. You're living a good life. Go home and live with it. And in a way, that kind of helped. Hey, live with it. I'm doing okay in my life. Ive got things to do other than play golf.

MAUREEN CAVANAUGH: This is exactly the kind of thing that people are afraid of though, when they talk about socialized medicine. That you won't be treated, basically that care will be rationed.

T. R. REED: Yeah. Well, that's a good -- I'm glad you brought that up. Rationing, that's a nasty word, and you're not allowed to say it. Of the fact is, the other countries do ration care. In fact, every country rations care, because no country, not even the United States of America can afford to pay for everything that modern medicine can do. The difference, there's a difference in the way we ration. In the other countries, there's kind of a basic floor that everybody gets. And then at the top, at the ceiling, there are limits. There are some procedures they won't do. In America, some people with good insurance upon have no ceiling. They can get anything they can pay for. But lots of people don't have a floor. They barely get in the door. So we too are rationing care, millions of times a day. We ration medical care in the United States. But we do it in a harsher way.

MAUREEN CAVANAUGH: Let's talk a little bit about the healthcare reform act that is now law, and if independent the provisions of that law go into effect, as they are supposed to over the next few years, go back to the story of Monique white. The young woman who contracted lupus and lost her insurance and ultimately died. Would Nicky be covered under the new federal healthcare act and how would that help someone in her position.

T. R. REED: Maureen, the paperback of my edition has just come out, and in that book I have -- I tried to explain the Obama care legislation in plain English. And I think it's clear that Nicky White would have been covered because as Kenny was just saying they're expanded the definition of who can be covered by Medicaid. She would have gotten medicate and would be covered and would be alive today under Obama care. But I have to say, having really worked hard to turn that bill into 7 or 8 pages of plain English, it is incredibly complicated, critics have complained that it's a bureaucratic monstrosity. It's an incredibly complicated bill. It's 450000 words, 4 times as long as my book where I went and did the whole word, you know? So it's very complicated. And frankly, Medicaid is -- it's good that they're putting more people on Medicaid. But I don't think Medicaid's a very good program. It depends totally on legislative budgets. Your state has no money, my state, Colorado, has no money. And the federal government is supposed to pay for the expansion of Medicaid, as Kenny said, so it won't cost California anything. But I now think that the Republicans who won the election they ran on cutting Obama care, and I think they're gonna do it. I don't think they're gonna provide the money. But it's not the best way. Another thing that happens in Obama care is about 16 million more people will get private insurance. They'll buy it from Anthem or Bluecross, and the government is it gonna subsidize families to buy it. About almost two thirds of the families in America will get a subsidy from the federal government to help them pay their insurance bills if Obama care goes ahead. This starts in 2014. I think that's a better way to provide care. But at least whatever you think about Obama care, it does expand know a number of Americans who have health insurance. This is a good thing. It saves lives, it reduces suffering and it saves all of us money because it's -- if you treat everybody early when they get these diseases, it's cheaper than doing it the American way, which is wait till the appendix bursts then treat them in the emergency room.

MAUREEN CAVANAUGH: Finally T. R. Reed, as you said, you think it comes down to a fundamental moral question that countries have to ask themselves, and they have to answer whether or not everyone in the country deserves a basic level of healthcare. And I'm wondering, we in America think of ourselves as very, very giving people, and we prove that over and over again with a pretty good moral compass. So why do you think there is such loud opposition to universal healthcare in this country?

T. R. REED: I really struggle with that question. 'Cause I think we are a decent, compassionate people. I think the final answer is this is -- healthcare in America is a two- point sword trillion dollar industry. There are more than a thousand companies making a billion dollars a year off of our current system. So that gives you a huge build- in pressure group to protect the current policy. And the reason Obama care is 2400 pages and so complicated that nobody can figure it out is because they tried to build on the current system to protect each one of the current winners so nobody lost too much. And the result is an equally -- an even more complicated system that still doesn't cover everybody. So I think -- nobody designed our system. It just kind of happened over time. What I saw in other countries is at some time dating back to 1871? Germany, somebody sat down and said, okay, let's find a way to provide healthcare for all our people. And once you make that commitment, you can do it. We never did, we have a system that just grew up in some crazy fashion. A lot of people are making lots of money on it, so they want to protect it.

MAUREEN CAVANAUGH: I want to thank you so much for speaking with us today. Thanks.

T. R. REED: Thank you Maureen, great to be on your show.