Dear FRONTLINE,

It is clear that our current health care system is not serving our citizens very well - unless they hapen to have a decent supply of money. Change will be difficult but we need to take care of our own with no exceptions. The issue of malpractice insurance is not as straightforward and those who complain about it would have you believe. In 2001 and 2002 I lived in AZ and recall a report on NPR regarding the loss of obstetricians from neighboring Nevada. The cause was extremely high malpractice insurance. The insurance companies blamed the high cost of lawsuits but investigative reporting found that the actual cost of lawsuits was relatively small. The real reason the insurance companies were hurting was that they lost big time in their stock and real estate investments. A few years later I heard a similar tale from Colorado. Sadly, our country is overburdened with a lot of phony, self-serving assertions all the way from main street to the highest levels of government.

T Larson
Helena, MT

Dear FRONTLINE,

I was born in the UK, emigrated to Australia, and now (having married a US citizen) live in the USA.

I do not know what changes have taken place in Australia since I left, but an Australian businessman to whom I spoke a couple of years ago was horrified at the amount we are paying for health insurance. In Australia it is no more than 2.5% of taxable income, so those without income are covered automatically. It's a mixed system, with the government-run plan covering basic health care and many private insurance companies offering upgrades (everybody has to choose one of these). The 2.5% levy covers both the basic and the upgrade.

It's even longer since I lived in UK, so I don't know all the details of how it works currently, but we experienced the system ourselves while visiting with a young child, and we saw how it worked for my parents in the final years of their lives. Our infant son developed a high fever one Sunday, and the on-call GP came to the house on Sunday evening -- no charge. The normal prescription charge was waived because the patient was less than 12 months old. (And way back it used to be that even over-the-counter medication was covered by the NHS. I don't know whether that is still the case, and the prescription charge is much higher these days anyway.)

My parents lived in their own home to the very end. Doctors and nurses made house calls. The normal prescription charges were waived because of their age. The ambulance service transported them to hospital when necessary -- no charge. (They also got an allowance to pay a part-time home help, with no account being taken of their income or assets.)

It's true that the tax rate is higher in UK and Australia than in the USA, but if you add up taxes and health insurance premiums in the USA, I think the Brits and Aussies get a better deal.

Zeeland, Michigan

Dear FRONTLINE,

Changing our healthcare system will by no means be easy when there are so many private for-profit interests involved, everyone from pharmaceutical companies, medical device makers, medical supply companies, insurance companies, hospitals, health care providers, lawyers, etc.

Reform will be stifled as long as each of these concerns have as their first priority "how much money can I make" versus "how can we make sure no one is denied health care".

Neither are consumers innocent. When insurance premiums were more affordable, it was easy to be unconcerned about how much health care was costing and not to question unnecessary procedures.

We all need to play a part in fixing our system. I volunteered as a physician in a free neighborhood clinic here after Katrina; several things became crystal clear: 1) more than 80% of the patients needed only low-tech primary care 2) they needed ACCESS to nearby, convenient, low-cost facilities 3) most of them were coming in for problems related to diabetes and hypertension, conditions and cases that were very preventible. Many of these patients merely been heavily medicated over the long-term instead of being encouraged to reduce their own symptoms and need for medication

We can all do things to stay more healthy and reduce our need for expensive care and we all better be ready to pay higher taxes for a fairer medical system where everyone gets care. Or stay with our current black hole of a system and be ready to go bankrupt paying medical bills.

Dr. Lexa Lee
New Orleans, LA

Dear FRONTLINE,

While I found this program interesting and instructive, I found the interviews with healthcare experts on the FRONTLINE website even more valuable. Our ability to improve healthcare in the U.S. largely depends on two cultural factors which are difficult to change: social consensus and political will. In a mature democracy like ours, it is hard to say which of these is the horse and which the cart. As we have learned ( too often the hard way ) as a consequence of our ballot initiative process in California, the electorate is in favor of many progressive ideas, but unwilling to pay for them. Until we truly reach the conclusion that universal access to affordable healthcare is something that we as a society insist on and are willing to pay the price for, it will be nearly impossible to move forward. No current political leadership exists that is willing to enact meaningful healthcare reform that runs counter to public sentiment. And public sentiment on this has typically been expressed as "Yes, everyone should have access to healthcare, but, no, I'm not willing to pay for anyone else's." I think that the clarification of terms that Uwe Reinhardt urges in his FRONTLINE interview must be understood by a broader audience. The distinction between a system of socialized insurance as opposed to socialized medicine is a critical one. Letting the government regulate coverage and payment, but not "own" the providers, might be the approach that can work. However, the first step is for the government to realize that providers cannot be reimbursed less than their actual costs of delivering care if the system is to be sustainable. In this respect, Medicare and Medicaid are glaring examples of how not to do things.

Gerald Arcuri
Thousand Oaks, California

Dear FRONTLINE,

Thank you for this show. As an Certified Elder Law Attorney, I found it interesting that nothing was mentioned regarding the provision and payment for long term care in any of the countries. Another show comparing countries on that topic would be appreciated as well.

Leslie Wizelman
Towanda, PA

Dear FRONTLINE,

I am a Briton who has lived in the US for two years. We are very fortunate in that we have excellent health insurance at a cost that is much less than our UK tax. We have received excellent care here and it has made me question the NHS. For a start, not all hospitals are as nice as the one shown--the show picked one of the best and it's far from the average. Your program showed preventive care brochures in a GP office and then stated that prevention is practiced? Not correct.

For example, I am 42 and never once had a full check-up in the UK. It's not done-not for sports, for university, pregnancy, etc. A nurse does a pap smear every 1-5 years but there is never a doctor check--even when pregnant (that is handled by midwives). When I had my children I was monitored by a midwife--no doctor--and I was on a ward with a dozen women. I also never had a blood test or any health check-until I moved here. Turns out I have a thyroid condition for which I now receive treatment. The asthma my son suffered with is no also gone--because the NHS baseline treatment did not work for him. Yes, the NHS has one prescribed care treatment for each ailment--the cheapest option is the only approved option.

My best friend waited over a year for gallballder surgery and had to quit work as she was too sick to continue. She and her husband finally paid to have the surgery at a private hospital and the $60K in bills have forced them to sell their home. All to keep her from suffering. Yes, sadly this happens in the US, too, but in the UK the system she pays into is supposed to help her.

The Frontline program, like so many others, is the type of expose that we need in order to see change in the US. I don't recall hearing one key item mentioned: it is only in the US and New Zealand that allows pharma companies to advertise. How do we stop that?

The US system definitely needs help, but please show more of the truth about the rest of the world when trying to help with change.

Jennifer Andreson
Philadelphia, PA

Dear FRONTLINE,

I am a naturalized citizen, originally from Western Europe, and have lived in the US legally for 18 years. I love it here. I am 35. The only 2 reasons why I ever think of moving back to Europe are the questions: "What will happen to me if I get really sick?" and "What will happen to me when I get old?" Although still young, that worries me a lot. Thanks for the program. And I will still take advantage of universal coverage while visiting my family overseas.

Chicago, IL

Dear FRONTLINE,

While I support universal healthcare (the stated goal of the producers of this program), I fear that this program added little to the current debate regarding how to provide universal healthcare in the US. While excessive administrative costs and relatively high doctor compensation are important differences between the US healthcare system and the healthcare systems in most other developed nations, there are at least three other major differences that are equally, if not more, important that the program failed to sufficiently address: first, our excessive use of expensive technology; second, providing expensive end-of-life care devoid of any cost-benefit analysis; and third, the high costs of our malpractice system (which results in both high malpractice insurance costs and redundant and unnecessary treatment). No serious discussion of the US healthcare system, and its differences with other systems in the developed world, can occur without meneangful consideration of these matters.

Corey Brown
Houston, Texas

Dear FRONTLINE,

One of the topics I blog about, as a former insurance executive, is health care. The difference between Taiwan's cost of overhead versus American's (2% and 22% respectively) is driven by the population's willingness to forego a great deal of privacy.

The business side of me took this favorably while the personal side of me responded in fear because I don't want Big Brother knowing about my every ailment and treatment. After all this information could be used against me in applying for a job or even to blackmail me if a hacker gains access to this marvelous, centralized goldmine of data.

After a few hard swallows and a night's sleep I've come to see it in a more favorable light. While you could say the business side of me won out (cutting 20% is attractive), actually my acceptance is more a matter of philosophy than the result of number crunching.

One of the reasons none of us wants our TRUE medical history known is that we are subjected to a system wherein insurers can deny us coverage based on our health. In the Taiwanese system (as indeed with all five of the systems covered in the program) there is no medical underwriting, therefore no denial of coverage.

The second reason I'm prepared to participate in such a program has to do with entering into a larger social contract. Look, NONE of us has perfect health, none of us descended from perfectly health people and our environment makes it difficult to maintain mental, physical and spiritual health. Participating in a universal program is sort of like entering the locker room in Junior High. I worried a bit about it that summer between six and seventh grades, but when I finally entered it, I saw that even the most popular, lively, shapely and otherwise other-worldly girls had pimples on their backs and mismatched undergarments - just like mine.

The more we share the less we have to fear and the better prepared our health care system will be to deal with the TRUE depth and breadth of health issues in the population.http://tamelarich.com/2008/04/16/sick-around-the-world-part-1-big-brother-watching/

Tamela Rich
Charlotte , NC

Dear FRONTLINE,

Thank you for such a comprehensive program on healthcare around the world. As a Registered Nurse and more importantly, a person with a chronic illness(MS) I am impacted by the lack of universal health care in our country. When I was first diagnosed, I had a good nursing job, with decent private insurance. As my illness progressed and working became difficult I learned what it's like to be a second class citizen in the healthcare world. Last year,I personally paid out $7,000, in medical costs, (medication, wheelchair). This year I lost my job. I have had to choose between buying medicine and paying monthly bills.

Why do we fund an insurgency in Iraq when basic health care is denied our own citizens?

Watching this program I wondered whether our country is too large for universal health care. All of the countries Mr. Reid visited are small, no bigger than one of our larger states.

Fixing problems in our huge country will be no easy task. And with the lobbying power of pharma and insurance companies I do not feel a new president will make much difference.

My last thought is this, with 46 million persons not getting basic preventative health care now, we're laying the foundation for lots of sick people who will need very expensive treatment in twenty years time.

Again thanks to PBS for this type of programming.

Susan Noonan
Wilmington, Delaware

Dear FRONTLINE,

I enjoyed your excellent program. As an Internal Medicine physician I am appalled at the expensive, unnecessary expenditures we have in the US.I have seen 90 year old patients get chemo, end-stage AIDS patients on dialysis, completely demented patients with multi-system organ failure in ICUs, etc. Are these things regulated in the other systems? The money we would save by limiting this sort of expensive, futile care could provide a lot of preventive services. I would be interested to see how the other countries deal with the examples I've given.

Janice Oliveri
farmington, CT

Dear FRONTLINE,

After the program concluded, we changed the channel to a commercial station, and were immediately hit with another "Ask your doctor about Ad Nauseum..." ad. It would have been useful if Mr. Reid could have included some information about how much drug companies spend on promotion in each of the countries he compared. Would the pharmaceutical companies be able to find enough cash to fund their R&D if they stopped running so many TV ads?

David Burkhart
Laurel, Maryland

FRONTLINE's editors respond:

Click here for more on the cost of drugs in other countries.

Dear FRONTLINE,

Mr Reid- please note that while the INDIRECT costs of medical malpractice litigation in the US are not a large percentage of total health care expenditures, the INDIRECT costs (ie defensive medicine) are extraordinarily large , many many billions of dollars ; estimates are that between 1/3 and 1/2 of all tests are ordered by doctors primarily for defensive reasons (ie to avoid lawsuits) not because they are indicated medically. I am glad you acknowledge that med mal reform is a sina qua non before any major health reform in the US (as well as addressing physician educational indebtedess, now routinely approaching a quarter of a million dollars for the majority of students (who attend private medical schools without state subsidies) - but do not underestimate the profound impact meaningful tort reform would have on 1) overall health care expeditures 2) enhanced and expedited compensation to ALL injured patients, not just high earners with a severely bad outcome, or 3) the income of the trial bar, the real impediment to medical tort litigation reform, and (as you accurately note) NOT physicians !

Washington, DC

Dear FRONTLINE,

Thank you for an outstanding report on the different health care systems. Living in Europe most of my life, especially in Germany, I can testify to their outstanding health care. It is upsetting to see that here in the US, Health Care does not seem to be a fundamental right. Insurances can decide which patients they accept and so can doctors, by choosing the insurance they accept.

An issue which was not addressed in Frontline is the fact that a lot of people in the US are overmedicated and a lot of procedures and/or surgeries that are performed are unneccessary and just a way to make money.

As long as our Health Care is a profitable business for insurances,doctors and the pharma industry, the system will not change.

Louisville, Kentucky

Dear FRONTLINE,

I found the program to be missing three key variables when comparing the United States to other countries. I wonder why Mr. Reid did not address illegal immigration; our litigation system and how lawsuits are handled in other countries; and America's poor diet choices and weight problem. All three of these have a huge impact on the price of medical services in our country and yet were not addressed. I feel that a true comparison cannot be made on just comparing population, billing/administrative costs, and medical salaries.

Steven Tesdahl
Spokane, WA