Aside from the fact that his name reminds of Tara Reid, he came up with three basic limits:

• Basic coverage was required by all, or at least most- the Germans allow the richest people to opt out of universal coverage, and the government pays the healthcare for the poor.
• Insurance companies must accept everyone and operate on a not-for-profit basis.
• Doctors and hospitals have to accept one standard set of prices for services rendered.

Reid doesn’t offer a specific solution for the U.S., but he urges us to look abroad to study what has and hasn’t worked for our counterparts.  This is an abstract, so I suggest you watch the episode.  (BTW, PBS has an amazing website that’s easy to navigate, has a great interface to watch videos with freedom to jump/fast forward/ go back as needed and all the sharing mechanisms to the right of the screen.  Of course, I realize that they have little to lose by adopting this innovative new media approach, since they have little advertisers to piss off.  Still, I think the public should enjoy.)

I see several major subjects that aren’t covered in Reid’s argument, which from what I’ve seen of him, he will definitely cover in his book:

• The ‘universal’ systems covered by the other five countries put a huge strain on the healthcare providers and insurance companies. 
  • According to the other systems, the U.S. would have to ditch profits for insurance companies all together.  The U.S. political system highly reliant on lobbyists, how will that go through?
  • Doctors in other countries are paid about $80k-$120k a year, which is somewhere between 50-67% of what U.S. doctors earn a year.  Yes, that will piss off some doctors, but more importantly, how will they pay for the $200-500k price tag of getting the education?  That doesn’t even include interest.  Will the U.S. reform their education system as well?  (That price tag in London: 1,100 pounds sterline b/c of a shortage in doctors.)
  • Note: doctors also have extremely high mal-practice insurance in the U.S. compared to other countries.
• These five nations are rather small in terms of population and size.  Reid mentions that many of the countries only spend about 6% or so of GDP on healthcare, but he doesn’t take into account that cost for healthcare grows exponentially.  Every fixed increase in population size requires another hospital, more service providers, etc., which all increase fixed cost.  Also, the size of the U.S. itself means that we need to have more hospitals servicing our widespread population.
• Despite many people in the IT age, who have adopted smart phones, the Internet, etc., many of our agencies and corporate entitites are still using the paper trail.  Therefore, it’s increasingly difficult to ask the entire nation to switch to something like the healthcare card system that Taiwan has.  This sytem keeps track of all the patients symptoms, needs, bills, prescriptions, etc. along with doctor’s notes.  Even with adoption in most major cities and suburbs, is this achievable for the nation’s rural and low-income areas?  Who will pay the bill?
• Rumour has it that the U.S. pharmas support much of the world’s medicine, both in terms of research and in terms of cost premiums.  Deregulation and price fixing in other countries lowers profit margins for U.S. based pharmas.  Will they be able to afford the high FDA regulation fees, R&D and still be able to make a profit?  How will lowering prices in the U.S.  drug market affect the international drug market?  Switzerland’s former president says that the Swiss pharmas are fairing well.  However, I believe the U.S. has the largest pharmas in the world.
• If it takes Hollywood months to negotiate a contract with writers.  I can’t wait for the U.S. to try and tackle price setting for all the thousands and thousands of medical services offered.  That’s not even taking into account cost of living differences across cities, regions, states, etc.  Japan negotiates on a yearly basis; I guess that would work if we negotiate 2020′s prices starting in 2010.

We need change, but we also need to be heavily invested in how we enact change.  Short term policies, i.e. a presidential candidate promising one thing or another that will be carried out in 4 years, might now work.  Healthcare reform needs to be a long term goal.  With the U.S. political system asking for re-elections every 2-4 years, politician’s aren’t always focused on the long term changes necessary.  And all the stuff that Hillary, Barack and John tout in their speeches?  Fluff.  Flowery.  Powder.

I’m not paid or even encourage to promote PBS, but you should really go to the Frontline site to read more about this, especially here and here.

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End notes:

• The Swiss didn’t allow women to vote until the 70s, but they’ve already had a female president.
• T. R. Reid is ridiculous.  His Japanese is mostly perfect for a Westerner, he speaks a bit of German and seems completely comfortable traveling all over.  I realize that he used to be the Washington Post bureau chief in London and Tokyo… but still, very admirable.