If America wants to revamp its ailing health care system, it has many models to choose from around the world -- and other countries do it better because they have one system for all citizens, writer T.R. Reid told a health forum in Helena on Thursday.

"The fundamental difference between us and others is that they have decided on one model, and everybody's in it," he said. "I asked why, and they had two answers: It's so much cheaper and they think it's fairer.

"All of them have decided that it's fairer if everyone has the same access to the same care for the same price -- in the same sense that everybody gets one vote, everybody is entitled to a free public education."

Reid, a National Public Radio commentator and former Washington Post reporter who's writing a book on health care systems around the world, was the keynote speaker at the two-day Montana Healthcare Forum in Helena.

He told the 250 forum participants that America needs to fix its health care system, and should look to other countries for what works and what doesn't.

Reid said the United States is the only developed country that allows its citizens to go bankrupt because of medical bills and that has thousands of people dying every year from treatable diseases because those people can't see or pay for a doctor.

"These are our neighbors, in the richest country in the world," he said. "I just don't think that's acceptable. If we make the moral commitment to provide health care for everybody, there are a lot of models in other countries who can teach us how to do it."

Reid, who has lived in Japan and Great Britain, said his family received great, affordable care in both countries.

Health-care systems in other countries follow one of three basic models, Reid said:

n National health insurance, in which government-funded, taxpayer-supported insurance covers all citizens and pays private doctors and hospitals that provide the care. Canada and South Korea are among the countries using this system.

n The "Beveridge" model, which is the purest form of socialized medicine, where the national government employs physicians, owns the hospitals and offers taxpayer-supported care for free to all citizens. This model exists in Great Britain, Spain, Italy and New Zealand, among others. It is named for Lord William Beveridge, the British economist who proposed Britain's national health service in the 1940s.

n The "Bismarck" model, in which health insurance is offered through one's employer, and the cost is split between the employer and the worker. Unlike in the United States, countries using this model tightly control insurance markets and profits, and make sure people who are poor or without a job can still buy insurance. It's named for Otto von Bismarck, the first chancellor of united Germany, who developed it in the 1880s.

The other "system" is no system at all, which exists in most countries in the world, Reid said: "If you have money, you get treated. If you don't have money, you stay sick and you die."

Reid said while U.S. political figures sometimes criticize these other health systems as foreign or "un-American," they really aren't, because the United States has versions of all four.

Medicare is a national health insurance for the elderly; the Veterans Administration health care for military veterans is a Beveridge system; the Bismarck system is used for many Americans; and millions of Americans without insurance or much money are essentially living in a Third World country when it comes to health care, Reid said.

Having one system would cut costs incredibly, he said, because it would eliminate the "crazy quilt of administrative nonsense" that exists with the United States' multiple approaches.

America's fractured system also discourages preventive care, he said.

The average American, in a lifetime, is covered by six or seven different insurers, ending with Medicare, Reid said. It's not in the financial interest of private insurance companies to pay a lot for preventive care, because that person usually moves on to another insurer.

"By the time you get badly sick, you're Medicare's problem," he said.

But in countries that have one system that covers everybody, they want to keep you healthy, because it saves the overall system money in the long run, Reid said.

He recalled something the British health minister once told him: "From the minute the line turns blue on your mother's pregnancy test, to when you die, you're my patient. Don't you think I want to keep you healthy?"

Health forum recommendations

The Montana Healthcare Forum is recommending several concrete proposals to expand and improve health care in Montana. Here are some of its recommendations:

- Implement and fund Initiative 155, which expands government-funded health insurance for children in Montana. Voters approved it this month by a 70-30 margin and Gov. Brian Schweitzer has included $20 million a year in his proposed budget for 2009 and 2010. I-155 can't be implemented without approval by the 2009 Legislature.

- Increase funding for Insure Montana by $11 million the next two years, to clear the waiting list for this program that helps subsidize health insurance purchased by small business for its employees.

- Increase by $8 million the funding for the Montana Comprehensive Health Association, which offers health insurance for 'high risk' people with health problems.

- Expand state funding for community health-care clinics, increasing it from $650,000 to $2 million a year. The clinics provide primary, basic health care to many who are uninsured or have trouble affording care.

- Fund a $1.5 million proposal to begin developing a statewide health-care data base, which can exchange information between providers and others across the state.

- Create a pool of state funds to help repay college loans of people who take health-care jobs in underserved, rural areas of Montana.

- Have Montana hospitals put their prices on the Internet starting next year.

Reporter Mike Dennison: 447-4068 or mike.dennison@lee.net