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Friday, October 9, 2009

"The Healing of America", by TR Reid

This latest book which is currently climbing the best seller lists is subtitled "A Global Quest for Better, Cheaper and Fairer Health Care". Suffering from a shoulder injury, Mr. Reid decided to compare the different health systems of the world in his search for treatment options to help his shoulder - a compelling quest indeed. However, it is difficult from the very beginning of the book to get a handle on what Mr. Reid is evaluating - the economic models of payment for services,or the treatment and decision making utilized within the different cultures around the world. At the beginning of the book he introduces the various economic models of health care systems focusing on payment and delivery of services. This is very informative for a general understanding of models that exist. But it is puzzling to me how journalists and politicians refer to the cost of our health care when they admit that commericial or private insurance companies do not divulge what they actually spend directly for health care. And because of this, it is well known that these numbers that are thrown around about the cost of health care are extrapolated from what is known about medical costs from Medicare. That said, it was interesting to me that Mr. Reid included in his book the much used comparison of Health Expenditure as a percentage of GDP, 2005. In this well known study, the US is shown to spend 15.3% of GDP as opposed to Germany, which it cites as spending 10.7% of its GDP. Who did this study, and how did they get this number? The source is cited as the OECD Health at a Glance, 2007 done by the Government of Taiwan. Mr. Reid leaves it to the reader to draw their own conclusions, although he does follow the study by asking, "There's nothing particularly wrong with spending a lot of money on something important, as long as you get a decent return for what you spend." I have seen this study and heard these numbers thrown around in numerous articles and books, as well as quoted by politicians, journalists and media pundits.

So what are we getting when we spend so much? Interestingly, the German model, or the Bismarck model, is discussed in Reid's book and is said to be a model of a well run health care plan. One aspect among many I find interesting about this model is the distinction between medical education in Germany and the US. Much of the cost of our health care "system", has to include the economics of training future physicians and what part this plays in the overall cost of health care. In Germany, physician training is comprised of apprenticeships, in a type of journey-man system. Foreign student-physicians follow a practicing physician to learn as much as possible from observation. In the U.S. we take for granted the extensive and rigorous training of our physicians as compared to the rest of the world.

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