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FL: You say that the United States uses all four models, depending on your demographic. Veterans Administration hospitals use the Beveridge Model. Americans who get insurance through work are in the Bismarck Model. Americans over 65 on Medicare are in National Health Insurance Model. And the 40 million Americans without insurance are in the Out of Pocket Model. How did we get to this point?

TRR: Nobody planned our system. Nobody would have planned our system. It's completely undesigned, it happened by accident and along the way. I think the biggest change came in the '70s and '80s when for-profit insurance companies like Aetna, Wellpoint, United Health started buying up non-profit health insurers like Blue Cross and Blue Shield and converted them to for-profit. And once your health insurance system is for profit, well then obviously they don't want to cover anybody who might be sick. And they hire lots of underwriters to deny claims.

That's really what distinguishes the American insurance system from other countries. In other countries, they cover everybody and they pay every claim. They usually have to pay every claim in a matter of days or a week or two at the most. American health insurance companies turn down ... some say 30 percent of claims the first time, but they turn down a lot of claims. And they often take two months or more to pay the claims.

When health insurance was created in America, the initial Blue Cross and Blue Shields were all nonprofits, but once the insurance industry converted them to for profit, then we started to get the pattern we have now. The result of it is that 40-some million American can't get any insurance, and a lot of other people who have insurance find that it doesn't really pay the bills. For tens of millions of Americans the term is "underinsured"—they think they have insurance but if they have a serious ailment, then the insurance conks out.

FL: I think I had that insurance when I graduated from college.

TRR:
When you're young and healthy, that makes sense—except if you get hit by a truck, then somebody, probably your parents, is stuck with the million-dollar bill. And nobody wants to do that to their family. And you don't know it, who read the fine print on page 38 of their insurance policy? Nobody does. You don't know until it's too late that they have built in a mechanism to cut you off. And in other countries they're not allowed to do that. Nobody would even dream of it.

FL: Are you hopeful that healthcare reform is still possible in America?

TRR: I think a bill will pass in Washington, and it will definitely be better than what we have now. Congress is now willing to regulate the private insurers in ways they've never done before. And that's all going to make things better. But no, we're not going to reach the goal that all the other rich countries have arrived at, which is universal coverage at a reasonable cost.

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