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Social science tells us that a demonstration effect occurs when people change their behavior by observing the behavior of others - and the outcomes they produce.

The demonstration effect is applicable to many fields of study, from tourists to civil rights, but the author and journalist T.R. Reid thinks it may be the key to solving America's health care crisis.

Consider this. Health care reform has been on the agenda of American presidents since Woodrow Wilson, but only a few have succeeded, and those successes have been limited.

The latest effort, by the Obama administration and a Democratic-controlled Congress, seems stunted as of late.

Despite failure at the federal level, though, some states have moved ahead with universal care for their citizens. And more states are following.

That's the demonstration effect at work.

What if, Reid said Tuesday to a large crowd at St. Patrick Hospital, a mainstream state such as Montana provided all its citizens with health care coverage?

"I think that's how we're going to get to universal coverage," said Reid, who described such coverage as a moral imperative for a rich nation like the United States.

Reid is a former foreign correspondent for the Washington Post and author of the book, "The Healing of America: A Global Quest for Better, Cheaper and Fairer Health Care."

That book examined health care systems in the world's most prosperous democracies and found the United States sorely lacking.

Reid spoke Monday night about what's wrong with America's system. On Tuesday, he focused on the likelihood of reform.

"I'm not an optimist about it," Reid said, noting the considerable headwinds posed by a Congress tied deeply to a health care industry with plenty of money to spend.

That said, Reid evidenced some optimism that the American people might be able to reform health care without the assistance of Congress.

"Come on, if France can do it, the United States can do it," Reid said.

As evidence, Reid told a couple of stories, one involving the demonstration effect, the other outrage, pure and simple.

***

Back in the 1940s, a man named Tommy Douglas became the premier of Saskatchewan. Douglas was a socialist. He was also a man who thought it unconscionable that citizens of his province might not be able to go to the doctor.

Douglas then set up a province-run health care system funded by a premium paid by the citizenry.

"It's not a tax, it's a premium," Reid noted wryly.

Not surprisingly, doctors in Saskatchewan abhorred the new plan and promptly went on strike.

Douglas struck back.

"He called them scandalous plutocrats," Reid said.

Five days later, the doctors went back to work.

Fourteen years later, Canadians, convinced by the popularity and effectiveness of Douglas' provincial program, passed national health care.

The name of the Douglas program? Medicare.

Not long after Canada approved health care for all, the U.S. Congress passed President Lyndon B. Johnson's effort at health care reform. The plan covered the elderly. The program's name?

Medicare.

And who did Canadians vote for when they had the chance to name the most famous Canadian in a 2004 national poll?

Wayne Gretzsky? Pierre Trudeau? Nope.

Tommy Douglas.

Reid said the Canadian system is not perfect, and one of the complaints is long waits for elective procedures. But, he said, a Canadian doctor told him recently that even the wait is acceptable.

"We don't really mind the wait as long as a rich Canadian and a poor Canadian have to wait for the same time," the man told Reid.

***

During a question and answer session, Reid launched into another story, this one involving Switzerland.

Although the country has but a fragment of America's population, the countries are similar in their aggressive approach to capitalism and the inextricable link of money to the Swiss electoral process.

"They have big insurance companies and big drug companies," Reid said.

Those insurance companies had, in fact, studied American insurance companies to glean the secrets of their financial success.

Which, at least in part, turned out to be denying coverage to those who'd been sick and denying the insurance claims of those who were supposedly covered.

When the Swiss learned that 5 percent of the country's citizens weren't covered by insurance, the health care system was overturned.

"That 5 percent was a national scandal," Reid said. "Can you imagine that?"

The Swiss overhaul, which required all insurance companies to offer basic insurance to all, was led by the activist-politician Ruth Dreifuss, who later became the first female president of Switzerland, Reid said.

***

T.R. Reid called himself a pessimist, but he narrowed the scope of his pessimism.

He cited a failure to lead on behalf of the Obama administration, weakness in congressional Democrats and the just-say-no attitude of congressional Republicans. But he also noted something in the outlook of Americans.

In recent surveys, Reid said, 65 percent of Americans have said we are a country in decline.

Similar percentages have said life will be harder for coming generations.

"If you believe all that, then you are afraid of change," Reid said. "We are scared of big, systematic change. I do think that's what's doing this."

Still, Reid said, effecting change on a smaller scale may not seem as daunting. That's why he's sees promise in health care systems run by places like Massachusetts, Vermont and Maryland.

"Why don't you talk to (Gov.) Schweitzer about this?" Reid said with a smile and a knowing nod toward the legacy of the greatest Canadian. "He could be the greatest American in history."

Reporter Michael Moore can be reached at 523-5252 or at mmoore@missoulian.com.

 

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