The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care
By T.R. Reid
Hardcover, 288 pages, $25.95
The Penguin Press: New York
August 2009
Last Sunday I reviewed, T.R. Reid's, The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care, a sort of healthcare travelogue from the patient's perspective, with a great deal of non-wonky systems analysis thrown in. I also conducted an e-mail interview with Mr. Reid, which is presented below.
Unfortunately, the interview was done before Kent Conrad's rather bizarre interpretation of the book, from which (he told "his progressive friends) he learned that "they're not government-run systems in Germany, in Japan, in Switzerland, in France, in Belgium -- all of them contain costs, have universal coverage, have very high quality care and yet are not government-run systems," which would be news to the citizens of France and Japan, at the very least. Steve Benen has a good review of blogospheric reaction to this assertion, but like him, my favorite is Kevin Drum's:
This has been sort of rattling around in my head ever since I saw it, but I couldn't quite put my finger on what I wanted to say about it. But then I figured it out: it's completely, 100% batshit crazy.
Senator Conrad might have been the only reader of the book to come away with that lesson from Mr. Reid's book. As of yet, I haven't seen a public response from the author. Which is a shame, because I'm pretty sure it would be entertaining.
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Joan McCarter: The strongest theme in your book is the moral case for universal health care, and how that moral question provides the basis for the universal healthcare systems in all the developed nations you wrote about. Do you think there's a fundamental difference in the American national character with that of France, or Sweden, or Germany or any other country? Or are our leaders missing the boat by not galvanizing the American people behind that moral argument?
T.R. Reid: In my book, I review how each of the industrialized democracies got to universal coverage. In every case, it started with a moral decision -- that a rich nation has an obligation to provide health care for everybody who needs it. In all the other countries, they first committed to that goal, and then found a mechanism to get there. In our country, the moral argument always gets lost amid the noise about details: insurance company employment levels, hospital reimbursement rates, malpractice premiums, etc.
My book shows that each country needed a leader to keep the moral consideration foremost. I concluded that that's the way to achieve universal coverage in the U.S. as well.
JM: You focused primarily on Canada, Great Britain, France, Germany, Switzerland, Taiwan and Japan. Why?
TRR: I wanted to look at countries like us: advanced, industrialised, free-market democracies. All those countries are just as committed as we are to individual liberty, private property, and free markets. But all of them provide high-quality universal coverage at reasonable cost. Cuba won't be a model for the US, so I didn't go there.
Plus, I wanted to visit examples of each of the four models of health care I found around the world. Plus, Britain and Japan were natural destinations, because my American family had lived in those countries and used the health care systems. Also, I could speak the language pretty well in Japan, and fairly well in the UK (though I had trouble sussing out the boffins when they were chuntering rumbunctiously).
JM: You make a startling comparison in the book between 9/11 and the American healthcare system, that should really help crystallize the debate over healthcare reform.
TRR: On Sept. 11, 2001, some 3,000 Americans were killed by terrorists. We have spent hundreds of billions of dollars to make sure that doesn't happen again. But that same year, according to gov't. and private studies, more than 20,000 Americans died of treatable diseases because they could not afford medical care. And every year since, we have let 20,000 of our neighbors die because they can't obtain medical care in the richest country on earth.
Other rich countries have also lost people due to terrorist attacks, But no other industrialized democracy lets people die for lack of access to health care. That's a "uniquely American" tragedy, to use Max Baucus' phrase.
JM: In the book, you start with the story of Nikki White, a young woman who died from complications of lupus as a result of being denied insurance coverage, and you come back to it throughout. Can you explain a little bit why this story is such a prototypical example of what's wrong with the American system?
TRR: Nikki White was a 32-year-old college grad who died of a treatable disease because she couldn't afford health care. She had too much money to get treated under welfare, but too little to pay for the drugs and care that would have kept her alive. A tragedy -- but the bigger tragedy is, Nikki is not alone.
As noted above, government and private studies say more than 20,000 Americans die each year of treatable diseases, because they can't afford care. These Americans tend to be working people with a chronic illness who lose their jobs, and thus their insurance --and can no longer get the treatment that would keep them alive. As noted, no other rich country lets that happen.
JM: At the end of Nikki White's life--and after many insurance denials--she got the care she needed, too late. Do you have any idea how much those extraordinary, last ditch measures to save her cost?
TRR: The local hospital in NE Tennessee says it gave Nikki about $900,000 worth of care, uncompensated, after she was admitted in a critical state. For 1/100th of that amount per year, she could have received the routine treatment and drug regimen that would have kept her healthy.
JM: Instead of a moral argument for healthcare reform, we hear from policy makers the economic argument for healthcare reform that it can't cost too much, so we might not be able to actually reach universal coverage because it'll cost too much. You argue that universal coverage is essential for controlling increases in medical costs. Why?
TRR: We know this is true because all the other rich democracies cover everybody, but spend about half as much as we do on health care.
One reason is that it's much, much cheaper to treat common ailments in a doctor's office, early, than to wait until they condition requires hugely expensive intervention in an emergency ward. In Europe, no emergency room has to admit a young woman who is 7 cm. dilated but has never seen a doctor during her pregnancy. Those emergency pregnancies are common in the U.S., and cost our system millions of dollars each.
Beyond that, if everybody is in the system, then the system has both the economic clout and political will to impose strict cost controls. I show this repeatedly in my book. Foreign docs and hospitals perform the same procedure for 1/10 the cost in the U.S. The doctors have to do that, because there's only one system setting the prices. And people are more willing to put up with cost restraints, because the money saved will go to help another sick person. In the U.S., cost controls are likely to do nothing more than pad the bottom line of a for-profit insurance company.
JM: None of the proposals before us provide that unified system. In light of that, do you think that Barack Obama will be able to fulfill his goal of being the "last president" to deal with healthcare reform?
TRR: The proposals currently floating around Washington are largely tinkering at the margins of the most expensive and most unfair health care system in the developed world. My research for the book showed me that we can provide universal coverage at reasonable cost --after all, the other countries like us all do it --but we are not going to get there with the current plans in Congress.
I think it is possible we will get to universal coverage through state-by-state reform efforts. In my book, I found some other nations that did it that way.