Dear FRONTLINE,

The editorial largely consisted of Reid making the same statements in regards to the United States system, and asking the same two questions: 1. Is everyone covered? 2. Does anyone go bankrupt paying medical bills.

Removing these ibstacles to our current system would be an excellent result.

Yet there were no real examination of what rasies costs in this country and lowers them in other countries. Reid asumed that if you remove the profit motive the costs will automatically go down.

He is sadly mistaken in that assumption. What adds to the costs in this country are endless procedures that are required to protect the doctors from malpractice. A three minute office visit would be proof that the doctor had not been complete enough in his diagnosis.

Would Reid be willing to close the door on his fellow constiuents the trial lawyers as quickly as he suggests the insurance companies should in the US?

I currently work at a Community Health Center (the US solution for low income people and those who have no insurance). The federal government has recently decreased the funding for malpractice insurance which causes the clinics to find funding from other sources. The result is to put in danger the long term financial stability of these clinics. This is occuring at non-profit clinics that are helping those of us who are most in need of help.

The public system Reid suggests will cause lack of access as the hospitals and clinics shut down due to lack of funding.

Ken Banks
Port Orchard, WA

Dear FRONTLINE,

I thank Mr Reid for a well done comparative look at various health care systems in other developed countries. I was raised in Hong Kong, lived in the UK for five year before settling down in the US permanently.

My opinion after running a sizeable business of over a hundred in staff with private health insurance, is that the litigious environment in the US has added significant costs to the health care system. Doctors, insurers, hospitals, drug makers, and medical equipment makers etc all incur hugh costs (legal, training, insurance) in serving the health care needs of the public.

While it is difficult to account for the legal costs precisely, I estimate that it adds on the order of 2 to 5% of the overall health system costs.

Comments and discussions are welcome.

David Liu
Diamond Bar, CA

Dear FRONTLINE,

I'm a paraplegic individual and I understand the importance of medical coverage. Medicaid for me is a life line. Try to imagine not being able to work, therefore you can't buy your medical necessities. You would die. I greatly appreciate Frontline for this and all their humanitarian informative programs.

The bottom line for this topic is that Universal Health Care would save lives and alleviate worry and stress. Come on people this is a moral issue, put away your political posturing. As long as people have their health and life, we as a country can reconcile the costs.

Ken Rags
Southfield , MI

Dear FRONTLINE,

I found the piece on Japan's healthcare system interesting, especially the brief statement on insurance companies - they are "non-profit" by law. I've long thought that we could do something like that in the U.S. without the burden of such a regulation, by creating Insurance co-ops. Similar idea I suppose to credit unions; essentially a (large) group of people getting together to finance each other's health care, i.e. an insurance company without the profit.

Doug Dibley
Federal Way, WA

Dear FRONTLINE,

As someone who benefited from Japanese national health insurance during three year-long stints in Tokyo in three successive decades, I appreciated TR Reid's portrait. But he was not very probing in his interviews with Japanese patients.

My own experience, shared with most of Japanese friends, confirms many aspects of the report, notably the easy access and good diagnostics (despite the short face-time with physicians). However there is also a tendency to prescribe too much medication (most often mixed and sold at the physician's office, a major source of their income) and a requirement for frequent return visits that does not value the patient's time.

For example, when my wife had a root canal done at a major university hospital, she had to return six times to complete the procedure. The cost for each visit at the hosptial was slightly less than the bus fare. But, had she had the choice, she would have preferred to pay more and complete the root canal in one fell swoop. And she would have definitely preferred novocain, rather than simply, as she was asked, to "gamman" (bear with it).

Japanese health statistics are impressive, and quality of care is good, but it is the consumer of health care, well-informed and patient, willing to return frequently (to allow the physician to earn another modest fee) who is central to making the system work as well as it does.

Jim Matson
Colorado Spring, CO

Dear FRONTLINE,

Thanks to T.R.Reid for a nice report. Being someone who lived in India a long time, I can vouch that even third-world India has a lower cost of decent private medical care than the United States; Mr Reid never mentioned medical tourism which is driving droves of Americans to countries like India (PBS did a story on that recently).It seems some on this forum support the drugmakers' contention that research budgets will go down with pricing controls. They need to read realize (see Q/A with Reid) that the drugmakers' marketing budgets are greater than their research budgets. I think most of the resistance to change in this forum is coming from doctors who are afraid of a fall in their incomes. The fact is that society has a way of balancing need against remuneration; if doctors' incomes fall, their supply will fall and then compensations will have to rise up.

Vic Kohli
Dallas, Texas

Dear FRONTLINE,

I spent most of my professional career in Europe working for and in relation to an international organization. The systems there work well and I have been shocked at the greed of doctors and drug companies here in the USA. I could walk into any pharmacy in Belgium and pay retail for a drug I use and get more than four times as much for the same payment here: the drug is made and supplied by the same multinational drug company in both countries Americans are being defrauded by these companies and by the US government (FDA) which is supposed to regulate them. Your program is absolutely dead center on the truth. Thank you.

William Richards
El Paso, Texas

Dear FRONTLINE,

The most striking aspect of the program was the absence of a solution for the United States' healthcare crisis-and it was also its best feature. By presenting the pros and cons of each of the countries visited, it allows each viewer to weigh each option. However, one thing is very clear: each system was far more efficient, compassionate, and cost-effective than our own.

Daniel Snow
Salt Lake City, UT

Dear FRONTLINE,

I salute your providing Mr. Reed's insightful overview of several country health systems.
Health care systems are a critical component, along with income, environment, etc. in determining health.
As a public health physician I would say the US can be proud of incredible medical advancements. At the same time, when it comes to providing equity in access to health care. we have shamefully allowed the dollar to serve as a de facto rationing mechanism that encourages many with limited resources to put off preventive and primary care. The control of blood pressure or diabetes is too often ignored due to expense till the stroke or heart attack requires hospitalization, increasing the burden to them and others. Surely we are a better nation than to allow that.
The single Frontline episode can only provide limited information on robust health systems that help other countries, even with a few blemishes, achieve much better overall health than the US has. I encourage your revisiting the topic in depth.

,

Dear FRONTLINE,

Excellent presentation of how other developed nations deal with the health of their peoples. Twice, the program came very close to nailing two significant problems with the US's approach, but missed the mark. First, we do not have a SYSTEM. We have a mess of loosly alligned, rarely integrated providers of care. Second, your program stepped lightly in distinguishing between HEALTH CARE and MEDICAL CARE. In the US we focus on MEDICAL CARE. Individuals and providers are focused on treating rather than preventing illness.

Helen McGaw
Eagle River , Alaska

Dear FRONTLINE,

This was the best comparison report I have seen. I wish there had been some more information about the personal taxation in these countries. I know UK taxes are much higher than US, but how are they in Switzerland, Germany, and Taiwan?

I listened to an NPR program recently about Denmark. Everything was free. Health care, College, etc. But then the interviewer ask about taxes; 60% income tax, 25% sales tax on everything , even food, and 150% tax on new automobiles, although they said most people only had one auto.(No kidding).

Sometimes it all sounds good, until you look at the actual taxation cost.

Tom Thomas
Columbus, OH

Dear FRONTLINE,

Your report makes two glaringly falacious assumptions:

1) The ends justify the means. The means with every system you covered are compulsion. Do evil means beget good ends? I doubt it. Just look at Germany. As you reported, the doctors who were happy in the 1980s now feel victimized by a "bait and switch." They've essentially been enslaved by the system. What message does this send young people considering medicine as a career? Germany will have a serious problem attracting talented doctors to their government-created hell - just wait.

2) The U.S. suffers under a "free market" system. Nonsense. The U.S. system is such a mess (wasteful and expensive) because the government has intervened in every nook and cranny - from the provision of Medicare/Medicaid, to the licensing of doctors, to heavily regulating drugs and devices, to a myriad of rules tying insurance companies in knots. The fact is, Mr. Reid failed to report on a capitalistic alternative because, sadly, none exists.

Have we not learned anything from the collapse of Soviet and Eastern European central planning? Central planning will eventually do to health care what it did to the Soviet economy and K-12 education in this country.

Mr. Reid mentioned that the U.S. is the richest nation on earth. Could this have anything to do with the fact that we're not paying the level of taxes other countries must levy in order to provide "free" health care for all? The inalienable rights we're supposed to hold dear in this country are life, liberty, and property - not free health care.

Kevin Duffy
Houston, Texas

Dear FRONTLINE,

As I read the reactions here to "Sick around the world" I realized that your respondents didn't understand the question you posed.

The program does not offer a solution for the U.S. per se, it simply says that other industrialized people have found a way to deliver health care to themselves more cheaply and more effectively measured by national outcomes than the U.S. has. And then prompts U.S. citizens to examine ways that they could deliver the same for themselves. The documentary made no attempt to go beyond that to answer in depth administrative complexities.

I think Americans have to answer three questions to themselves negatively before the discussion can continue and go deeper into how best to deliver health care.1) Can you live in a society that leaves 47 million fellow citizens with no health coverage and 50 million with inadequate coverage?2) Do you want your country to accept the highest health cost in the world yet rank 37th in outcomes?3) Do you want to have your industrial base (and largest companies) bear a unfair burden of the high cost of health care rather than spreading the cost for all citizens to all citizens? Do you want to let other industrialized countries/competitors as a result have a 6% to 10% cost advantage in the global market?AS a corollary to 3) above; do you want to continue to chain workers to jobs they might want to leave because of non-transferable health insurance?

If your answer is 'no' to the three questions above, then you have to figure out how to fix it. "Sick around the world" was an excellent overview of some solutions that have been adopted elsewhere to manage citizen's health.

William Case
Ottawa, Ontario, Canada

Dear FRONTLINE,

What are the salaries of hospital supporting staff (nurses, nursing assistants, pharmacists..etc) compared to that of the united states? Thanks for looking into this subject...I believe insurance, medical technology and pharmaceutical companies contribute to at least 50% of our higher costs.

columbus, oh

FRONTLINE's editors respond:

Click here to read an interview about the high cost of the U.S. health care system.

Dear FRONTLINE,

Your Frontline program on health care systems in other countries was very interesting. I can see some definite advantages to a possible combination of approaches to improve US healthcare.

However, I felt that the program really didn't provide an adequate response to understand what levels of healthcare are being provided in each country's system. To what extent does each healthcare system go to preserve life or restore health? For example, if someone gets a rare form of cancer, how much resource does each health care system expend to preserve life or restore life? Do they expend "whatever it takes", or does each system have limits? For example, in the Swiss example with a "basic" plan that everyone participates in, what is the level of that "basic" care? What conditions are NOT covered by that health care?

I feel that Americans expect the health care system to do "whatever it costs", which drives up the cost of health care. Reality is, sometimes people have to make difficult decisions - and sometimes we can't treat it or can't make someone better in a cost effective manner. But so far, Americans seem to believe that we'll do everything and anything - no matter the cost. Making the decision to not treat something is something we don't like to face.

Could you provide an analysis of each county's willingness to live within healthcare limits and what those limits are?

Marion, IA

FRONTLINE's editors respond:

Read the extended interviews for this report for more detail on what benefits are covered in each country.