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
On September 11, 2001, some three thousand Americans were killed by terrorists; our country has spent hundreds of billions of dollars to make sure it doesn't happen again. But that same year, and every year since then, some twenty thousand Americans died because they couldn't get health care. That doesn't happen in any other developed country. Hundreds of thousands of Americans go bankrupt every year because of medical bills. That doesn't happen in any other developed country, either.
Since T.R. Reid wrote those words in the prologue to his new book, the picture has gotten even bleaker, with a new study from the Harvard Medical School putting the number of lives lost at 45,000 a year--one every 12 minutes--from lack of insurance. Which makes this critical book from Mr. Reid all the more important for activists, concerned citizens, healthcare providers, and most critically, policy-makers.
In his book, Reid embarks on what he calls "a quest for two cures," one for a bum shoulder that has bothered him for years, causing pain and curtailing some activities, and a second for a fatally flawed American health system. Using his shoulder as a means of entree into the healthcare systems of some of the worlds other industrialized nations, Reid gives in-depth (and totally accessible) descriptions of those systems. We see how it'd done in the French, Canadian, German, Japanese, and British systems, along with descriptions of the recently implemented Swedish and Taiwanese systems. You don't necessarily realize it while you're reading, but you're taking Comparative Health Economics 101. With a really fun professor.
You learn that there are four basic models of national healthcare delivery at use in the industrialized world: The Bismarck model, named for Germany's Otto von Bismarck, a private system in which the government shapes the rules of the market, but insurers and providers are private actors. The Beveridge model, named for England's William Beveridge, is a socialized system--the government owns the hospitals and the medical professionals are all employed by the government. The National Health Insurance model, or single-payer, is sort of a hybrid of Bismarck and Beveridge in which the government is the insurer, but the doctors and hospitals are private. None of these systems is perfect, and all struggle with keeping costs under control. But none of them let people die for the simple reason that they can't pay.
Then there's the fourth model, the Out of Pocket model, which is what the U.S. as well as the whole rest of the world--primarily developing nations--has. You can get health services if you can afford to buy them. It's a model that no other developed nation has followed. Every other developed country has made the fundamental moral decision that healthcare is a basic right for its citizens, and each has achieved universal coverage. Reid doesn't really try to answer the basic question of what is lacking on the moral character of the U.S. to leave us out of the club, but that's not a deficiency in the book, nor was it his job. He's not an ethicist, but a reporter.
His reporting, thus, is geared toward describing how it can be done. To his credit, he keeps the discussion outside of the current battles and American political debate, and systematically advances that debate by debunking the most pernicious and pervasive American myths about healthcare systems overseas, myths that he also addressed in a Washington Post article:
- It's all socialized medicine out there.
Not so. Some countries, such as Britain, New Zealand and Cuba, do provide health care in government hospitals, with the government paying the bills. Others -- for instance, Canada and Taiwan -- rely on private-sector providers, paid for by government-run insurance. But many wealthy countries -- including Germany, the Netherlands, Japan and Switzerland -- provide universal coverage using private doctors, private hospitals and private insurance plans....
- Overseas, care is rationed through limited choices or long lines.
Generally, no. Germans can sign up for any of the nation's 200 private health insurance plans -- a broader choice than any American has. If a German doesn't like her insurance company, she can switch to another, with no increase in premium. The Swiss, too, can choose any insurance plan in the country.
In France and Japan, you don't get a choice of insurance provider; you have to use the one designated for your company or your industry. But patients can go to any doctor, any hospital, any traditional healer....
As for those notorious waiting lists, some countries are indeed plagued by them. Canada makes patients wait weeks or months for nonemergency care, as a way to keep costs down. But studies by the Commonwealth Fund and others report that many nations -- Germany, Britain, Austria -- outperform the United States on measures such as waiting times for appointments and for elective surgeries.
- Foreign health-care systems are inefficient, bloated bureaucracies.
Much less so than here. It may seem to Americans that U.S.-style free enterprise -- private-sector, for-profit health insurance -- is naturally the most cost-effective way to pay for health care. But in fact, all the other payment systems are more efficient than ours....
- Cost controls stifle innovation.
False. The United States is home to groundbreaking medical research, but so are other countries with much lower cost structures. Any American who's had a hip or knee replacement is standing on French innovation. Deep-brain stimulation to treat depression is a Canadian breakthrough. Many of the wonder drugs promoted endlessly on American television, including Viagra, come from British, Swiss or Japanese labs....
- Health insurance has to be cruel.
Not really. American health insurance companies routinely reject applicants with a "preexisting condition" -- precisely the people most likely to need the insurers' service. They employ armies of adjusters to deny claims. If a customer is hit by a truck and faces big medical bills, the insurer's "rescission department" digs through the records looking for grounds to cancel the policy, often while the victim is still in the hospital. The companies say they have to do this stuff to survive in a tough business....
The final myth debunked in the book: "Those system are too foreign to work in the USA." American exceptionalism often leads to this argument. We're different, we have to find our own path. The trouble is, all four models of healthcare delivery are alive and well within the U.S. today. The British model covers veterans, active-duty military personnel, and Native Americans. The Canadian model covers all of our seniors. People who have employer-provided insurance are just like those in Germany and Japan. As Reid says, "Of course the foreign models could work for Americans; they already do."
There's another myth that underlies the entire debate, as well as Reid's book; the U.S. has the best healthcare in the world. We have got the makings of it; the best medical education, the most advanced technology, outstanding hospitals, and cutting-edge research. All of the components for achieving that goal are here, in our hands. But until the day when no American dies because of a lack of health insurance, we're nowhere near best in the world.
That's Reid's basic message. He's shown more than one path to getting there, including the most critical one: making that moral decision that healthcare is a right. Until our leaders make that decision, every single one of those deaths--one every 12 minutes--is on their hands. This book should be required reading for each and every one of those leaders.