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Congress should look overseas for health models

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It's amazing that deliberations over U.S. health care reform involve next to no discussion of health plans in other industrialized countries, where everybody is covered, costs are lower and health outcomes are better.

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For sure, reform opponents have cited foreign horror stories -- delays in Canada, care denials in Britain -- but advocates rarely cite the success of countries like France, Germany, Switzerland and the Netherlands.

A new book by Washington Post correspondent T.R. Reid, "The Healing of America: A Global Quest for Better, Cheaper and Fairer Health Care," should be the textbook for reformers, especially in the White House and Congress.

Reid traveled the world inspecting health plans and writes that his quest "makes it clear that other wealthy democracies can show us how to build a decent healthcare system, if that's what we want."

And, to debunk the first argument to be heard from the Tea Party set, he writes, "it's not all socialized medicine out there. Most wealthy countries rely on private-sector mechanisms to provide and/or pay for health care.

"Indeed, some foreign health systems are more privatized than ours."

He's referring to Germany and Switzerland, where seniors continue to rely on private insurance, whereas most U.S. seniors are on government-run Medicare, which is going broke.

As a matter of fact, Reid told me, Senate Finance Chairman Max Baucus, D-Mont., did invite him last year to brief members, and he showed them his PBS documentary "Sick Around the World."

"And just from the questions and comments, I could tell that they got it," he said.

But this year, "nobody who read my book would have written the Baucus bill," Reid said.

Baucus' bill, currently the centerpiece of the health debate, does contain two elements of foreign systems, he said -- a requirement that insurance companies cover everyone regardless of health and an individual mandate expanding coverage.

However, Baucus' bill -- to save money -- doesn't really cover everyone. It would cover 29 million of the uninsured but leave about 17 million citizens and legal residents still without insurance.

"If I had gone to another rich country and 9 percent of the people weren't covered by insurance, I would not have called that a successful plan," Reid said.

And, by relying heavily on state-run Medicaid, the Baucus bill would maintain what Reid calls the "crazy" multi-layer U.S. coverage system, while one of the key efficiencies of foreign systems is to cover everyone the same way.

Liberals in Congress want a nearly unified system -- everyone in a single-payer system like Canada's -- but Reid confirms that delays in treatment there are a reality.

To my mind, the best U.S. proposal for a rational health care system is the bipartisan Healthy Americans Act, co-sponsored by Sens. Ron Wyden, D-Ore., and Bob Bennett, R-Utah, which would eliminate Medicaid and give poor people subsidies to buy private insurance.

The Wyden plan also has been scored by the Congressional Budget Office as "roughly revenue-neutral."

It would cover everyone, as well as offer them a range of choices of competitive private plans -- and it has four GOP co-sponsors.

As Wyden says, "it combines what Republicans want -- private insurance, choice and competition -- with what Democrats want, universal coverage."

And yet, Wyden hasn't been able to persuade Baucus, President Barack Obama or other leaders of the merits of his legislation, largely because they think it will chaotically detach health insurance coverage from employment.

Wyden's plan would eliminate the tax exclusion for employer-provided benefits and give employees a tax credit to purchase their own insurance, but he insists that does not mean that everyone would leave their employers' plans.

Wyden's proposal, which he says closely resembles that in Holland, also has another key characteristic of all foreign systems -- heavy regulation of insurance companies.

According to Reid, in France, Germany, Japan, Belgium and Switzerland, insurance companies are nonprofit entities that not only have to take all customers, but have to pay all claims -- and quickly.

In most countries, they can make a profit on supplemental insurance, covering nonbasic services like Botox, Viagra and hair transplants, but not basic coverage.

Wyden would not force insurance companies to be nonprofit but would forbid insurance companies from charging different premiums based on age or gender.

Three elements of all successful foreign plans would be highly controversial in the United States: Governments "negotiate" or set prices of medical services and ration what will be paid for and what won't.

Also, doctors and hospitals in other countries are paid much less than in the United States -- a half to a third for most doctors.

On the other hand, doctors have their educations paid for, so they don't have student loan burdens, and medical malpractice insurance costs are low because claims are not taken to court.

And consider the results: In France, everyone has an electronic health card containing digitized medical records.

Health spending per capita in France is $3,165, versus $7,000 in the United States.

On the Commonwealth Fund's quality ranking of countries according to "avoidable mortality" -- that is, survival of successful treatment -- France came in first and the United States 15th.

On the CIA's measure of life expectancy at birth, the United States ranks 47th, just ahead of Cyprus, and on the World Bank measure of "healthy life expectancy" -- years lived before encountering disability -- the United States was 24th.

"For all their problems," Reid writes, "the other industrialized countries tend to do better on ... coverage, quality, cost control, choice."

It's probably not necessary to duplicate all the government controls and restrictions that other countries employ, but clearly we can do better than we are doing.

And, instead of drafting a health care reform bill that's an amalgam of compromises among interest groups, it would be edifying to see Congress pass legislation that gave consumers choice, coverage and competition -- and also put responsibility on them. Wyden's bill does that.

Morton Kondracke is executive editor of Roll Call, the newspaper of Capitol Hill.

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