March 26, 2025 • 53 mins
In this crossover show of TCNalks / Anatomy Of Leadership, host Chris Comeaux interviews NY Times bestselling author T. R. Reid. They discuss T. R. Reid’s experiences and insights from researching healthcare systems around the world, particularly focusing on the need for universal coverage and the various models of healthcare delivery.
T.R. emphasizes the importance of a key principle in any functional healthcare system at a national level: healthcare for everyone. He wrote about this in his NY Times bestselling book The Healing of America. Some of the key discoveries in the book are the inefficiencies of the U.S. healthcare system compared to others worldwide and the potential benefits of adopting a government-run healthcare model similar to Medicare and the VA. Reid also critiques the profit-driven nature of American health insurance and advocates for reforms prioritizing patient care over profits.
T.R. and Chris then discuss the unique window of opportunity in 2025 and the need for a new framing of universal healthcare, suggesting alternatives in language around 'Medicare for All.' T.R. emphasizes the importance of price controls in reducing administrative costs and improving efficiency in healthcare systems. Reid also addresses the role of innovation in healthcare, arguing that high costs do not necessarily lead to better medical advancements. He cites several excellent examples of recent innovations, all from outside the U.S.
This is a great listen as the U.S. spends more on healthcare, yet we are not even in the top 10 in the world. It’s hard to make one aspect of healthcare successful, like Hospice and Palliative Care, if the broader ecosystem it resides in is flawed and unsustainable. Join us; this is very timely.
Guest: T.R. Reid, Author of the NY Times Best Selling book The Healing of America
Host: Chris Comeaux, President/CEO of TCN/TCG
https://www.teleioscn.org/tcntalkspodcast/the-healing-of-america-with-t.r.-reid
Teleios Collaborative Network / https://www.teleioscn.org/tcntalkspodcast
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Melody King (00:01):
Welcome to TCN Talks.
The goal of our podcast is toprovide concise and relevant
information for busy hospice andpalliative care leaders and
staff.
We understand your busyschedules and believe that
brevity signals respect.
And now here's our host, ChrisComeaux.
Chris Comeaux (00:23):
Hello and welcome to TCNt alks.
I am super excited.
Today, our guest is T.
R.
Reid.
He is the author of Healing ofAmerica, which was a New York
Times bestseller.
He's also been author of manybooks, many articles.
T.
R.
welcome, it is so good to haveyou.
T.R. Reid (00:40):
Great to be with you, Chris.
Thanks a lot for having me.
Chris Comeaux (00:43):
What's your audience?
What would you like ouraudience to know about you?
T.R. Reid (00:54):
I like writing and I'm a writer.
I'm a reporter.
I was a reporter for theWashington Post and National
Public Radio.
I've made a bunch of movies forPBS and basically I'm a
freelance writer.
I write for anybody who willpay me to write something.
I really like writing, so I'vealways felt lucky that people
are paying me to do what Ireally like to do.
Chris Comeaux (01:15):
Well, I was trying to think about it.
I'm almost positive.
It was Christy Whitney, who wasthe longtime CEO of what's now
Hope West in Grand Junction,Colorado.
I think she was the originalperson who recommended your book
to me and I just devoured itthe first time I read and I was
sharing with you.
We're in the green room.
I had a sabbatical last year, in2024.
And there's a lot of bigquestions I wanted to wrestle
(01:37):
with, like what's my cause andpurpose and long-term.
But one of the books that wason my reading list was to go
back and reread the Healing ofAmerica, and there's something
about reading it the second time.
Maybe I'm just more maturethinking about some of the macro
issues that spill over intohealthcare.
One of my first mentors saidChris, hospice is a tail end of
(01:58):
healthcare and you know whatrolls downhill.
It's kind of his way of saying.
You know, we're at a prettycritical juncture here in this
whole healthcare continuum and Ihave to tell you so when I read
it over sabbatical I thought Ineed to reach out to T.
R.
Never met him and you were sogracious to respond.
So I am so excited that youagreed to be on this podcast and
(02:19):
to talk about this book andwhat you learned during your
research.
So why don't we go there?
You've traveled all over theworld, so there may be some
listeners that aren't familiarwith your book, but you traveled
all over the world to researchjust different healthcare
systems in other countries.
Can you talk about what youlearned in those travels and
maybe what even brought you?
to write the book.
T.R. Reid (02:40):
So here's what happened.
We have several kids, and myyoungest daughter, Willa, had a
condition called Otitis Media,and this means she gets ear
aches, she gets ear infections,and the treatment for this is
totally standard and alwaysworks.
So Willa wakes up and she hasan earache.
We go to the pediatrician.
(03:01):
The doctor looks in her ear andsays oh yeah, you have an ear
infection.
She says I'm going to give youa shot of penicillin and it'll
go away.
And sure enough, it alwaysworked.
And in America, when Willow wasa child, this was what 25 years
ago.
This cost $120, $140 a visit.
Sometimes the insurance paid,sometimes the insurance company
(03:24):
found an excuse not to pay.
Anyway, we then moved to Japanwhen Willow was five years old
and, sure enough, two weeks in,Willa woke up with an earache.
We didn't know what to do.
So we went to the nearestpediatrician and the doctor in
Japan looked in her ear.
She said oh, she has an earinfection.
She said I think I'll give hera penicillin shot.
(03:46):
She gave her a penicillin shot.
Well, it got better.
And guess what?
This cost 1,500 yen, $14.
And I'm thinking wait a minute,how can they give me the same
care, effective care, kinddoctor, for a tenth of what I
paid in the United States.
For a tenth of what I paid inthe United States.
Then we moved to Britain.
I was a foreign correspondentand we moved to London and
(04:10):
another one of my daughters wasin a place called Camden Town.
This is a run-down section ofLondon.
It's where Tiny Tin lived in AChristmas Carol and Katie was
over there and she saw thissecondhand jewelry store and
they had earrings for sale forlike five quid, five pounds, and
(04:34):
we had not allowed our girls tohave pierced earrings.
But anyway, she went ahead andbought these five-pound earrings
but her ears weren't pierced.
And so the woman in thisjewelry store says oh no problem
, mate, I can handle it.
Punch, punch, pierce your ears.
And Katie came home with thesenew gold earrings and guess what
(04:58):
?
The next morning she woke up andher ear was swollen, painful,
oozing puss.
It was badly infected.
We didn't know what to do.
We got in one of those bigblack London cabs and I showed
the cab driver my daughter's ear.
I said what do I?
No problem, mate, no problem.
And he took us to St Mary'sHospital.
This is a big hospital rightdown the street from Paddington
(05:21):
Station in London.
Where Paddington Station inLondon, where Paddington Bear
lived, and this, like many, theydon't spend any money on
physical plant in Britain.
It's a run-down red-brick shackkind of place.
It didn't look very promising.
But when you walk in the frontdoor of St Mary's Hospital
there's a plaque and it says inthis hospital in 1927, Sir
(05:46):
Alexander Fleming discoveredpenicillin, and that made us
feel a little better about thewhole thing anyway.
So we went to what's called thecasualty ward, that's the ER in
a British hospital, and thenurse there took one look at our
family and figured out thatKatie was the person who needed
help, took her in a room.
(06:06):
A doctor pierced the puncture,cleaned her ear.
She came out beaming.
She was cured.
You know the system had takencare of this health problem.
So I went over to the nurse andgot out my checkbook and here's
what she said.
She said oh, no, no, no, no, no, no.
You may put away your checks.
You Yanks don't seem tounderstand.
(06:26):
We do it differently here.
You don't pay for health care.
In Britain you pay throughtaxes, but you don't pay at the
doctor's office at the hospital.
So I'm thinking, gee, these arebetter ways to organize health
care than what we're stuck within the United States ways to
organize health care than whatwe're stuck with in the United
(06:47):
States.
And so that's why I wrote abook where I went around the
world talking to doctors in veryseveral developed and a few
developing countries, and what Ifound was all the other
countries, all the othercountries like us.
They're industrialized,advanced, high-tech countries.
All of them provide betterhealth care.
They cover everybody, they havebetter health outcomes, longer
(07:11):
life expectancy, better recoveryrates from disease or injury,
and they spend about half asmuch as we do.
So that's why I wrote the book.
What can the United Stateslearn from these Other Countries
About how to Fix Our HealthcareSystem?
Chris Comeaux (07:27):
What are some of those?
Maybe principles that youstumbled upon that we could
apply to the healthcare system,and I also just the two chapters
, because I kept asking myselfhow can we adopt this?
And the Japan and Germany seemto be the flavor that might be
the most palatable to Americans.
(07:48):
You might disagree now it'sbeen a bit since you wrote the
book, but what were the elementsthat you saw?
Across?
All of them, but maybe if youcould speak to those in
particular, if you think thatthey're still maybe our two
greatest learning lessons as faras those two particular
countries learning lessons asfar as those two particular
countries.
T.R. Reid (08:11):
Yeah, I used to think , like you, that Japan and
Germany were the right modelsfor the United States.
I'll explain why in a minute.
I don't feel that anymore.
The key point of my book, thekey lesson for any successful
healthcare system, is you got tocover everybody.
Everybody has a right to healthcare.
When people are sick, get theminto the doctor and treat them,
(08:31):
and the United States is theonly advanced democracy that
doesn't do that.
Anywhere in Western EuropeIreland, Britain, France,
Germany, Switzerland,Scandinavia, Netherlands, Italy,
Spain, and then in East AsiaJapan, South Korea, Malaysia,
taiwan they cover everybody.
If you're sick and need adoctor, if you're injured,
(08:53):
doggone it.
You get the care you need.
The United States, the world'srichest country, currently has.
According to the CongressionalBudget Office in June of last
year, 30.5 million Americanshave no health insurance.
No health insurance, get this.
There's some disagreement aboutthe numbers, but roughly 100
(09:18):
times every week, 5,000 times ayear, a woman shows up in the
emergency room nine monthspregnant, seven sentence dilated
, ready to give birth, and shehas never seen a doctor.
Because lots of young women inthe United States have no health
insurance.
And guess what?
(09:39):
Those are the babies we lose.
Those are the mothers we losein childbirth.
Of the 23 richest countries inthe world, guess what?
The United States ranks last23rd in keeping babies alive
until their first birthday.
Can you believe that?
I mean with all our expertise,with all our skill.
(09:59):
And it's not because we don'tknow how to care for these sick
babies, it's because we don'tprovide the care, because so
many young women don't have anyhealth insurance.
So the first rule is make sureeverybody is covered.
You know, when I went aroundthe world I asked health
ministers, economists, doctors,why do you cover everybody, why
(10:23):
do you do this?
And the most common answer Igot was why don't you?
It's so obvious that you wantto provide health care for
everyone who needs it.
The health minister in Britainwas a guy named John Reed,
probably a distant uncle of mine, a very nice guy.
I liked him a lot and I askedhim why is health care free in
(10:45):
Britain?
Why don't you just charge fivebucks or something to go to the
doctor?
And here's the example he gaveme.
And he says let's take a personwho's working in a convenience
store or a maid in a hotel notmaking a lot of money, and she
feels kind of a vague pain onthe right side of her abdomen.
(11:07):
Well, in Britain she's going togo into the doctor because it's
free and the doctor says oh,you have an infection, an
infected appendix, let me giveyou a shot and it'll go away.
If she can't get to the doctoras in the United States, she
doesn't have health care doctor.
As in the United States, shedoesn't have health care Then
three months later that becomesa burst appendix she's in the
(11:34):
emergency room.
We're talking about a $35,000procedure that could have been
avoided with one visit to thedoctor.
So perhaps it seemscounterintuitive, but if you
cover everybody, you save money,and it's not a coincidence.
All the other countries thatprovide health care for
everybody have better healthoutcomes and spend less on
health care.
(11:54):
So that's the first rule covereverybody.
And this is one thing theUnited States has never done.
Chris Comeaux (12:01):
What other rules?
T.R. Reid (12:03):
Another rule is it doesn't matter what procedure
you use to do it.
In my book I said there werefour different models for
providing health care and threeof them work.
So in Britain they have asystem where the government
provides the care, the hospitalsare owned by the government,
the doctors work for thegovernment and the government
(12:25):
pays for the care.
We would call that socializedmedicine.
Of course it's terrible.
Americans hate socializedmedicine, except they love it
when they get it.
Now I'm a US Navy veteran andthe VA system where I get a lot
of care is one of the world'spurest examples of socialized
medicine.
And every time somebody says,oh, we don't like socialized
(12:46):
medicine, the veterans stand upand say well, I like it just
fine, it works fine for me.
People in the US military havesocialized medicine, they have
government medicine.
Anyway, that's one way to run amedical care system.
Another way is completelyprivate.
Germany, Japan, Switzerland,netherlands they rely on private
(13:07):
insurance.
They don't have a Medicare,they don't have Medicaid.
People stay on privateinsurance.
Company is required to coverevery doctor.
You choose the doctor.
(13:27):
They can't have these narrownetworks.
They're required to pay everybill submitted by a doctor or a
hospital.
They can't turn you downbecause you were sick once.
They don't have this businessthat our insurers have, where
the doctor has to call theinsurance company to get
approval before she can treatyou.
If the doctor wants to providethe care, the insurer has to pay
(13:51):
.
So private insurance can workit does work very well in those
countries if you have certainrules to make sure that the
insurance pays and covers peopleas they need it.
And then the third method is asystem that was invented in
Canada which is a mix.
This is government insurancepaying private doctors and
(14:13):
hospitals.
This was invented in Canada inthe 1940s, as I talk about in my
book.
Tommy Douglas was the governorof Saskatchewan and he invented
this system where everybody paysa tax into the government and
then the government insurancesystem pays the doctor.
And in 1940, when Tommy Douglasinvented this system, he came
(14:37):
up with a name for it, and youknow what he called it.
He called it Medicare Medicare.
And sure enough, in 1965, whenthe United States finally
provided health insurance forall our seniors, we took the
model, that is, governmentpayment of private doctors and
the name Medicare from Canada.
So those three models all work.
(14:59):
We could use any of them.
Chris Comeaux (15:02):
Did you say there was a fourth or did I
misunderstand?
T.R. Reid (15:07):
The fourth model is for poor countries.
For most of the countries inthe world, the fourth model is
no insurance for almost anybodyexcept rich people.
This is called theout-of-pocket model.
If you have 10 bucks in yourpocket to pay the doctor, you
get treated.
If you don't have any money,you stay sick or you die.
This is the model in all thirdworld countries.
(15:29):
Rich people and governmentemployees do get health care.
Most people don't, and they,you know these countries tend to
set up some free hospitals.
When I was, I made a movie ofthis book for PBS and we went to
(15:49):
India and while I was in Indiawe went to a hospital in New
Delhi and there was a line, Iwould say maybe 130 or 140
people lined up outside the doorof the hospital and I went up
to one gentleman and was talkingto him and he had been there
two days but he was pretty surehe was going to get in by the
next morning.
So that's how health care worksin poor countries.
(16:11):
And guess what?
That's how health care worksfor Americans, the 30 million
Americans who have no healthinsurance.
You hope to get into one of thefree hospitals or a free clinic
and hope to get care and quiteoften those people don't.
The life expectancy for a manin America today is about 78.
(16:32):
For people without healthinsurance it's 56.
They lose 20 years of lifebecause we're not providing them
care.
So the first rule is you got toprovide health care for
everybody.
It gives better care and savesmoney.
And the second rule is thereare many different models for
how to get there.
Chris Comeaux (16:53):
So you alluded to .
Again, when I read the book Iwas very kind of drawn to Japan
and Germany, but it sounds likeyou've changed your thinking
about maybe that's the solutionfor America.
Can you talk about that?
T.R. Reid (17:04):
So Japan, Germany, Switzerland, Netherlands, they
rely on private insurance and Ithought, boy, that's capitalism
and Americans can go for that.
That's what we would go for.
But I don't think it's going towork in America.
And the reason is the insurancecompanies have enormous clout
(17:24):
in Congress and in statelegislatures and the insurance
companies will fight against therules that make this work.
In Germany, for example, in theUnited States, if your doctor
recommends an expensiveprocedure, she first has to call
(17:46):
United Healthcare in Minnetonka, Minnesota, and some insurance
executive not the doctor, theinsurance executive decides
whether that's approved for you.
That's not allowed in Germany.
In Germany what the doctor saysgoes and they have to pay.
They can't turn down your claimlike they do for 20, 30 percent
of claims in the United States.
(18:06):
American insurance companies,all the private insurance
companies, have what they call anarrow network, which is they
dictate which doctor or whichhospital you can see, and in
many cases they have a new termin the insurance industry now
it's called an exclusive network.
If you want to see, say, adermatologist or a cardiologist,
(18:29):
a particular specialist, theyonly have one.
You only get one.
You don't get to choose yourdoctor.
In Germany, in Japan, inSwitzerland, you go to the
doctor and insurance has to pay.
Well, that makes things moreexpensive for the insurers.
They don't want that and theyuse their lobbying clout in
(18:50):
Congress and the legislatures tofight it.
So I now don't think thatprivate insurance for everybody
will work in the United Statesbecause of the way the insurance
history works.
I think the way we're going toend up is some kind of
government insurance system forall.
So of all the insurance planhealth insurance plans in the
(19:12):
United States most of them theprivate insurers
UnitedHealthcare, Cigna, Aetnathey have administrative costs
in the range of 15 to 20 percent.
(19:33):
Now, any insurance plan hasadministrative costs.
You've got to collect thepremium, you've got to deal with
the doctors, you've got to paythe bills.
But in other countries theadministrative costs are limited
to about 5 percent.
They're limited by law.
In America, the law allows ourinsurers to charge 20% of any
bill as administrative costs,just added on to the cost of
your premium.
(19:55):
There's one insurance planthat's much more efficient than
that, and that is Medicare.
This is the government-run planfor seniors and people with
disabilities.
This is the government-run planfor seniors and people with
disabilities.
Medicare says that itsadministrative costs are in the
range of 3%.
They're much more efficientthan the private insurers and
(20:15):
they're also the lowest payerbecause they use their
bargaining clout with hospitalsto get lower rates.
So Medicare for all wouldcertainly work.
Medicare, as I say, is the mostefficient.
It's the lowest cost insuranceplan and has the highest rates
(20:35):
of appreciation among itsinsured.
In fact, when you ask peopleover 65, would you like to drop
Medicare and go back to privateinsurance?
No, the answer to that is no.
88% say no.
Don't do that to me, don't takeaway my Medicare.
So this is.
Chris Comeaux (20:53):
This is fascinating.
I'm just thinking that you know, when I originally asked you
for this podcast, you know wesomething tragic happened.
The CEO of United isassassinated and the dialogue in
our country is fascinating andone of the best articles.
Dr Neal Shaw wrote an articleand the gist was it's horrible
(21:18):
that someone would getassassinated.
It is fascinating that half thecountry is reacting in the way
they do, and maybe it's a signalof the moral bankruptcy of have
you kind of lost sight of whatyou were there to do?
Is this really about helpingpeople be healthier?
And then, of course, theassassin's bullet had what was
(21:39):
it?
Depose, deny, I forget what thethird term was.
I had a personal experienceright about the same time.
The lady next to my office Iwas having to go and fax my son
had wisdom teeth and they deniedit.
He had wisdom teeth removed.
She goes hey, can I fax thatfor you?
I'm like that's wonderful, I'mdoing it.
(21:59):
It's an appeal.
So it's personal, I feel like Ineed to do it.
We get to talking.
She goes you know, they deniedmine too.
And she goes you know, theydenied mine too.
And I'm like, well, do you knowyou can fight that?
No, and she was just going topay $1,000.
And how many people are likethat?
And that's exactly the strategy.
Why do they actually do thedenials is, most people won't
fight it and that has nothing todo with health care, nothing to
(22:22):
do whatever.
And actually it's funny.
You mentioned that I've got page232 of your paperback version
under myth number three,healthcare for-profit insurance
have the highest administrativecosts in the world.
And then you quoted about the20 cents.
I did not know about Medicareat three cents, and it
definitely seems like that'sdefinitely part of what's wrong.
(22:43):
There's major dollars that arenot adding value, and also love.
And I'll show up and let youcomment.
In the very beginning of yourbook you actually spoke to
Dwight D Eisenhower.
This book is dedicated toPresident Eisenhower for the
reasons set forth in Chapter 1.
I had actually never readsomeone else say this.
I thought this was like our ownthing behind the scenes.
(23:05):
But Eisenhower talkedmilitary-industrial the complex
.
Beware the people that willmake war, because it's
profitable and health care isperverse that way.
It's not really about makingpeople better.
The more bad stuff that happensthen, the more money that you
make, and so, anyway, I'll shutup and let you comment to some
of those things.
T.R. Reid (23:23):
Yeah, I think that's a crucial point, chris.
One fundamental differencebetween the health insurers in
the United States and those inother countries Germany, japan,
switzerland, for example is thatother countries don't allow
insurers to make a profit.
They're basically charities.
They're not there to payinvestors or to pay executives
(23:45):
huge sums.
The reason for insurancecompanies is to provide a
healthy society, a healthynation, and the reason they
don't allow profit is they thinkthere's a fundamental
contradiction between making aprofit on health care, health
insurance and keeping peoplehealthy.
The reason for a healthinsurance plan would be to get
(24:08):
people to go to the doctor whenthey need care by paying their
bills.
The way you make a profit inhealth care is by not paying
bills.
This is why they have narrownetworks, this is why they have
to approve your procedure inadvance, and so it's really that
fundamental difference betweencharity health insurance in
(24:30):
Germany, Japan, Switzerland,Netherlands versus for-profit
health insurance.
Once you have to make a profitin health insurance, then you
adopt all the tactics that makepeople hate their insurance
company.
Chris Comeaux (24:45):
Yeah, that is very well said.
Well, it's also fascinating thetime.
So this show will be airing inthe early spring of 25.
When your book first came out,Obamacare was being enacted and
now here we are with a possiblesea change window of opportunity
in DC.
So you were king for a day andyou could change the American
(25:06):
healthcare system.
How would you do it?
I feel like you've kind ofalluded to it, but if you were
king for a day, and then alsoI'd love for you to talk about,
do you think there is thatwindow, possibly this year?
T.R. Reid (25:16):
Well, here's the thing
president, Donald Trump, hassaid in all three of his
campaigns that we should providehealth care for everybody.
He realizes that we have tensof millions of people with no
health insurance and that thisadds to costs, it doesn't save
money, and it makes our overallnational health worse.
(25:37):
So he's said that he's nevercome up with a plan to make it
work, but he realizes theproblem.
To me, that's the first step: Figure out that we need to (25:46):
undefined
provide a system that coverseverybody.
And Donald Trump has alsocomplained very strongly about
the costs of health care.
And there are certainly ways tocontrol the costs of health care
that we could adopt from othercountries.
So if he means it and if hereally wants to do it, and if he
(26:08):
During the 2024 campaign lastyear, Americans were polled on
health insurance, and onequestion was, should we provide
Medicare, that is, governmentinsurance for everybody?
to achieve something historicfor our country in his second
term as president, this is theway he could go and it would be
quite popular.
In the Pew Research Institutepoll, 58% said yes.
(26:39):
So that would be.
It would be a popular step andit would be a valuable step for
our country.
It would improve our health andsave money.
So yeah, maybe I'm kind ofhoping that the new
administration will take this on.
Chris Comeaux (26:53):
Well, you have spent a lot of your life
crafting words, and so wordcrafting is a superpower.
It's almost art.
Do you think the term Medicarefor all is the right framing, or
is there a different framingwith the same concept?
T.R. Reid (27:10):
No, that's not the right term.
It's the right concept.
An efficient, government-runhealth insurance system with
lower costs for everybody, sothat everybody gets the same
care, is the way to go.
But Medicare for all is tainted.
It sounds like socialism topeople.
So, no, we need a plan calledAmeriCare or Unicare or US Care
(27:36):
or something like that.
We need a new name, AmeriCare,and not the same name that
Canada uses.
But a plan like that whereeverybody pays into a
government-run, highly efficientinsurance system and then
everybody is covered in the sameway by that system.
(27:59):
As I say, people when they geton Medicare at age 65, never
want to go back.
If you poll people on Medicare,would you like to go back to
private insurance?
No, 88% say no.
Jeff Haffner (28:14):
Thank you to our Anatomy of Leadership / TCNtalks
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Dragonfly Health is also thetitle sponsor for leadership
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Dragonfly Health is a leadingcare at-home data technology and
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Dragonfly Health uses advancedtechnology and robust analytics
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services as part of a single,efficient solution for
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The company serves millions ofpatients annually across all 50
states.
Thank you, dragonfly Health,for all the great work that you
do.
Chris Comeaux (29:01):
I didn't tell you I was going to ask you this.
But price controls.
I think it was Japan, right,that had really tight price
controls on the way their systemworked.
And as I sit here and process,I mean you basically Medicare
has Medicare allowable, so wekind of got price controls in
place.
But I'd just love to hear youtalk about that a little bit,
(29:22):
like what role does pricecontrols play in a system like
this working?
Perhaps?
T.R. Reid (29:28):
You know, in most other countries somebody sets
the price for a medicalprocedure and the price is the
same for everybody.
In the United States now, forexample, I was on the board of
the University of ColoradoMedical School.
We have a hospital and in thathospital we had a team that
performed 36 hernia repairs,about five or six a day, 36 a
(29:54):
week.
It was the same team in thesame room doing the same, just
about the same procedure foreverybody.
And guess what?
We got 36 different pricesbecause it all depended on what
your insurance company waswilling to pay.
That just adds to the paperworkand administrative burden.
When I was on the board of themedical school, we were building
(30:18):
a brand new campus, which waskind of nice for us board
members because like every threeweeks they opened a new
building and they would cut aribbon and we would sip wine and
have hors d'oeuvres.
It was quite pleasant.
And there were so many newbuildings on this campus it was
hard to keep track of what theywere.
And one day we board memberswere out there and they opened a
(30:38):
six-story, a big six-storybuilding, brand new, beautiful
building.
We clipped the ribbon, I wassipping wine and I said to the
dean in the medical school whatare we going to treat in this
building?
He said treat, we're nottreating anybody here.
This is the billing office.
It's 75 people are there justto dig through the different
insurance plans and figure outwhat we're going to be paid for
(31:02):
a procedure that we did fivetimes and we're paid five.
You don't need that kind ofadministrative costs.
If prices are set so that allprices are the same, you save
huge amounts of administrativecosts, and that's what other
countries have done, and thenthis leads to more efficiency,
(31:22):
as I point out in my book.
Once here in Colorado I had agrowth on the back of my neck
and the doc said, oh, you bettergo get that looked at.
So I went to get an MRI of myneck, which was fine, and the
bill came.
It was $1,800, about standardfor that procedure.
Anyway, a few months later Iwas in Japan working on our
(31:45):
movie about health care and inthe doctor's office I saw an MRI
machine and I said to him hey,if I had to get an MRI of the
back of my neck, what would itcost?
And he looks in his book and hesays well, that would be
Ichimayen.
That's $98.
$98.
I just paid $1,800, but that'sthe price that the Japanese
(32:08):
health ministry has assigned forthat procedure.
And guess what?
The doctor makes money.
The doctor comes out okay, andthe reason is to meet the need
for those low-cost MRIs.
The Japanese tech companieslike Fujitsu and Hitachi have
built very simple, plain-janeMRI machines without all the
(32:31):
bells and whistles, and usingthat doctors can provide the
same decent care.
For what was it?
For one-twentieth of the cost.
And that so what?
My argument is that kind ofprice control leads to
efficiencies.
It doesn't undermine healthcare, it leads to more efficient
(32:53):
health care.
Chris Comeaux (32:54):
Well, it leads to another good question.
So when I think about what youjust said, what about the role
of innovation?
And let me maybe frame it thisway I think, as you went through
your book, some of thecountries you research allowed
more affluent people that couldpay for concierge type medicine,
so the higher.
(33:15):
I'd love to be able to drivearound a Mercedes, but I drive
around a Toyota and so on.
My salary I'm okay with middleof the road, but if someone
could afford a Mercedes or aLexus, good on them.
Do you create that ability ontop of the system for more of a
concierge?
And then is that the placewhere innovation?
And then does that innovationeventually trickle down as costs
(33:37):
go lower, et cetera.
T.R. Reid (33:39):
Yeah.
So innovation, research,medical advances.
The United States is great atthis.
We lead the worldleadingmedical research.
I don't know if you've seenanybody who has seen their baby
(34:19):
in the womb through ultrasound,which every new parents do that
nowadays.
That's a procedure that wasdeveloped in Sweden, not in the
United States.
Sweden is a very low-costcountry.
Deep brain stimulation isconsidered one of the few
treatments that seems to workfor dementia.
(34:41):
That was developed in Canada,which is a very low-cost country
.
If you happen to take a statin,that is, an anti-cholesterol
pill like, for example, crestor,is one of the best-selling
medicines in the United States.
It's one of the top 10 pillsevery year.
On the label of Crestor it sayslicensed to Shioyaki Company,
(35:04):
Japan.
That is, that pill wasdeveloped in Japan, which also
has very low cost.
So yes, the United States isgreat at medical innovation and
research, but it's not becauseof our high costs.
The most important newdevelopment in dentistry in the
last 25 years is dental implants, where they put a whole new
(35:26):
bridge in your mouth.
That was developed in theNetherlands, which is another
very low-cost country.
So you don't need our highcosts and our outrageous
administrative costs to havegood medical innovation.
We do have that we lead theworld in medical research, but
it's not because of our highcost burden.
Chris Comeaux (35:47):
I'm so glad I asked you that question.
The other thing you alluded toI think it was Japan and Germany
both that they were starting todeal with a pretty steep
increase in cost, and I don'tknow if you've read recently,
but 2024, it looks like nowwe're on 8% 9% increase in cost,
which means now all theemployers that are going to be
going into 2025 with theirhealth insurance renewals are
(36:09):
going to be be looking at maybedouble-digit increases.
And what do you do?
You're going to pass that alongto your employees in a high
inflationary period when theirpaychecks has already been
eroded because of inflation.
So costs are happening inAmerica, but cost was happening
in some of those countries thatyou researched.
Was it simply because thedemographics CR, because more
(36:30):
people were?
Just, I know Japan's baby boompopulation, I think, is almost
10 years ahead of oursdemographic wise.
Is that what it was or what wasreally driving those costs, and
what are the lessons for us inthat?
T.R. Reid (36:43):
It is true that all the rich countries have aging
populations Japan is the oldestpopulation in the world and
aging people have more medicalneeds and therefore more medical
expenses.
I think a big problem is thesefabulous advances that we talked
about, that save lives andimprove people's daily health,
(37:06):
cost money.
They're really expensive, costmoney, they're really expensive.
And this new wave of Ozempicand Wegovy, weight-controlled
drugs and diabetes-controlleddrugs they are fabulous, they're
medical miracles, but they'rereally expensive.
I notice, however, that theNetherlands is now allowing the
(37:29):
sale of those drugs and Sweden,of course, where Denmark is,
where Ozempic is made they'reallowing them, but the cost that
the companies are allowed tocharge is about a tenth of what
they're charging in the UnitedStates.
That is, they control drugprices, but even there, even
(37:50):
with controlled prices, thesenew advances in drugs and
procedure and technology arereally expensive.
And, yes, they're causing aserious strain for every country
.
Well, we don't want to say noto those.
We want to take advantage ofany advances that will improve
our health and extend our lives,of any advances that will
(38:13):
improve our health and extendour lives, and so the way to
deal with that is to reduce theadministrative costs, to get our
overall costs down so that wecan afford these expensive new
procedures.
And that's where the UnitedStates lags.
As I said, our insurancecompanies have administrative
costs three, four times whattheir counterparts in Germany or
(38:33):
the Netherlands would have.
Chris Comeaux (38:36):
So you know, I actually personally have like a
high deductible plan, so I'vegot a health savings account, so
I got skin in the game with meand my family.
How do you bake that into asystem like that?
Do you come up with like astratification, like the gold,
silver and the bronze and everyAmerican gets the bronze in
AmeriCare and then maybe thesilver and gold.
(38:58):
Maybe you're having to pay acopay with an HSA and then maybe
you could have the outside forthe super elites that want to go
pay for whatever they want topay for.
Or how would you do it, giventhat challenge?
T.R. Reid (39:16):
I would set a system where everybody gets a standard
level of care.
There's a floor below which youdon't go, you can get the care
you need at a reasonable costfor everybody.
And then guess what, chris?
Rich people are going to getwhat they want and there's no
country that's been able to stopthis.
In Canada, you're not allowedto go out of the system.
So billionaires in Canada cometo the United States and buy
(39:39):
their health care In Britain, inGermany, in France.
Rich people can go to a privatedoctor who's outside of the
system and you can't stop that.
That's going to happen.
In the same way that they canbuy a Rolls Royce or a Mercedes.
That's fine, as long aseverybody else gets a decent
(40:01):
Toyota.
It's fine if rich people wantto blow their money on some
fabulous specialist somewhere,they're going to do that.
But let's make sure we have astandard level of care that
everybody else gets.
In the United States we have noceiling.
People can buy anything theywant and we have no floor.
(40:23):
As I said, 30 and a halfmillion Americans have no
insurance at all.
Sona (40:27):
Good employers know that health benefits can make or
break your business.
But while employers are lookingout for their employees' best
interest, who is looking out fortheirs?
Sona Benefits is an independentpharmacy benefit manager who
partners with employers tooptimize their pharmacy benefits
while supporting their businessgoals.
But by offering no spreadpricing contract, guaranteed
(40:50):
rebates and the Sonamax program,clients are regularly able to
save 20% to 35% off their totaldrug spend.
The result Pharmacy benefitsthat improve employees'
well-being and employers' bottomline.
Chris Comeaux (41:07):
So would you create some type of like how do
you make sure that I'm not afrequent flyer?
And you know I'm loving thissystem.
I'm going to get whatever Iwant.
It's the buffet and you knowGod, this guy keeps coming back
to the buffet.
You're going to put us out ofbusiness.
Do you create some type of likeHSA health savings account
where they've got a little bitof skin in the game?
(41:28):
What
T.R. Reid (41:30):
Yeah, I believe that people ought to pay for health
care.
So I'll give you two differentpoints of view on this.
In France everybody has decenthealth insurance.
The World Health Associationrated France the number one
health care system and healthsystem in the world.
Costs are low.
Their life expectancy is waylonger than the United States.
(41:52):
But they make people pay.
I think currently the requiredpayment is about 21 euros that
you have to pay at the time oftreatment 24 bucks, and
insurance pays about half ofthat back.
But they insist that you pay sothat you realize you're getting
something of value Across thechannel.
(42:14):
In Britain, as I say, you don'tpay at the point of service.
You never pay the doctor.
And I said to my doctor in themovie I made it's called Sick
Around the World.
It's a PBS frontlinedocumentary.
I think people can still streamit documentary.
I think people can still streamit.
Anyway, I say to the doctor, drBadat, my family doc in Britain
(42:35):
, you know I'm getting reallygood care here.
I pay five quid for this.
I pay five pounds that's aboutseven dollars to come see you.
And he said you know, if Icharged one pound, half the
people who need to see mewouldn't come in, and then
eventually we'd see them in theemergency room when their
illness got very serious.
(42:55):
So the Brits believe that makinghealth care free at the point
of service improves overallhealth, because people go to the
doctor at the first sign.
The French kind of believe thattoo, but the French also
believe that health care is ofvalue.
Health care is never freeanywhere.
Somebody's got to pay for itand they want you to know that
(43:18):
you should pay.
I'm on the French side on thisone.
I think people should paysomething for health care Five
bucks, 20 bucks.
They should recognize thatthere's a cost involved in
keeping them healthy, but weshould have a health insurance
system that sees to it thatthose costs are low, so that
people will go to the doctorwhen they need care.
Chris Comeaux (43:39):
So last night I was looking in your book.
There's a gentleman that youreferred to that he was like the
go-to guy at the time you wrotethe book.
I think it may have beenSingapore that was literally.
They had kind of a blank canvasand it may have been
Switzerland at the time that wasredesigning their system.
Who is that gentleman and is hestill around?
T.R. Reid (43:56):
Yeah, that's Professor William Hsiao,
H-S-I-A-O.
Bill Hsiao at the HarvardSchool of Public Health.
He has designed healthcaresystems for about 20 countries
and he's still on it.
Not recently, the healthminister of Ethiopia asked me if
(44:16):
I might help them design abetter health care system and I
referred him to Bill Hsiao andhe's going to go over there and
help.
So yeah, bill is still doingthis.
Incidentally, on this questionof pay or no pay, bill Hsiao is
kind of on my side.
He believes that people shouldhave to pay for health care, but
not much.
So the system that he designedin Taiwan required, at the time
(44:41):
he set it up, if you went tovisit your family doctor, you
had to pay.
Are you ready for this?
Two dollars to go see thedoctor, wow, just so you know,
I'm on your side.
Chris Comeaux (44:58):
I do think you should pay.
Yeah, exactly, I think one ofmy mentors said if you give it
for free, people won't value it,and so I do believe that's kind
of in the American ethos If I'mgetting it for free, I'm not
going to value it.
So having some skin in the game, I think, is wise.
There probably is a whole studyof what's that exact level is.
The right level is probably aninteresting thought process.
(45:18):
Well, a couple of lastquestions.
You've been awesome and againI'm so glad I reached out to you
.
What about hospice andpalliative care?
Obviously, our listeners aremore in this realm, are more in
this realm, and so where do youthink that, if there is a
possible sea change, anyopinions about how?
T.R. Reid (45:38):
hospice and palliative care should play into
that potential sea change inhealthcare.
It's not an area I know muchabout.
I think people I know who'vegone to hospice it's an
excellent way to end your lifeIf you know you're about to die,
rather than go throughextraordinary measures to try to
extend it for a few weeks.
Hospice is a way to face thefact that we're all going to die
(46:00):
and they make it as comfortableas possible.
I'm all for hospice, but howthat fits into a health care
system, I don't know.
Some people, some advocates ofuniversal health care care for
everybody, think that we shouldprovide long-term care for
everybody.
Long-term care it's for oldpeople like me and it's very
(46:23):
expensive.
I have long-term care insuranceand it's about three times the
cost of my Medicare premium.
It's expensive.
So I think those are you knowthat those are Cadillac, those
are gravy that would be nice toprovide, but are not an
essential element.
What we need to provide is abasic level of health care for
(46:46):
everyone in the United States ata price they can afford and
with access to the doctors thatthey get to choose.
Chris Comeaux (46:54):
That's what I would do.
Well, so just real quick then,since you said that way, I'm
personally biased.
I've got 30 years in hospice.
I think we're one of the mostbrilliant models of healthcare
Medicare designed it was BobDole 1983, during the Reagan
administration.
It's a holistic viewpoint.
People are body, mind, spirit,social, emotional component,
(47:16):
which is why there's a wholeteam of professionals doctors,
nurses, social workers,chaplains, CNAs, volunteers.
There's a care plan that thenkeeps everybody on the same page
.
It generally was originallyimagined as a six-month benefit.
Does the patient qualify?
Do they have six months or lessto live?
Have they quit seekingaggressive curative treatment?
(47:37):
Now great nonprofits like Iwork with TR.
They also develop thesebeautiful hospice houses.
Picture it like your hospicehospital.
And the downside is today isthat families will elect that
skilled long-term care benefitbecause that's how you get the
room and board paid.
So that's one thing, that if wewere king for a day where you
(47:58):
can go, well, what if I went thehospice route?
Would that pay for my room andboard?
And so today that's not thereality.
We don't get a payment.
You have to basically be what'scalled general inpatient care.
It's just a much higher acuityand you have these ups and downs
and peaks and valleys on thecare trajectory when someone is
hospice.
So that's something we'd loveto see because you have dollars
(48:20):
spent in long-term care.
I think there'll be a day we'lllook back and we'll say we
literally were torturing elderly, terminally ill people.
Get out of bed and do thistherapy because that's how you
pay for your room and board.
When being kept comfortable,more palliative care would have
been more appropriate and that'swhat these hospice inpatient
units do.
(48:41):
So if I was king for a day, Iwould make sure we'd write that,
but interestingly, you wouldlove this.
About 95% of most hospices istraditional Medicare today.
Now, one of the things that'sgot us worried is more of
Medicare has been going toMedicare Advantage plans, and
therein lies our concern of thefuture.
Now we're dealing with the denydepose and then we're barely
(49:03):
getting paid what we're gettingpaid before, and that's one of
the things that we're debatingquite a bit right now within,
like where do things go in thefuture, et cetera.
So I love your AmeriCare.
T.R. Reid (49:13):
That's really interesting, Chris.
Yeah, I see the virtue ofhospice.
Glad to know you've beenworking on it.
That's good for you to do.
Chris Comeaux (49:21):
Yeah, there's lots of data and I think, if I
remember, Christy Whitney sharewith me.
I think you were doing aDartmouth Atlas talk at the time
and you're about.
You know the Dartmouth Atlaswas a great data point.
You know great communities thathave wonderful programs, like
Hope West and Grand Junction,where I grew up, in hospice Four
(49:42):
Seasons in the Asheville, NorthCarolina area.
If you look at the total spinwhen you get hospice-empowered
care, you get a better care atthe right place at the right
time and you actually decreasethe trajectory of that one more
MRI or one more line of chemo.
And it's paradoxical becauseobviously patients die in
hospice and if you get a goodlength of stay, like at least 90
(50:03):
days, you actually get goodsatisfaction.
Even though the patient dies,the family feels like they were
part of the care.
You have less grief on the backend.
It's just a beautiful model ofcare.
But obviously, I'm prettybiased.
T.R. Reid (50:15):
I agree with that.
I think you've got that right.
Chris Comeaux (50:17):
Yes, well, final thoughts Again.
Tr, you've been great and I dohope that you get to be king for
the day that you get the rightears of the people and maybe we
I love the Meric here.
I'm like I'm taking that.
I'm going to repeat that overand over again because I think
that's actually brilliantframing.
So any final thoughts for ourlisteners.
These are our hospicepalliative care leaders.
(50:37):
Anything you'd like to sharewith them?
T.R. Reid (50:39):
Yeah, how are we going to get to universal health
care in the United States?
We need to provide health carefor everybody at a reasonable
cost.
We can do this.
We're the world's richest, mostinnovative country.
I do this.
We're the world's richest, mostinnovative country.
I don't think we're going to getthere through Medicare for all
or some federal program, and thereason is the big winners in
our system, that is, for-profithospitals, the health insurance
(51:02):
giants, big pharma.
They basically own the USCongress and they're not going
to allow the kind of change weneed.
So I think the way this changeis going to happen is state by
state.
What's going to happen is oneor two or three states are going
to come up with a single-payerplan that covers everybody
(51:23):
fairly and equally, and theother states will see that it
works and copy it.
I say this because I'm fromColorado.
As you may know, colorado wasthe first state to allow sales
of medical and recreationalmarijuana.
I always say Colorado is thehighest state in the country in
more ways than one, and now 38states have copied us because
(51:47):
they saw that we made it workand we can do the same thing on
a state-by-state basis in healthcare.
A lot of the most importantideas, policy ideas in American
history, started in one stateFree public education, votes for
women, minimum wage laws, childlabor laws started in one state
(52:09):
and spread, and we can do thatwith health care.
So people watching, get outthere and work to see that your
state puts in a universal healthcare single-payer system, and
then the rest of us will followyour example.
Chris Comeaux (52:23):
Great Well, T.
R.
, Thank you.
We're going to include a linkto your book If there is still a
link out there for the movie.
T.R. Reid (52:30):
Around the world yeah , PBS Frontline.
Perfect If there's a a link outthere for the movie Around the
world.
Yeah, PBS Frontline.
Chris Comeaux (52:33):
Perfect.
If there's a link that we couldget in that, we're going to
include that in the show notesTo our listeners.
We appreciate you.
Thanks for listening to TCNtalks.
This is a great listen.
Pass this one around,especially if you know
legislators, people of influenceCertainly hospice and
palliative care leaders use thisas a great resource.
We do this show in service toyou.
These are fascinating times.
(52:53):
We live 2025, one of our boardmembers said it's going to be
predictably unpredictable.
I think that's actually apretty good quote I think we're
in for an interesting ride thisyear.
And yeah, and with the increasedhealth care costs, while it
might not have been number onethrough number one or or the top
five issues in the election,with these costs I think it's
(53:14):
going to rise to the top prettyquickly, as we always do.
Ask you to subscribe to theshow.
That way you always know anyepisode of TCN Talks.
And I always want to leave youwith a quote.
I ran this one past TR.
I think you'd appreciate itbecause it's an early journalist
in our country, thomas Paine.
"These are the times that trymen's souls.
The summer soldier and thesunshine patriot will, in the
(53:35):
crisis, shrink from the serviceof his country, but he that
stands it now deserves the loveand thanks of men, men and women
.
Tyranny, like hell, is noteasily conquered.
Yet we have this consolationwith us.
The harder the conflict, themore glorious the triumph.
What we obtain too cheap, weesteem too lightly.
Tis dearness.
Only that gives everything itsvalue, and heaven knows how to
(53:58):
put a proper price upon itsgoods.
And it would be strange indeedif so celestial an article as
freedom should not be highlyrated and will pin health care
as well.
Thanks for listening to TCNTalks.
Welcome to TCN Talks.
The goal of our podcast is toprovide concise and relevant
information for busy hospice andpalliative care leaders and
staff.
We understand your busyschedules and believe that
brevity signals respect.
And now here's our host, ChrisComeaux.
Chris Comeaux (00:23):
Hello and welcome to TCNt alks.
I am super excited.
Today, our guest is T.
R.
Reid.
He is the author of Healing ofAmerica, which was a New York
Times bestseller.
He's also been author of manybooks, many articles.
T.
R.
welcome, it is so good to haveyou.
T.R. Reid (00:40):
Great to be with you, Chris.
Thanks a lot for having me.
Chris Comeaux (00:43):
What's your audience?
What would you like ouraudience to know about you?
T.R. Reid (00:54):
I like writing and I'm a writer.
I'm a reporter.
I was a reporter for theWashington Post and National
Public Radio.
I've made a bunch of movies forPBS and basically I'm a
freelance writer.
I write for anybody who willpay me to write something.
I really like writing, so I'vealways felt lucky that people
are paying me to do what Ireally like to do.
Chris Comeaux (01:15):
Well, I was trying to think about it.
I'm almost positive.
It was Christy Whitney, who wasthe longtime CEO of what's now
Hope West in Grand Junction,Colorado.
I think she was the originalperson who recommended your book
to me and I just devoured itthe first time I read and I was
sharing with you.
We're in the green room.
I had a sabbatical last year, in2024.
And there's a lot of bigquestions I wanted to wrestle
(01:37):
with, like what's my cause andpurpose and long-term.
But one of the books that wason my reading list was to go
back and reread the Healing ofAmerica, and there's something
about reading it the second time.
Maybe I'm just more maturethinking about some of the macro
issues that spill over intohealthcare.
One of my first mentors saidChris, hospice is a tail end of
(01:58):
healthcare and you know whatrolls downhill.
It's kind of his way of saying.
You know, we're at a prettycritical juncture here in this
whole healthcare continuum and Ihave to tell you so when I read
it over sabbatical I thought Ineed to reach out to T.
R.
Never met him and you were sogracious to respond.
So I am so excited that youagreed to be on this podcast and
(02:19):
to talk about this book andwhat you learned during your
research.
So why don't we go there?
You've traveled all over theworld, so there may be some
listeners that aren't familiarwith your book, but you traveled
all over the world to researchjust different healthcare
systems in other countries.
Can you talk about what youlearned in those travels and
maybe what even brought you?
to write the book.
T.R. Reid (02:40):
So here's what happened.
We have several kids, and myyoungest daughter, Willa, had a
condition called Otitis Media,and this means she gets ear
aches, she gets ear infections,and the treatment for this is
totally standard and alwaysworks.
So Willa wakes up and she hasan earache.
We go to the pediatrician.
(03:01):
The doctor looks in her ear andsays oh yeah, you have an ear
infection.
She says I'm going to give youa shot of penicillin and it'll
go away.
And sure enough, it alwaysworked.
And in America, when Willow wasa child, this was what 25 years
ago.
This cost $120, $140 a visit.
Sometimes the insurance paid,sometimes the insurance company
(03:24):
found an excuse not to pay.
Anyway, we then moved to Japanwhen Willow was five years old
and, sure enough, two weeks in,Willa woke up with an earache.
We didn't know what to do.
So we went to the nearestpediatrician and the doctor in
Japan looked in her ear.
She said oh, she has an earinfection.
She said I think I'll give hera penicillin shot.
(03:46):
She gave her a penicillin shot.
Well, it got better.
And guess what?
This cost 1,500 yen, $14.
And I'm thinking wait a minute,how can they give me the same
care, effective care, kinddoctor, for a tenth of what I
paid in the United States.
For a tenth of what I paid inthe United States.
Then we moved to Britain.
I was a foreign correspondentand we moved to London and
(04:10):
another one of my daughters wasin a place called Camden Town.
This is a run-down section ofLondon.
It's where Tiny Tin lived in AChristmas Carol and Katie was
over there and she saw thissecondhand jewelry store and
they had earrings for sale forlike five quid, five pounds, and
(04:34):
we had not allowed our girls tohave pierced earrings.
But anyway, she went ahead andbought these five-pound earrings
but her ears weren't pierced.
And so the woman in thisjewelry store says oh no problem
, mate, I can handle it.
Punch, punch, pierce your ears.
And Katie came home with thesenew gold earrings and guess what
(04:58):
?
The next morning she woke up andher ear was swollen, painful,
oozing puss.
It was badly infected.
We didn't know what to do.
We got in one of those bigblack London cabs and I showed
the cab driver my daughter's ear.
I said what do I?
No problem, mate, no problem.
And he took us to St Mary'sHospital.
This is a big hospital rightdown the street from Paddington
(05:21):
Station in London.
Where Paddington Station inLondon, where Paddington Bear
lived, and this, like many, theydon't spend any money on
physical plant in Britain.
It's a run-down red-brick shackkind of place.
It didn't look very promising.
But when you walk in the frontdoor of St Mary's Hospital
there's a plaque and it says inthis hospital in 1927, Sir
(05:46):
Alexander Fleming discoveredpenicillin, and that made us
feel a little better about thewhole thing anyway.
So we went to what's called thecasualty ward, that's the ER in
a British hospital, and thenurse there took one look at our
family and figured out thatKatie was the person who needed
help, took her in a room.
(06:06):
A doctor pierced the puncture,cleaned her ear.
She came out beaming.
She was cured.
You know the system had takencare of this health problem.
So I went over to the nurse andgot out my checkbook and here's
what she said.
She said oh, no, no, no, no, no, no.
You may put away your checks.
You Yanks don't seem tounderstand.
(06:26):
We do it differently here.
You don't pay for health care.
In Britain you pay throughtaxes, but you don't pay at the
doctor's office at the hospital.
So I'm thinking, gee, these arebetter ways to organize health
care than what we're stuck within the United States ways to
organize health care than whatwe're stuck with in the United
(06:47):
States.
And so that's why I wrote abook where I went around the
world talking to doctors in veryseveral developed and a few
developing countries, and what Ifound was all the other
countries, all the othercountries like us.
They're industrialized,advanced, high-tech countries.
All of them provide betterhealth care.
They cover everybody, they havebetter health outcomes, longer
(07:11):
life expectancy, better recoveryrates from disease or injury,
and they spend about half asmuch as we do.
So that's why I wrote the book.
What can the United Stateslearn from these Other Countries
About how to Fix Our HealthcareSystem?
Chris Comeaux (07:27):
What are some of those?
Maybe principles that youstumbled upon that we could
apply to the healthcare system,and I also just the two chapters
, because I kept asking myselfhow can we adopt this?
And the Japan and Germany seemto be the flavor that might be
the most palatable to Americans.
(07:48):
You might disagree now it'sbeen a bit since you wrote the
book, but what were the elementsthat you saw?
Across?
All of them, but maybe if youcould speak to those in
particular, if you think thatthey're still maybe our two
greatest learning lessons as faras those two particular
countries learning lessons asfar as those two particular
countries.
T.R. Reid (08:11):
Yeah, I used to think , like you, that Japan and
Germany were the right modelsfor the United States.
I'll explain why in a minute.
I don't feel that anymore.
The key point of my book, thekey lesson for any successful
healthcare system, is you got tocover everybody.
Everybody has a right to healthcare.
When people are sick, get theminto the doctor and treat them,
(08:31):
and the United States is theonly advanced democracy that
doesn't do that.
Anywhere in Western EuropeIreland, Britain, France,
Germany, Switzerland,Scandinavia, Netherlands, Italy,
Spain, and then in East AsiaJapan, South Korea, Malaysia,
taiwan they cover everybody.
If you're sick and need adoctor, if you're injured,
(08:53):
doggone it.
You get the care you need.
The United States, the world'srichest country, currently has.
According to the CongressionalBudget Office in June of last
year, 30.5 million Americanshave no health insurance.
No health insurance, get this.
There's some disagreement aboutthe numbers, but roughly 100
(09:18):
times every week, 5,000 times ayear, a woman shows up in the
emergency room nine monthspregnant, seven sentence dilated
, ready to give birth, and shehas never seen a doctor.
Because lots of young women inthe United States have no health
insurance.
And guess what?
(09:39):
Those are the babies we lose.
Those are the mothers we losein childbirth.
Of the 23 richest countries inthe world, guess what?
The United States ranks last23rd in keeping babies alive
until their first birthday.
Can you believe that?
I mean with all our expertise,with all our skill.
(09:59):
And it's not because we don'tknow how to care for these sick
babies, it's because we don'tprovide the care, because so
many young women don't have anyhealth insurance.
So the first rule is make sureeverybody is covered.
You know, when I went aroundthe world I asked health
ministers, economists, doctors,why do you cover everybody, why
(10:23):
do you do this?
And the most common answer Igot was why don't you?
It's so obvious that you wantto provide health care for
everyone who needs it.
The health minister in Britainwas a guy named John Reed,
probably a distant uncle of mine, a very nice guy.
I liked him a lot and I askedhim why is health care free in
(10:45):
Britain?
Why don't you just charge fivebucks or something to go to the
doctor?
And here's the example he gaveme.
And he says let's take a personwho's working in a convenience
store or a maid in a hotel notmaking a lot of money, and she
feels kind of a vague pain onthe right side of her abdomen.
(11:07):
Well, in Britain she's going togo into the doctor because it's
free and the doctor says oh,you have an infection, an
infected appendix, let me giveyou a shot and it'll go away.
If she can't get to the doctoras in the United States, she
doesn't have health care doctor.
As in the United States, shedoesn't have health care Then
three months later that becomesa burst appendix she's in the
(11:34):
emergency room.
We're talking about a $35,000procedure that could have been
avoided with one visit to thedoctor.
So perhaps it seemscounterintuitive, but if you
cover everybody, you save money,and it's not a coincidence.
All the other countries thatprovide health care for
everybody have better healthoutcomes and spend less on
health care.
(11:54):
So that's the first rule covereverybody.
And this is one thing theUnited States has never done.
Chris Comeaux (12:01):
What other rules?
T.R. Reid (12:03):
Another rule is it doesn't matter what procedure
you use to do it.
In my book I said there werefour different models for
providing health care and threeof them work.
So in Britain they have asystem where the government
provides the care, the hospitalsare owned by the government,
the doctors work for thegovernment and the government
(12:25):
pays for the care.
We would call that socializedmedicine.
Of course it's terrible.
Americans hate socializedmedicine, except they love it
when they get it.
Now I'm a US Navy veteran andthe VA system where I get a lot
of care is one of the world'spurest examples of socialized
medicine.
And every time somebody says,oh, we don't like socialized
(12:46):
medicine, the veterans stand upand say well, I like it just
fine, it works fine for me.
People in the US military havesocialized medicine, they have
government medicine.
Anyway, that's one way to run amedical care system.
Another way is completelyprivate.
Germany, Japan, Switzerland,netherlands they rely on private
(13:07):
insurance.
They don't have a Medicare,they don't have Medicaid.
People stay on privateinsurance.
Company is required to coverevery doctor.
You choose the doctor.
(13:27):
They can't have these narrownetworks.
They're required to pay everybill submitted by a doctor or a
hospital.
They can't turn you downbecause you were sick once.
They don't have this businessthat our insurers have, where
the doctor has to call theinsurance company to get
approval before she can treatyou.
If the doctor wants to providethe care, the insurer has to pay
(13:51):
.
So private insurance can workit does work very well in those
countries if you have certainrules to make sure that the
insurance pays and covers peopleas they need it.
And then the third method is asystem that was invented in
Canada which is a mix.
This is government insurancepaying private doctors and
(14:13):
hospitals.
This was invented in Canada inthe 1940s, as I talk about in my
book.
Tommy Douglas was the governorof Saskatchewan and he invented
this system where everybody paysa tax into the government and
then the government insurancesystem pays the doctor.
And in 1940, when Tommy Douglasinvented this system, he came
(14:37):
up with a name for it, and youknow what he called it.
He called it Medicare Medicare.
And sure enough, in 1965, whenthe United States finally
provided health insurance forall our seniors, we took the
model, that is, governmentpayment of private doctors and
the name Medicare from Canada.
So those three models all work.
(14:59):
We could use any of them.
Chris Comeaux (15:02):
Did you say there was a fourth or did I
misunderstand?
T.R. Reid (15:07):
The fourth model is for poor countries.
For most of the countries inthe world, the fourth model is
no insurance for almost anybodyexcept rich people.
This is called theout-of-pocket model.
If you have 10 bucks in yourpocket to pay the doctor, you
get treated.
If you don't have any money,you stay sick or you die.
This is the model in all thirdworld countries.
(15:29):
Rich people and governmentemployees do get health care.
Most people don't, and they,you know these countries tend to
set up some free hospitals.
When I was, I made a movie ofthis book for PBS and we went to
(15:49):
India and while I was in Indiawe went to a hospital in New
Delhi and there was a line, Iwould say maybe 130 or 140
people lined up outside the doorof the hospital and I went up
to one gentleman and was talkingto him and he had been there
two days but he was pretty surehe was going to get in by the
next morning.
So that's how health care worksin poor countries.
(16:11):
And guess what?
That's how health care worksfor Americans, the 30 million
Americans who have no healthinsurance.
You hope to get into one of thefree hospitals or a free clinic
and hope to get care and quiteoften those people don't.
The life expectancy for a manin America today is about 78.
(16:32):
For people without healthinsurance it's 56.
They lose 20 years of lifebecause we're not providing them
care.
So the first rule is you got toprovide health care for
everybody.
It gives better care and savesmoney.
And the second rule is thereare many different models for
how to get there.
Chris Comeaux (16:53):
So you alluded to .
Again, when I read the book Iwas very kind of drawn to Japan
and Germany, but it sounds likeyou've changed your thinking
about maybe that's the solutionfor America.
Can you talk about that?
T.R. Reid (17:04):
So Japan, Germany, Switzerland, Netherlands, they
rely on private insurance and Ithought, boy, that's capitalism
and Americans can go for that.
That's what we would go for.
But I don't think it's going towork in America.
And the reason is the insurancecompanies have enormous clout
(17:24):
in Congress and in statelegislatures and the insurance
companies will fight against therules that make this work.
In Germany, for example, in theUnited States, if your doctor
recommends an expensiveprocedure, she first has to call
(17:46):
United Healthcare in Minnetonka, Minnesota, and some insurance
executive not the doctor, theinsurance executive decides
whether that's approved for you.
That's not allowed in Germany.
In Germany what the doctor saysgoes and they have to pay.
They can't turn down your claimlike they do for 20, 30 percent
of claims in the United States.
(18:06):
American insurance companies,all the private insurance
companies, have what they call anarrow network, which is they
dictate which doctor or whichhospital you can see, and in
many cases they have a new termin the insurance industry now
it's called an exclusive network.
If you want to see, say, adermatologist or a cardiologist,
(18:29):
a particular specialist, theyonly have one.
You only get one.
You don't get to choose yourdoctor.
In Germany, in Japan, inSwitzerland, you go to the
doctor and insurance has to pay.
Well, that makes things moreexpensive for the insurers.
They don't want that and theyuse their lobbying clout in
(18:50):
Congress and the legislatures tofight it.
So I now don't think thatprivate insurance for everybody
will work in the United Statesbecause of the way the insurance
history works.
I think the way we're going toend up is some kind of
government insurance system forall.
So of all the insurance planhealth insurance plans in the
(19:12):
United States most of them theprivate insurers
UnitedHealthcare, Cigna, Aetnathey have administrative costs
in the range of 15 to 20 percent.
(19:33):
Now, any insurance plan hasadministrative costs.
You've got to collect thepremium, you've got to deal with
the doctors, you've got to paythe bills.
But in other countries theadministrative costs are limited
to about 5 percent.
They're limited by law.
In America, the law allows ourinsurers to charge 20% of any
bill as administrative costs,just added on to the cost of
your premium.
(19:55):
There's one insurance planthat's much more efficient than
that, and that is Medicare.
This is the government-run planfor seniors and people with
disabilities.
This is the government-run planfor seniors and people with
disabilities.
Medicare says that itsadministrative costs are in the
range of 3%.
They're much more efficientthan the private insurers and
(20:15):
they're also the lowest payerbecause they use their
bargaining clout with hospitalsto get lower rates.
So Medicare for all wouldcertainly work.
Medicare, as I say, is the mostefficient.
It's the lowest cost insuranceplan and has the highest rates
(20:35):
of appreciation among itsinsured.
In fact, when you ask peopleover 65, would you like to drop
Medicare and go back to privateinsurance?
No, the answer to that is no.
88% say no.
Don't do that to me, don't takeaway my Medicare.
So this is.
Chris Comeaux (20:53):
This is fascinating.
I'm just thinking that you know, when I originally asked you
for this podcast, you know wesomething tragic happened.
The CEO of United isassassinated and the dialogue in
our country is fascinating andone of the best articles.
Dr Neal Shaw wrote an articleand the gist was it's horrible
(21:18):
that someone would getassassinated.
It is fascinating that half thecountry is reacting in the way
they do, and maybe it's a signalof the moral bankruptcy of have
you kind of lost sight of whatyou were there to do?
Is this really about helpingpeople be healthier?
And then, of course, theassassin's bullet had what was
(21:39):
it?
Depose, deny, I forget what thethird term was.
I had a personal experienceright about the same time.
The lady next to my office Iwas having to go and fax my son
had wisdom teeth and they deniedit.
He had wisdom teeth removed.
She goes hey, can I fax thatfor you?
I'm like that's wonderful, I'mdoing it.
(21:59):
It's an appeal.
So it's personal, I feel like Ineed to do it.
We get to talking.
She goes you know, they deniedmine too.
And she goes you know, theydenied mine too.
And I'm like, well, do you knowyou can fight that?
No, and she was just going topay $1,000.
And how many people are likethat?
And that's exactly the strategy.
Why do they actually do thedenials is, most people won't
fight it and that has nothing todo with health care, nothing to
(22:22):
do whatever.
And actually it's funny.
You mentioned that I've got page232 of your paperback version
under myth number three,healthcare for-profit insurance
have the highest administrativecosts in the world.
And then you quoted about the20 cents.
I did not know about Medicareat three cents, and it
definitely seems like that'sdefinitely part of what's wrong.
(22:43):
There's major dollars that arenot adding value, and also love.
And I'll show up and let youcomment.
In the very beginning of yourbook you actually spoke to
Dwight D Eisenhower.
This book is dedicated toPresident Eisenhower for the
reasons set forth in Chapter 1.
I had actually never readsomeone else say this.
I thought this was like our ownthing behind the scenes.
(23:05):
But Eisenhower talkedmilitary-industrial the complex
.
Beware the people that willmake war, because it's
profitable and health care isperverse that way.
It's not really about makingpeople better.
The more bad stuff that happensthen, the more money that you
make, and so, anyway, I'll shutup and let you comment to some
of those things.
T.R. Reid (23:23):
Yeah, I think that's a crucial point, chris.
One fundamental differencebetween the health insurers in
the United States and those inother countries Germany, japan,
switzerland, for example is thatother countries don't allow
insurers to make a profit.
They're basically charities.
They're not there to payinvestors or to pay executives
(23:45):
huge sums.
The reason for insurancecompanies is to provide a
healthy society, a healthynation, and the reason they
don't allow profit is they thinkthere's a fundamental
contradiction between making aprofit on health care, health
insurance and keeping peoplehealthy.
The reason for a healthinsurance plan would be to get
(24:08):
people to go to the doctor whenthey need care by paying their
bills.
The way you make a profit inhealth care is by not paying
bills.
This is why they have narrownetworks, this is why they have
to approve your procedure inadvance, and so it's really that
fundamental difference betweencharity health insurance in
(24:30):
Germany, Japan, Switzerland,Netherlands versus for-profit
health insurance.
Once you have to make a profitin health insurance, then you
adopt all the tactics that makepeople hate their insurance
company.
Chris Comeaux (24:45):
Yeah, that is very well said.
Well, it's also fascinating thetime.
So this show will be airing inthe early spring of 25.
When your book first came out,Obamacare was being enacted and
now here we are with a possiblesea change window of opportunity
in DC.
So you were king for a day andyou could change the American
(25:06):
healthcare system.
How would you do it?
I feel like you've kind ofalluded to it, but if you were
king for a day, and then alsoI'd love for you to talk about,
do you think there is thatwindow, possibly this year?
T.R. Reid (25:16):
Well, here's the thing
president, Donald Trump, hassaid in all three of his
campaigns that we should providehealth care for everybody.
He realizes that we have tensof millions of people with no
health insurance and that thisadds to costs, it doesn't save
money, and it makes our overallnational health worse.
(25:37):
So he's said that he's nevercome up with a plan to make it
work, but he realizes theproblem.
To me, that's the first step: Figure out that we need to (25:46):
undefined
provide a system that coverseverybody.
And Donald Trump has alsocomplained very strongly about
the costs of health care.
And there are certainly ways tocontrol the costs of health care
that we could adopt from othercountries.
So if he means it and if hereally wants to do it, and if he
(26:08):
During the 2024 campaign lastyear, Americans were polled on
health insurance, and onequestion was, should we provide
Medicare, that is, governmentinsurance for everybody?
to achieve something historicfor our country in his second
term as president, this is theway he could go and it would be
quite popular.
In the Pew Research Institutepoll, 58% said yes.
(26:39):
So that would be.
It would be a popular step andit would be a valuable step for
our country.
It would improve our health andsave money.
So yeah, maybe I'm kind ofhoping that the new
administration will take this on.
Chris Comeaux (26:53):
Well, you have spent a lot of your life
crafting words, and so wordcrafting is a superpower.
It's almost art.
Do you think the term Medicarefor all is the right framing, or
is there a different framingwith the same concept?
T.R. Reid (27:10):
No, that's not the right term.
It's the right concept.
An efficient, government-runhealth insurance system with
lower costs for everybody, sothat everybody gets the same
care, is the way to go.
But Medicare for all is tainted.
It sounds like socialism topeople.
So, no, we need a plan calledAmeriCare or Unicare or US Care
(27:36):
or something like that.
We need a new name, AmeriCare,and not the same name that
Canada uses.
But a plan like that whereeverybody pays into a
government-run, highly efficientinsurance system and then
everybody is covered in the sameway by that system.
(27:59):
As I say, people when they geton Medicare at age 65, never
want to go back.
If you poll people on Medicare,would you like to go back to
private insurance?
No, 88% say no.
Jeff Haffner (28:14):
Thank you to our Anatomy of Leadership / TCNtalks
sponsor, Dragonfly Health.
Dragonfly Health is also thetitle sponsor for leadership
immersion courses.
Dragonfly Health is a leadingcare at-home data technology and
service platform With a 20-yearhistory.
Dragonfly Health uses advancedtechnology and robust analytics
(28:37):
to manage durable medicalequipment and pharmaceutical
services as part of a single,efficient solution for
caregivers, patients, and theirfamilies.
The company serves millions ofpatients annually across all 50
states.
Thank you, dragonfly Health,for all the great work that you
do.
Chris Comeaux (29:01):
I didn't tell you I was going to ask you this.
But price controls.
I think it was Japan, right,that had really tight price
controls on the way their systemworked.
And as I sit here and process,I mean you basically Medicare
has Medicare allowable, so wekind of got price controls in
place.
But I'd just love to hear youtalk about that a little bit,
(29:22):
like what role does pricecontrols play in a system like
this working?
Perhaps?
T.R. Reid (29:28):
You know, in most other countries somebody sets
the price for a medicalprocedure and the price is the
same for everybody.
In the United States now, forexample, I was on the board of
the University of ColoradoMedical School.
We have a hospital and in thathospital we had a team that
performed 36 hernia repairs,about five or six a day, 36 a
(29:54):
week.
It was the same team in thesame room doing the same, just
about the same procedure foreverybody.
And guess what?
We got 36 different pricesbecause it all depended on what
your insurance company waswilling to pay.
That just adds to the paperworkand administrative burden.
When I was on the board of themedical school, we were building
(30:18):
a brand new campus, which waskind of nice for us board
members because like every threeweeks they opened a new
building and they would cut aribbon and we would sip wine and
have hors d'oeuvres.
It was quite pleasant.
And there were so many newbuildings on this campus it was
hard to keep track of what theywere.
And one day we board memberswere out there and they opened a
(30:38):
six-story, a big six-storybuilding, brand new, beautiful
building.
We clipped the ribbon, I wassipping wine and I said to the
dean in the medical school whatare we going to treat in this
building?
He said treat, we're nottreating anybody here.
This is the billing office.
It's 75 people are there justto dig through the different
insurance plans and figure outwhat we're going to be paid for
(31:02):
a procedure that we did fivetimes and we're paid five.
You don't need that kind ofadministrative costs.
If prices are set so that allprices are the same, you save
huge amounts of administrativecosts, and that's what other
countries have done, and thenthis leads to more efficiency,
(31:22):
as I point out in my book.
Once here in Colorado I had agrowth on the back of my neck
and the doc said, oh, you bettergo get that looked at.
So I went to get an MRI of myneck, which was fine, and the
bill came.
It was $1,800, about standardfor that procedure.
Anyway, a few months later Iwas in Japan working on our
(31:45):
movie about health care and inthe doctor's office I saw an MRI
machine and I said to him hey,if I had to get an MRI of the
back of my neck, what would itcost?
And he looks in his book and hesays well, that would be
Ichimayen.
That's $98.
$98.
I just paid $1,800, but that'sthe price that the Japanese
(32:08):
health ministry has assigned forthat procedure.
And guess what?
The doctor makes money.
The doctor comes out okay, andthe reason is to meet the need
for those low-cost MRIs.
The Japanese tech companieslike Fujitsu and Hitachi have
built very simple, plain-janeMRI machines without all the
(32:31):
bells and whistles, and usingthat doctors can provide the
same decent care.
For what was it?
For one-twentieth of the cost.
And that so what?
My argument is that kind ofprice control leads to
efficiencies.
It doesn't undermine healthcare, it leads to more efficient
(32:53):
health care.
Chris Comeaux (32:54):
Well, it leads to another good question.
So when I think about what youjust said, what about the role
of innovation?
And let me maybe frame it thisway I think, as you went through
your book, some of thecountries you research allowed
more affluent people that couldpay for concierge type medicine,
so the higher.
(33:15):
I'd love to be able to drivearound a Mercedes, but I drive
around a Toyota and so on.
My salary I'm okay with middleof the road, but if someone
could afford a Mercedes or aLexus, good on them.
Do you create that ability ontop of the system for more of a
concierge?
And then is that the placewhere innovation?
And then does that innovationeventually trickle down as costs
(33:37):
go lower, et cetera.
T.R. Reid (33:39):
Yeah.
So innovation, research,medical advances.
The United States is great atthis.
We lead the worldleadingmedical research.
I don't know if you've seenanybody who has seen their baby
(34:19):
in the womb through ultrasound,which every new parents do that
nowadays.
That's a procedure that wasdeveloped in Sweden, not in the
United States.
Sweden is a very low-costcountry.
Deep brain stimulation isconsidered one of the few
treatments that seems to workfor dementia.
(34:41):
That was developed in Canada,which is a very low-cost country
.
If you happen to take a statin,that is, an anti-cholesterol
pill like, for example, crestor,is one of the best-selling
medicines in the United States.
It's one of the top 10 pillsevery year.
On the label of Crestor it sayslicensed to Shioyaki Company,
(35:04):
Japan.
That is, that pill wasdeveloped in Japan, which also
has very low cost.
So yes, the United States isgreat at medical innovation and
research, but it's not becauseof our high costs.
The most important newdevelopment in dentistry in the
last 25 years is dental implants, where they put a whole new
(35:26):
bridge in your mouth.
That was developed in theNetherlands, which is another
very low-cost country.
So you don't need our highcosts and our outrageous
administrative costs to havegood medical innovation.
We do have that we lead theworld in medical research, but
it's not because of our highcost burden.
Chris Comeaux (35:47):
I'm so glad I asked you that question.
The other thing you alluded toI think it was Japan and Germany
both that they were starting todeal with a pretty steep
increase in cost, and I don'tknow if you've read recently,
but 2024, it looks like nowwe're on 8% 9% increase in cost,
which means now all theemployers that are going to be
going into 2025 with theirhealth insurance renewals are
(36:09):
going to be be looking at maybedouble-digit increases.
And what do you do?
You're going to pass that alongto your employees in a high
inflationary period when theirpaychecks has already been
eroded because of inflation.
So costs are happening inAmerica, but cost was happening
in some of those countries thatyou researched.
Was it simply because thedemographics CR, because more
(36:30):
people were?
Just, I know Japan's baby boompopulation, I think, is almost
10 years ahead of oursdemographic wise.
Is that what it was or what wasreally driving those costs, and
what are the lessons for us inthat?
T.R. Reid (36:43):
It is true that all the rich countries have aging
populations Japan is the oldestpopulation in the world and
aging people have more medicalneeds and therefore more medical
expenses.
I think a big problem is thesefabulous advances that we talked
about, that save lives andimprove people's daily health,
(37:06):
cost money.
They're really expensive, costmoney, they're really expensive.
And this new wave of Ozempicand Wegovy, weight-controlled
drugs and diabetes-controlleddrugs they are fabulous, they're
medical miracles, but they'rereally expensive.
I notice, however, that theNetherlands is now allowing the
(37:29):
sale of those drugs and Sweden,of course, where Denmark is,
where Ozempic is made they'reallowing them, but the cost that
the companies are allowed tocharge is about a tenth of what
they're charging in the UnitedStates.
That is, they control drugprices, but even there, even
(37:50):
with controlled prices, thesenew advances in drugs and
procedure and technology arereally expensive.
And, yes, they're causing aserious strain for every country
.
Well, we don't want to say noto those.
We want to take advantage ofany advances that will improve
our health and extend our lives,of any advances that will
(38:13):
improve our health and extendour lives, and so the way to
deal with that is to reduce theadministrative costs, to get our
overall costs down so that wecan afford these expensive new
procedures.
And that's where the UnitedStates lags.
As I said, our insurancecompanies have administrative
costs three, four times whattheir counterparts in Germany or
(38:33):
the Netherlands would have.
Chris Comeaux (38:36):
So you know, I actually personally have like a
high deductible plan, so I'vegot a health savings account, so
I got skin in the game with meand my family.
How do you bake that into asystem like that?
Do you come up with like astratification, like the gold,
silver and the bronze and everyAmerican gets the bronze in
AmeriCare and then maybe thesilver and gold.
(38:58):
Maybe you're having to pay acopay with an HSA and then maybe
you could have the outside forthe super elites that want to go
pay for whatever they want topay for.
Or how would you do it, giventhat challenge?
T.R. Reid (39:16):
I would set a system where everybody gets a standard
level of care.
There's a floor below which youdon't go, you can get the care
you need at a reasonable costfor everybody.
And then guess what, chris?
Rich people are going to getwhat they want and there's no
country that's been able to stopthis.
In Canada, you're not allowedto go out of the system.
So billionaires in Canada cometo the United States and buy
(39:39):
their health care In Britain, inGermany, in France.
Rich people can go to a privatedoctor who's outside of the
system and you can't stop that.
That's going to happen.
In the same way that they canbuy a Rolls Royce or a Mercedes.
That's fine, as long aseverybody else gets a decent
(40:01):
Toyota.
It's fine if rich people wantto blow their money on some
fabulous specialist somewhere,they're going to do that.
But let's make sure we have astandard level of care that
everybody else gets.
In the United States we have noceiling.
People can buy anything theywant and we have no floor.
(40:23):
As I said, 30 and a halfmillion Americans have no
insurance at all.
Sona (40:27):
Good employers know that health benefits can make or
break your business.
But while employers are lookingout for their employees' best
interest, who is looking out fortheirs?
Sona Benefits is an independentpharmacy benefit manager who
partners with employers tooptimize their pharmacy benefits
while supporting their businessgoals.
But by offering no spreadpricing contract, guaranteed
(40:50):
rebates and the Sonamax program,clients are regularly able to
save 20% to 35% off their totaldrug spend.
The result Pharmacy benefitsthat improve employees'
well-being and employers' bottomline.
Chris Comeaux (41:07):
So would you create some type of like how do
you make sure that I'm not afrequent flyer?
And you know I'm loving thissystem.
I'm going to get whatever Iwant.
It's the buffet and you knowGod, this guy keeps coming back
to the buffet.
You're going to put us out ofbusiness.
Do you create some type of likeHSA health savings account
where they've got a little bitof skin in the game?
(41:28):
What
T.R. Reid (41:30):
Yeah, I believe that people ought to pay for health
care.
So I'll give you two differentpoints of view on this.
In France everybody has decenthealth insurance.
The World Health Associationrated France the number one
health care system and healthsystem in the world.
Costs are low.
Their life expectancy is waylonger than the United States.
(41:52):
But they make people pay.
I think currently the requiredpayment is about 21 euros that
you have to pay at the time oftreatment 24 bucks, and
insurance pays about half ofthat back.
But they insist that you pay sothat you realize you're getting
something of value Across thechannel.
(42:14):
In Britain, as I say, you don'tpay at the point of service.
You never pay the doctor.
And I said to my doctor in themovie I made it's called Sick
Around the World.
It's a PBS frontlinedocumentary.
I think people can still streamit documentary.
I think people can still streamit.
Anyway, I say to the doctor, drBadat, my family doc in Britain
(42:35):
, you know I'm getting reallygood care here.
I pay five quid for this.
I pay five pounds that's aboutseven dollars to come see you.
And he said you know, if Icharged one pound, half the
people who need to see mewouldn't come in, and then
eventually we'd see them in theemergency room when their
illness got very serious.
(42:55):
So the Brits believe that makinghealth care free at the point
of service improves overallhealth, because people go to the
doctor at the first sign.
The French kind of believe thattoo, but the French also
believe that health care is ofvalue.
Health care is never freeanywhere.
Somebody's got to pay for itand they want you to know that
(43:18):
you should pay.
I'm on the French side on thisone.
I think people should paysomething for health care Five
bucks, 20 bucks.
They should recognize thatthere's a cost involved in
keeping them healthy, but weshould have a health insurance
system that sees to it thatthose costs are low, so that
people will go to the doctorwhen they need care.
Chris Comeaux (43:39):
So last night I was looking in your book.
There's a gentleman that youreferred to that he was like the
go-to guy at the time you wrotethe book.
I think it may have beenSingapore that was literally.
They had kind of a blank canvasand it may have been
Switzerland at the time that wasredesigning their system.
Who is that gentleman and is hestill around?
T.R. Reid (43:56):
Yeah, that's Professor William Hsiao,
H-S-I-A-O.
Bill Hsiao at the HarvardSchool of Public Health.
He has designed healthcaresystems for about 20 countries
and he's still on it.
Not recently, the healthminister of Ethiopia asked me if
(44:16):
I might help them design abetter health care system and I
referred him to Bill Hsiao andhe's going to go over there and
help.
So yeah, bill is still doingthis.
Incidentally, on this questionof pay or no pay, bill Hsiao is
kind of on my side.
He believes that people shouldhave to pay for health care, but
not much.
So the system that he designedin Taiwan required, at the time
(44:41):
he set it up, if you went tovisit your family doctor, you
had to pay.
Are you ready for this?
Two dollars to go see thedoctor, wow, just so you know,
I'm on your side.
Chris Comeaux (44:58):
I do think you should pay.
Yeah, exactly, I think one ofmy mentors said if you give it
for free, people won't value it,and so I do believe that's kind
of in the American ethos If I'mgetting it for free, I'm not
going to value it.
So having some skin in the game, I think, is wise.
There probably is a whole studyof what's that exact level is.
The right level is probably aninteresting thought process.
(45:18):
Well, a couple of lastquestions.
You've been awesome and againI'm so glad I reached out to you
.
What about hospice andpalliative care?
Obviously, our listeners aremore in this realm, are more in
this realm, and so where do youthink that, if there is a
possible sea change, anyopinions about how?
T.R. Reid (45:38):
hospice and palliative care should play into
that potential sea change inhealthcare.
It's not an area I know muchabout.
I think people I know who'vegone to hospice it's an
excellent way to end your lifeIf you know you're about to die,
rather than go throughextraordinary measures to try to
extend it for a few weeks.
Hospice is a way to face thefact that we're all going to die
(46:00):
and they make it as comfortableas possible.
I'm all for hospice, but howthat fits into a health care
system, I don't know.
Some people, some advocates ofuniversal health care care for
everybody, think that we shouldprovide long-term care for
everybody.
Long-term care it's for oldpeople like me and it's very
(46:23):
expensive.
I have long-term care insuranceand it's about three times the
cost of my Medicare premium.
It's expensive.
So I think those are you knowthat those are Cadillac, those
are gravy that would be nice toprovide, but are not an
essential element.
What we need to provide is abasic level of health care for
(46:46):
everyone in the United States ata price they can afford and
with access to the doctors thatthey get to choose.
Chris Comeaux (46:54):
That's what I would do.
Well, so just real quick then,since you said that way, I'm
personally biased.
I've got 30 years in hospice.
I think we're one of the mostbrilliant models of healthcare
Medicare designed it was BobDole 1983, during the Reagan
administration.
It's a holistic viewpoint.
People are body, mind, spirit,social, emotional component,
(47:16):
which is why there's a wholeteam of professionals doctors,
nurses, social workers,chaplains, CNAs, volunteers.
There's a care plan that thenkeeps everybody on the same page
.
It generally was originallyimagined as a six-month benefit.
Does the patient qualify?
Do they have six months or lessto live?
Have they quit seekingaggressive curative treatment?
(47:37):
Now great nonprofits like Iwork with TR.
They also develop thesebeautiful hospice houses.
Picture it like your hospicehospital.
And the downside is today isthat families will elect that
skilled long-term care benefitbecause that's how you get the
room and board paid.
So that's one thing, that if wewere king for a day where you
(47:58):
can go, well, what if I went thehospice route?
Would that pay for my room andboard?
And so today that's not thereality.
We don't get a payment.
You have to basically be what'scalled general inpatient care.
It's just a much higher acuityand you have these ups and downs
and peaks and valleys on thecare trajectory when someone is
hospice.
So that's something we'd loveto see because you have dollars
(48:20):
spent in long-term care.
I think there'll be a day we'lllook back and we'll say we
literally were torturing elderly, terminally ill people.
Get out of bed and do thistherapy because that's how you
pay for your room and board.
When being kept comfortable,more palliative care would have
been more appropriate and that'swhat these hospice inpatient
units do.
(48:41):
So if I was king for a day, Iwould make sure we'd write that,
but interestingly, you wouldlove this.
About 95% of most hospices istraditional Medicare today.
Now, one of the things that'sgot us worried is more of
Medicare has been going toMedicare Advantage plans, and
therein lies our concern of thefuture.
Now we're dealing with the denydepose and then we're barely
(49:03):
getting paid what we're gettingpaid before, and that's one of
the things that we're debatingquite a bit right now within,
like where do things go in thefuture, et cetera.
So I love your AmeriCare.
T.R. Reid (49:13):
That's really interesting, Chris.
Yeah, I see the virtue ofhospice.
Glad to know you've beenworking on it.
That's good for you to do.
Chris Comeaux (49:21):
Yeah, there's lots of data and I think, if I
remember, Christy Whitney sharewith me.
I think you were doing aDartmouth Atlas talk at the time
and you're about.
You know the Dartmouth Atlaswas a great data point.
You know great communities thathave wonderful programs, like
Hope West and Grand Junction,where I grew up, in hospice Four
(49:42):
Seasons in the Asheville, NorthCarolina area.
If you look at the total spinwhen you get hospice-empowered
care, you get a better care atthe right place at the right
time and you actually decreasethe trajectory of that one more
MRI or one more line of chemo.
And it's paradoxical becauseobviously patients die in
hospice and if you get a goodlength of stay, like at least 90
(50:03):
days, you actually get goodsatisfaction.
Even though the patient dies,the family feels like they were
part of the care.
You have less grief on the backend.
It's just a beautiful model ofcare.
But obviously, I'm prettybiased.
T.R. Reid (50:15):
I agree with that.
I think you've got that right.
Chris Comeaux (50:17):
Yes, well, final thoughts Again.
Tr, you've been great and I dohope that you get to be king for
the day that you get the rightears of the people and maybe we
I love the Meric here.
I'm like I'm taking that.
I'm going to repeat that overand over again because I think
that's actually brilliantframing.
So any final thoughts for ourlisteners.
These are our hospicepalliative care leaders.
(50:37):
Anything you'd like to sharewith them?
T.R. Reid (50:39):
Yeah, how are we going to get to universal health
care in the United States?
We need to provide health carefor everybody at a reasonable
cost.
We can do this.
We're the world's richest, mostinnovative country.
I do this.
We're the world's richest, mostinnovative country.
I don't think we're going to getthere through Medicare for all
or some federal program, and thereason is the big winners in
our system, that is, for-profithospitals, the health insurance
(51:02):
giants, big pharma.
They basically own the USCongress and they're not going
to allow the kind of change weneed.
So I think the way this changeis going to happen is state by
state.
What's going to happen is oneor two or three states are going
to come up with a single-payerplan that covers everybody
(51:23):
fairly and equally, and theother states will see that it
works and copy it.
I say this because I'm fromColorado.
As you may know, colorado wasthe first state to allow sales
of medical and recreationalmarijuana.
I always say Colorado is thehighest state in the country in
more ways than one, and now 38states have copied us because
(51:47):
they saw that we made it workand we can do the same thing on
a state-by-state basis in healthcare.
A lot of the most importantideas, policy ideas in American
history, started in one stateFree public education, votes for
women, minimum wage laws, childlabor laws started in one state
(52:09):
and spread, and we can do thatwith health care.
So people watching, get outthere and work to see that your
state puts in a universal healthcare single-payer system, and
then the rest of us will followyour example.
Chris Comeaux (52:23):
Great Well, T.
R.
, Thank you.
We're going to include a linkto your book If there is still a
link out there for the movie.
T.R. Reid (52:30):
Around the world yeah , PBS Frontline.
Perfect If there's a a link outthere for the movie Around the
world.
Yeah, PBS Frontline.
Chris Comeaux (52:33):
Perfect.
If there's a link that we couldget in that, we're going to
include that in the show notesTo our listeners.
We appreciate you.
Thanks for listening to TCNtalks.
This is a great listen.
Pass this one around,especially if you know
legislators, people of influenceCertainly hospice and
palliative care leaders use thisas a great resource.
We do this show in service toyou.
These are fascinating times.
(52:53):
We live 2025, one of our boardmembers said it's going to be
predictably unpredictable.
I think that's actually apretty good quote I think we're
in for an interesting ride thisyear.
And yeah, and with the increasedhealth care costs, while it
might not have been number onethrough number one or or the top
five issues in the election,with these costs I think it's
(53:14):
going to rise to the top prettyquickly, as we always do.
Ask you to subscribe to theshow.
That way you always know anyepisode of TCN Talks.
And I always want to leave youwith a quote.
I ran this one past TR.
I think you'd appreciate itbecause it's an early journalist
in our country, thomas Paine.
"These are the times that trymen's souls.
The summer soldier and thesunshine patriot will, in the
(53:35):
crisis, shrink from the serviceof his country, but he that
stands it now deserves the loveand thanks of men, men and women
.
Tyranny, like hell, is noteasily conquered.
Yet we have this consolationwith us.
The harder the conflict, themore glorious the triumph.
What we obtain too cheap, weesteem too lightly.
Tis dearness.
Only that gives everything itsvalue, and heaven knows how to
(53:58):
put a proper price upon itsgoods.
And it would be strange indeedif so celestial an article as
freedom should not be highlyrated and will pin health care
as well.
Thanks for listening to TCNTalks.
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