Dear FRONTLINE,

T. R., We knew each other in Tokyo 15 years ago. My recollection of the Japan healthcare system is not as favorable as portrayed in your excellent program. Doctors over-prescribe medications because they sell the drugs to patients and make a lot of money doing that. If you are 'somebody' you get excellent care. If you are not you get hustled through. You are not permitted to question a doctor, quite often not allowed to get second opinions. My Japanese friends tell me it is still that way. More than once in recent years I have been asked by Japanese to arrange medical appointiments in the US for individuals who have serious illnesses (I now live in Seattle). Birth control is discouraged because doctors make money on abortions. And so on. But I do respect you as a man of integrity and one of the best reporters I know, and hope all our political leaders read your book and watch the program.

Bill Franklin
Seattle, WA

Dear FRONTLINE,

Great program. Two points:

The routine denial of insurance coverage in the US due to a 'pre-existing condition' is more than a mere inconvenience or cost burden. It's a serious disincentive to sensible preventative care. Recently, I went to my doctor for a routine cholesterol test. I was told my liver enzymes were elevated, a possible indication of NASH, or Non-Alcoholic Steatohepatitis. Further tests confirmed that I have Fatty Liver, which should moderate if I lose weight and improve my diet.

These results are now part of my medical record, and make me a slightly elevated statistical risk for liver disease later in life. My doctor isn't worried - as long as I bet healthier, the matter should clear up.

In Canada, this won't affect my insurance coverage in any way. But in the US, a patient who inadvertently tested for Fatty Liver and/or NASH could well have their insurance coverage cancelled for a range of liver and endocrine problems, including cirrhosis.

The only way to avoid the possibility of contracting a 'pre-existing condition' is to avoid periodic physicals and medical tests. This makes no sense at all.

In public single-payer health care systems, there is no such disincentive to preventative care.

H. Hughes
Vancouver, BC , Canada

Dear FRONTLINE,

Cry me a river for the complaining medical students. U.S. physicians are a major contributor to the exorbitant cost of U.S. healthcare. Not only do physician fees account for 20% of healthcare, but physicians control nearly the remaining 80% of the remaining costs.

This "poor me" saw of medical student debt is a frequent refrain. A March 11, 2008 article in The Chronicle of Higher Education noted that the American Association of Medical Colleges and the American Medical Association had written a joint letter asking Congress to reverse the Department of Education's decision to end a program that has allowed new physician graduates to lower student loans and defer interest on their student-loan payments.

The article states that "in 2007 the average medical student graduated with $140,000 in debt, and the average first-year resident earned less than $45,000. Eliminating the provision, the letter warns, could discourage students from pursuing less-lucrative careers in medical education, research, public health, or primary medicine."

Give me a break. I borrowed $100,000 to earn a doctorate in healthcare administration (DBA-Healthcare) in September 2007 at the age of 57. I teach at a small college in Virginia, with four international campuses, where I earn $50,000 in base salary. I'd like to believe that what I am doing is working with the future healthcare leaders in the U.S. and around the world.

And I am not alone. There are many occupations where students have assumed substantial debt to earn terminal degrees. I personally cannot support carte blanche treatment of physicians who have been and continue to be bulwarks against universal healthcare in the U.S.

Let's replace the Neanderthal notion that physicians are "entitled" with one where physicians join equally skilled and indebted graduates who direct their time and talent to service to America.

Arlington, VA

Dear FRONTLINE,

Tom Reid has done a wonderful job of explaining health care systems in a way that the average viewer (non health care professional) can understand. What I think is most difficult to get across to the American public, is that due to the way we finance health care, what is delivered is often designed to meet the needs of the provider rather than the patient. Moreover, because we have relegated our health care to a market free for all, it has served to justify the class based bigotry that is now spreading to other institutions of American life. The resistance in our country to facing this situation, has fed a kind of cultural hubris, that has put us all at risk... For instance, we have public funding of policemen and firemen. Do we consider the NYPD to be socialized policemen? I also think we have rejected the notion of social goals, and as such are resistant to seeing our well being as part of a larger context. These are cultural values, that inhibit real healthcare reform. What brought national health care to Britain, was a war on their soil - a publicly observable, shared catastrophe. Let's hope we don't have to wait for that here...

Carole Bahou
New York, New York

Dear FRONTLINE,

When I lived on the West Bank (1991-2000), health care was available to all, without so much as a shekel if you didn't have the money. I sometimes wonder about this paradox. In the U.S. I can't get basic health insurance because it would cost me over $400/month (I'm over 60 and couldn't afford that), but in the West Bank I can walk into any clinic along with others and be seen and helped within a couple of hours, no questions asked.

Elaine Kelley
Portland, OR

Dear FRONTLINE,

Hello, first of all a very interesting program and many interesting comments to read. I would just like the comment on the issue of malpractice in other countries since I see a lot of Americans ask about this.

Here in Norway, and I believe it is the same in many other northern European countries you don't sue the doctor, nurse or surgeon directly for malpractice. You apply to what we call "Pasientskadenemda" which translates to something like "patient injury institute". Basically it is a government organ which pays you money if you were subject to malpractice. They will review if you are entitled or not. Usually it is standard procedure. It is obvious that you should be compensated. If it is not and you are denied payment you can sue them in court.

So basically physicians, nurses, surgeons etc are not sued personally in Norway. That doesn't mean there is no risk to them of course. They can be fired for negligence or have their license revoked.

Whether they can actually be sued in court or not personally I am not sure. It is simply not custom to do there. It is easier to simply apply for money from government. Since they provide the health care they are also essentially responsible for its outcome too.

As a side note I read that in Germany you don't sue the surgeon at a hospital for malpractice. You sue the hospital itself. Responsibility lies at the organizational level not the individual level.

Oslo, Norway

Dear FRONTLINE,

I think this show provided a good starting point for discussions on how to improve healthcare in the U.S. Some thoughts:

Employer based health care is a dinosaur in our present day economy. The average job lasts less than 5 years. Who can afford to pay premiums for personal plan or COBRA if there is a gap in employment? This actually discourages many possible entrepreneurs from taking risks to start their own business.

Why do people complain about taxes going up to pay for universal care? The average family insurance plan costs over $1000/mo. and doesn't cover all healthcare costs. It is also increasing nearly 10% per year. That equates to a 24% tax per year for a family making $50,000 per year and it doesn't include out of pocket expenses. The only way employers can reduce insurance costs passed on to employees is to provide cuts in coverage, which just means higher out of pocket costs for them.

Regarding malpractice costs, would a universal plan not include some type of cap on these costs for doctors. I believe that that is a sacrifice that would have to be made by patients to have universal care. Since the patient wouldn't be facing possible huge medical bills in the future, there would be no need to sue for future medical costs, thus reducing the need for malpractice.

Due to the dire need for doctors to care for our aging population, there should be free or greatly tuition for those that work in the system. They would have to accept lower salaries in return. More emphasis could be placed on educating and recruiting nurses, nurse practitioners and general practice physicians that can handle the bulk of health issues faced by patients.

The medical smart cards just make sense. With our aging population, we need a way to ensure that doctors don't have to rely on the memory of the patient for all meds taken and past health history. Also, the overhead costs saved from using a card and card reader versus massive file rooms and file clerks would be substantial. It would not take a huge education process to get the patients to use the cards and produce the cost savings. Most of us are used to using a card at the grocery store to get decent prices on food, why would it be so hard to do the same at the doctor's office.

J K
Knoxville, TN

Dear FRONTLINE,

Mr Reid,That was a fascinating, well done documentary. I appreciate the diverse backgrounds of the people you interviewed, and your choice of current healthcare systems to include. My hope for you (America as well)is that your poingnant prayer will be anwered after the next U.S. election.

I am an advanced-practice nurse in Denver currently working with Hospice/Palliative Care. I would be very interested to see a similar type story of how different countries view healthcare at the End of Life, and what are priorities in funding of the various systems throughout the world?

I also have one comment for the 1st year medical student from Baltimore. My AP nursing education cost me (and my colleagues) almost as much as you describe paying for medical school. Would you please find another shoulder to cry on, people do not enter the healthcare industry purely for financial gain. I am not advocating for MD's to be in debt, and surely they deserve a handsome salary-many hardworking americans would agree that a starting $80k/year is indeed "handsome". My exact sentiment goes to Hospital administrators and Insurance company executives, whom reportedly earn (on average) over $500k/year.

Denver, CO

Dear FRONTLINE,

I really enjoyed this program and I found it very informative on many things but as a nurse and part of the health care system I wonder what the effects are on nurses and other health care employees in these other countries. I am all for health care for everyone and I do think the US has some serious issues to be dealt with but I wish there was more information on other aspects of health care presented in this program. I also wish, as others have said, that there was more information on the treatments involved with long term health needs. Overall it was very interesting and topical but perhaps a second program answering more of these questions should be considered.

Portland, Maine

Dear FRONTLINE,

The program was a reasonable comparison of the U.S. system compared to other more socialized systems, however, at least in the case of Japan, the view presented was both accurate and incomplete.

I have lived in Japan for seven years and the nationalized health care system unquestionably delivers inexpensive access to competent medical care. This is principally accomplished by strictly managing cost and imposing very high opt out cost.

As an example of the opt out cost, under the Japanese system only treatment regimes authorized by the national system can be used. If a patient is being treated for leukemia and the approved regimes are not successful they may opt out for a newer treatment not yet approved by the national system, but the patient is then responsible for the entire cost of treatment based on the actual cost and not the national system's price scheme. Though this is critical to the economic viability of the system, the patient must accept significantly slower adaptation and access to new treatments for non-routine care as compared to patients in the United States.

Japan's deeply traditional medical community also significantly contributes to the low cost of care. The best example is organ donation and transplantation, which are virtually unheard of in Japan.

Perhaps the most incomplete part of the Japan system portion of the program was the lack of participation in municipal and community insurance schemes by "arubaito" - a growing percentage of the population that works in transient part-time positions without employer co-sponsored insurance premiums. Though extremely painful for the deeply egalitarian Japanese society, private providers have begun to deny services to such individuals that are not participating in the national system.

Ginowan City, Okinawa, Japan

Dear FRONTLINE,

The one theme that I see is universal health care. This seems to make sense because it focuses on preventive medicine. If an insurance company through your company will only have you for several years or you may move to another company with a different insurance plane what incentive is there for that insurance company to keep you healthy for the long term?

This is also an ethical issue. If you believe in the "sanctity of life" then why do people have to die from preventable diseases in a county with a GDP of 14 trillion dollars. For me the "sanctity of life" is just market mumbo jumbo to make this nation of Christian feel good about themselves.

Oakdale, MN

Dear FRONTLINE,

It is interesting to see a report on Japan by a man who had actually lived here in the past but yet went around relying on the statements of those with an interest in the system.

Mr. Reid missed a lot about the healthcare system that he could have learned by simply picking up an English language newspaper here (or better, a Japanese paper.) Many are free online now.

It is pretty well known that if a loved one has to undergo major surgery, that the family often pays a substantial amount to the doctor to ensure the best care. This is outside the system and it seems darn close to a bribe.

Mr. Reid has missed the recent scandals resulting from patients dying while in an ambulance and he crew is desperately calling around to hospitals trying to get one of those wonderful private clinics (gotta be generous to call most of them hospitals) to accept a critically ill patient. Reasons given by the "hospitals": understaffing, no doctor of the proper specialty, or even a fear that the patient may have a contagious disease! There is no law that says that a hospital must accept an emergency patient.

The insurance premiums are much, much cheaper than in the US, but they is rising and have been for years---even when Mr. Reid was here. Did he not know that? As the population ages, the problem is going to get much more serious. The systems so popular they have to preserve it? The question is how is that possible? The government seems to have no answers, but Mr. Reid did not even do enough research to ask the question.

Child care? There is a critical shortage of pediatricians in Japan now due to the horribly long working hours required and the relatively low pay does not help.

Malpractice? Trick question. How many physicians in Japan have lost their licenses due to malpractice? 1000? 100? 10? 1? Well, my information is a few years old, but I'd pick between 1 and 0.

How do physicians' qualifications compare to those of the US? I guess since the government stats show show good results we ought not worry about it, but since I use the system, I know enough to be concerned.

The Japanese health care system has many good points, but it is in trouble. It is not a model for the US.

David Huff
Tokyo, Japan

Dear FRONTLINE,

As an American living in Germany, I see the health care system here in a great light. In the US I lived for about 4 years after college without health insurance because I could not afford the $400 monthly premium (in NJ). Then when I did break down and get some (now in Mass) it cost me over $200 a month just for catastrophic care with astronomical copays and a pay ceiling. Luckily I did not get in an accident of really sick during those years.

As a freelance journalist in Germany, get this, the government pays the employer's half of my healthcare bill. So for under 200 euros a month I am completely covered with health, dental etc. And yes, they did pay for my yoga classes last year!

Now to answer the question in everyone's mind: I do pay more taxes here than I would in the US, but the difference is not astronomical.

As Reid reported the system is not perfect and is especially unfair on its doctors. They are overworked and underpaid. I know three doctors who have left Germany to work less hours for more pay in Norway and Finland.

Ole Tangen
Bonn, Germany

Dear FRONTLINE,

I am a first year medical student and I am watching this show in some degree of fear and anxiety. By the time I graduate, I will have accumulated over $150,000 in debt from both medical school and undergraduate. While my friends were partying in high school and college, I was stuck in a library studying for exams. Right now, as my friends are making $70,000 I am taking on $30,000 dollars of debt per year and working just as hard as they are.

When I am in residency, I will be making below minium wage for the duration of my training because of the 40,000 per year residents get paid and the 80 hour workweek we must endure. I am not a greedy person, but there is no way that I would accept working as a physician after all of this for 80,000 a year.

People talk about compassion and the physician's duty, but they forget that duty cuts both ways. The population at large can't expect physicians to work so hard and make little so that they can enjoy more of their money.

There is a looming shortage of physicians in this country which will simply be worsened by cutting physician reimbursements. I know that I and many of my friends are now considering careers in finance and research. Certainly, no one wants to go into primary care, which is least paid but most needed type of physician. Please remember in your efforts for health care reform that doctors ultimately must buy into your system or else its an empty pipe dream.

John Michaels
Baltimore, MD

Dear FRONTLINE,

Taiwan is part of China~~please do not refer to it as a nation or a country!!!

lesley smith
beijing, china