Terry Gross, of NPR's "Fresh Air": It's proving awfully difficult to change our healthcare 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 US -- have decided that every human being has the 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 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 is our nation's health care system; the second was his bad shoulder. He took his shoulder to doctors around the world seeking alternatives to the risky surgery that was recommended for him in the US. T. R. Reid's new book is called "The Healing of America: A Global Quest for Better, Cheaper, Fairer Health Care." T. R. Reid: Welcome back to Fresh Air!
NPR: One of the main arguments that we're hearing at every forum is that this would be socialized medicine. You point out in your book that argument was actually created by a PR firm in the 1940's. Can you describe what happened then?
TRR: Yes. Harry Truman wanted to provide universal health care in 1947. The American Medical Association -- the doctors -- hired a PR firm that invented the term "socialized medicine." Nobody knew what it meant. But I think the idea was that if you wanted to provide health care to your sick neighbor, you were a commie! During the Cold War that was a powerful argument! The amazing thing is that it's still a powerful argument. I don't know that anybody can define "socialized 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.
NPR: You've broken down western healthcare systems into four categories. It would be really helpful for us to understand what some of the options are out there -- how other countries do it. Let's talk about those systems, starting with what is often called "the William Beveridge model" because he's the person who inspired the British National Health Service (NHS). And you describe the British National Health Service is probably closest to what Americans have in mind when they talk about "socialized medicine." Give us an overview of that system.
TRR: In the Beveridge model, taking care of people's health is the government's job -- just like picking up the trash, 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% of the people in Britain -- and Spain, Italy, New Zealand which are also Beveridge Model countries -- never get a doctor's 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, employs a lot of the doctors and nurses, and government buys the pills, pays the bills. Yeah, I'd say that's socialized medicine. But you get a lot of benefits. For one thing, it's so simple administratively. The billing office of a British hospital with 900 beds? I said to the guy, where's the billing office? Oh yeah, it's one drawer in my secretary's desk over there. She opens it once a month to send records to the government. It's so much simpler. There's one set of rules. Those systems really work. 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 him and says, "I believe it's otitis mediae and I gave him a penicillin jab." Your kid feels better, the parent feels better, and then, guess what? She walks out the door. No bill. No 3-month 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.
NPR: Are there insurance companies in England?
TRR: Yes. Because the NHS covers almost everything, there are private insurance plans that will cover things they don't cover like Botox or breast enlargement. Private health insurance would 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% of the people in Britain have private insurance but it only accounts for about 3% of the money spent on health care. When anything serious has to happen -- this is interesting -- people go to the public hospital. This is really interesting: I had a friend who had a baby. She had private insurance. And I said, "Well, then you're going to go to a private doctor?" "Oh, no, no, no, no, no! For my baby, that's too important and I trust the NHS!"
NPR: 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?
TRR: 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 the guy who's right down the street. Our doctor was two blocks away. So when we called her, she could get to our in an hour. But if you want to go to an orthopedist or a cardiac surgeon, you have to go to the GP first and get a recommendation. When we lived there four years ago, there were still some waiting lines to see specialists. It was tough. But I think those waiting lists are way down since Blair and Brown spent a lot of money.
NPR: On the health insurance system.
TRR: Yes. You know they have the thing in Britain on Wednesdays when the prime minister stands up in Parliament and the other party insults him and shouts questions at him? 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 corporate-style medicine! This we will never do! And they never will.
NPR: Is that the worst thing you can say? We're going to institute American-style corporate medicine?
TRR: 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 that we let people go bankrupt and die by the thousands in the healthcare 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, "We don't go around chanting, 'We're #1,' like some countries I know. But there are two areas where we're better than the States. Hockey and health care."
NPR: What about the question of choice. You quote the British health minister saying, "We cover everybody but we don't cover everything." So what are some of the things the NHS won't cover?
TRR: 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 I said to him, "Hey, I should get his 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 and I like that!" But they're thinking of an entire society and of course, as we now know and American researchers have now concluded, that that is not a useful test.
NPR: Is there anything you would describe as "rationing" -- the kind of rationing Americans are really afraid of?
TRR: Every country rations health care, Terry. There's no question about that. They do some 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 US rations health care. The distinction is that we ration differently from everybody else and this is important. In other countries they have a basic floor of care that everybody has access to. As a result of this, nobody dies from lack of a doctor. In America, some people get everything -- the ceiling is the sky -- and get in right away with no waiting. But a lot of people don't have access to any health 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.
NPR: Okay. Here's another question about the British National Health Service. You mentioned that there is a kind of rationing at the end of life. So what are some of the procedures -- or some of the things that are typically done -- at the end of life in the US that wouldn't be done under the NHS in England?
TRR: That's really hard to say. I think there's an age cut-off 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 89, 90 or something, they won't do it. but that's true in some plans in America, too. This business about throwing grandma off the cliff -- I think it's frankly baloney 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 'em alive longer than ours are!
NPR: Let's look at the French model. You seem particularly interested in the French system and I think that was rated the #1 health care system by the World Health Organization study that ranked countries around the world.
TRR: Yes. Everybody in France knows this and they're thrilled about it. The WHO did rate them #1. I went there and I can see why. It's a very good health care system. But in contrast, you remember we said in the British system the government provides the care and the government pays for the care? The 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.
NPR: So are these insurance companies in the model that France has -- are they for-profit companies like our for-profit insurance companies?
TRR: No. No country that has insurance companies lets insurance companies make a profit on basic health insurance. And they have pretty strict rules. 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 and anybody in Germany can buy any of the 200 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. That's 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. It's 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 5 days, your next month's premium is free!
NPR: Wow! That's amazing!
TRR: 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 and you have to get pre-authorization? In France -- this is true in Germany and Japan -- any doctor, any clinic, any chiropractor, anybody in the entire country -- you choose 'em and you go and insurance has to pay the bill within 2 weeks or so. Pretty good insurance!
NPR: I'm trying to understand how a non-profit insurance company would operate. I think there are some in the US but for the most part we, in the US, think of insurance companies that kind of bet against you in a way. (laughter) 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 and 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 sometimes, as the insured, you lose the gamble! So what's the difference between a for-profit American-style insurance company and a French non-profit-style insurance company?
TRR: Well, all over the world health insurance in non-profit except in the US and, as a matter of fact, when health insurance started in the US -- the original Blue Cross and Blue Shield in every state -- were non-profit 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: 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. Guess what! In the mid-'90's, the Swiss companies were copying our companies. They finally decided, "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 to the point -- fasten your seat belt, Terry! -- where 5% of the people in Switzerland couldn't get insurance and that was a scandal. That was unthinkable! Well, we're at 16% today. That is 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.
NPR: So in the model that we're talking about that France and Germany and Belgium and Switzerland and some other countries follow, do you have your choice of insurance companies or is there just one national company to buy from?
TRR: In some countries -- like France and Japan -- you get the insurance that applies to your industry, your company, or your region, and that's it. But some countries -- like Germany and Switzerland ... Germans can choose any of 200 health insurance plans and the plans do compete even though they can't make a profit. Why do they do that? Well, one reason is that the more members -- the more customers -- the 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 non-profit basic health insurance plan also sells life insurance, and fire insurance. They sell this kind of supplemental insurance to cover breast enlargement or hair replacement. So they try to win you by being really good non-profit health insurance companies and then you say, well, that's good, I'll buy my life insurance there, too. And they're all making more money because they use the basic health insurance as a way to bring in customers.
NPR: When you say they're making more money, do you mean that the salaries of insurance executives in the countries you're talking about compare to the multi-multi-million dollar salaries of insurance CEO's in the US?
TRR: Oh, no! Nobody makes American insurance CEO kind of salary!
NPR: 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?
TRR: The "carte vitale." Yes, French doctors don't make a lot. They do fine. They're good middle class people. But they're not rich. And their offices are spartan. They don't have National Geographics 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 are the files and files of patients' records. There's no billing office. And I said to this doc -- I spent some time with him -- "Where's your billing office?" He said, "Oh, zees would be ree-diculous! I don't make enough money to pay somebody to do 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 called the "carte vitale." He puts that in a reader on his desk and her entire medical record shows up on the screen. He chats with her about her problem. He's typing what she's got wrong. And he says to her, "Well, I think I'm going to prescribe a course of antibiotics. 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 and he turns to me and he says, "Please watch." He hits one key and the entire bill has gone to her insurance company. He's going to be paid in 3 days and she's going to get her co-pay back from the insurance company within two weeks. Done. No paper.
NPR: 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.
TRR: That's right. And he'll ask, "Did that other antibiotic work for this condition when you had it two years ago?" Yes. It's perfect. They find you. You can actually see on this card: there's a little good chip where you're 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 is pretty good.
NPR: Japan has borrowed this model that France has. You say that in Japan there's good access to fine doctors -- lots of choice. But the system is over-stretched and it's pinching pennies. So how does that affect the health care of Japanese people?
TRR: Well, their health care is fabulous. They have the longest lived and healthiest population in the world. They have much better recovery rates for 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 a year in America. Average hospital stay in Japan is 36 nights. Ours is 6 nights. So they're big consumers of medicine with 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. They're under a severe strain. The solution -- they spend 8% of GDP on health care and we spend about 17% -- is to raise that to 9% and pay all their doctors and hospitals better. So far they've tried to resist that. But they're going to have to do it.
NPR: So that would mean raising taxes a little bit.
TRR: Yes, or maybe raising the insurance premium or something.
NPR: We've talked a little about Britain's National Health Service. We looked at the French model -- 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 are the basics of that model?
TRR: Remember Britain: government provides the care and government pays for the care. 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 14: there's one for each province. Everybody pays. In some provinces it's a tax. In some it's called a premium. You pay in every month just like we pay social security taxes and medicare taxes. You go to the doctor and it's free. This works pretty well. The doctors are private and they just bill the government. You don't get a bill. This means anybody can go. It means that nobody with an acute condition in Canada dies for lack of health care, as happens in America. The flaw with the Canadian system is that to save money, they've cut back sharply on the number of specialists and operating rooms and 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. 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'd better send you to an orthopedist." "How long would it take?" He said, "Oh, ten or twelve months..."
TRR: Twelve months? Twelve months! It hurts! It hurts every morning when I wake up. And I've got to wait twelve months to get treatment? And this guy says, "I didn't say treatment. No, it would be ten 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 a 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 and they do it to save money.
NPR: Can you get supplemental insurance and through that jump ahead of the line?
TRR: 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 line. The number of people who do that seems to be pretty small. It's not as big as you hear in the argument, but some do that. But three years ago, the Canadian Supreme Court ruled that they can't bar you from buying private insurance and going to private doctors. This created all sorts of concern in Canada because their big bugaboo -- you know how we're all worried about "socialized medicine"? -- their equivalent, 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! So what they did is, they tried to step up the spending on the system they have so that people can get care. As it turns out, there are a few places in Canada where a doctor can operate privately but not many. The rule is, if you operate in the Medicare system -- the national system -- then you can't also treat people privately. So you've got to be a doc in a pretty rich neighborhood to have enough private customers to make a living.
NPR: Let's look briefly at the fourth and final model that you write about and this is the out-of-pocket model that you sum up very quickly. (laughter)
TRR: Yes, that's the most common model in the world. It's only really the 40 or 50 richest countries that 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, and if you can't pay, you stay sick or you die. That's it. Brutal. Simple. Fact of life in most countries. Some third-world countries have a big hospital in the capital city where the people can line up. But out in the villages, no care. So people, if they have money, pay in money. 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.
NPR: Okay, so we looked at four models and three of the four models -- the three models that most westernized countries use -- everybody is guaranteed health care. You write that in America we have aspects of all four of the models, the three where people are guaranteed health care and the fourth where if you don't have the money you don't get the treatment. Explain how we have aspects of each of those models.
TRR: So look, please don't tell my publisher because I spent a lot of their money going around all the world for three years looking at these different models of health care. Turns out we have them all right here in the US! If you're Native American or a veteran, you live in Britain. They get government health care at 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 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 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 it you can pay for health insurance, you can get it -- or maybe line up at the free hospital sometimes. We've got them all, and that's really the most important difference. All the other countries have decided that it's cheaper and it's fairer to provide one model so that everybody has the same access to the same care at the same price.
NPR: But it's not just a sense of egalitarianism that underlies your criticism of our multi-tiered system. It's really also an expensive system to maintain because there are so many different systems within it -- so many different forms of billing, so many different prices! Give me some examples of why that both complicates things for doctors and patients and also makes it much more expensive.
TRR: Well, just think about it. It's just vastly simpler if there's one set of rules, one set of forms, one price or one regional price for the whole country. 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 100 most common procedures that she does. And then the next column says how much insurance is going to pay you back, and then how many days before the insurance company 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 -- it's free enterprise, it's competitive, and those guys, as we said, make huge salaries -- it's the least efficient payment system in the world. They spend 18-20% of every premium dollar on administration costs. Do you think of France, Terry, as a model of management efficiency? The French insurance industry spends 4% on administration. Germany, 5%. Japan about 5%. So we are just pouring tons of money into stuff that doesn't buy anybody health care largely because we have this hugely complicated and overlapping set of systems. And that's one of the reasons all of 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. In our system, the insurance company is 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 keep you healthy! By the time you get sick, you're somebody else's problem.
NPR: One of the reasons you undertook this travelogue around the world looking at health care systems is that you have a bum shoulder. Tell us briefly what's wrong with your shoulder.
TRR: I fell and broke my shoulder in the US Navy some thirty years ago. The Navy fixed it at Bethesda Navy Hospital. They literally screwed my shoulder back together so there's a big stainless steel screw in there you can see in the x-rays. I'm gettin' 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 do better health care in America. But let's admit it, I also had a selfish reason: maybe I could get good care for my shoulder, too. So I set out to see what I could do.
NPR: In America, the doctor you saw recommended a very challenging (laughter) operation for you which would have been ... what?
TRR: 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 he says, "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, this doctor. Well, so what could go wrong? "Well," he said, "It's major surgery. There are always some problems." "Like what?" And he says, "Well, death, paralysis,disease..." (laughter)... So I said, "Okay. Maybe I'll go look around."
NPR: So let's start with England. You took your shoulder to England and what was the advice you got there?
TRR: Britain? That's where they developed the stiff upper lip. To be blunt about it, my GP in Britain said, "Live with it." It's not destroying my life that much. I've got another hand 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 and he'd say, 'No, not serious enough. We're not going to do the operation.' And you could come back to me and we could send you to another surgeon and he'd say no." He says, "I'll tell you what, in the National Health Service we'll give you physio" -- that's physical therapy -- "and that'll help some, that'll reduce the pain, but go home and live with it." That's the advice he gave.
NPR: Was that satisfying to you?
TRR: You know, it helped a little. It's not that bad. Rather than sit around and moan about it, just live your life and you can kind of forget your shoulder hurts. Yeah, it wasn't bad.
NPR: You went to France? What kind of advice did you get there?
TRR: The orthpod in France loved me because he threw my x-ray on that light machine they have. Big smile on his face because he saw that stainless steel screw I got at Bethesda. That operation was invented in France. It's called the "Latarjet procedure" and this guy was so thrilled that I had a French operation on my American shoulder. So we did just fine. He said that he, too, could cut out my shoulder and give me an artificial one and it would only cost about $6,000 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 of choice. But he didn't think it made sense.
NPR: He was recommending cortisone shots?
TRR: I think it was a steroid, but...
NPR: Okay. You went to Japan. What did they tell you?
TRR: That was the most interesting doctor. For one thing, he was the only doctor I went to who called up my condition on the computer and read about it while I was in the room just to make sure he was right. He said that in Japan they definitely would do that surgery if I wanted to replace my shoulder. He suggested monthly or bi-monthly steroid shots. He said he thought I'd 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. He suggested physical therapy. 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. I know a lot of people get good results from acupuncture -- I got nothin'. 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.
NPR: I should mention that the cortisone shots and the physical therapy that the Japanese doctor recommended -- you could have gotten the same advice from a lot of American doctors and had your health insurance company in America pay for it, too.
TRR: I think that's absolutely right, yes. I went to an orthopedic surgeon and they want to orthopedically surge -- that's what they do. And he's a good one. I'm sure it would have helped.
NPR: You had a very interesting experience in India.
TRR: Yes. In India we went to an ayurvedic clinic. That's a 3,000-year-old Indian form of medicine. 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, nim wood table and six people massage you with warm oil. I mean it was fabulous! I did this for five weeks and made a movie about it for PBS Frontline called "A Second Opinion." After the massage, the guy would take me to the shower and these same, strong masseuses would take the 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, 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!")
NPR: How is your shoulder? Did the massage work?
TRR: It definitely improved. I did not believe in this ayurveda. It comes out of the Hindu religion. So while I was being treated, they made me go over to the temple and walk three times around Dhanwatari, the Hindu god of healing, clockwise -- it had to be clockwise. They made a person from the yajnapati department -- that's astronomy -- 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.
NPR: I'm glad you shoulder has improved and I hope it stays that way! We're having a lot of political obstacles in the US that are slowing or prevent health care reform. You went to two countries that recently remade their systems. Taiwan and Switzerland. And you say in both countries, liberal political parties stepped up the pressure for change to such a level that the conservative parties were unwilling to resist. Could you elaborate on what happened in those countries politically that enabled major health care reform?
TRR: Taiwan is one of these new Asian tigers, a country that got very rich. They went from about 100th in the world in GDP per capita to 20th in about 15 years. Once they got there in the mid-'90's, they said, "Well, we ought to have a rich country's health care system." So they did what I did -- they went around the world and looked at all the health care systems, including ours,and ended up choosing the Canadian model. Then they had this political fight to put it into effect. 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 election. Pretty interesting development!
NPR: You mean it was so popular -- reform had become so popular -- that the conservatives decided they wanted to take credit for it?
TRR: Yes. I think that's exactly right. They saw they couldn't stop it. Taiwan felt 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.
NPR: 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.
TRR: Yes, most of them go to medical school for free or almost nothing. Their malpractice insurance premiums are much lower than in the US. But I think a lot of it is expectation. They don't expect to make $450,000 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 life that way. Frankly a lot of American doctors have that same set of expectations. They don't particularly want to be rich. They just want to treat their patients and help their community. 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 talk to medical societies a lot and most docs definitely would accept a system with lower payments if they had an easier way to treat their patients.