70. The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care by T.R. Reid
I wish I could force every member of Congress to read this book right now. It is an excellent fairly unbiased look at American health care compared to other mostly successful health care models from around the world. Reid makes no qualms about the fact that he thinks that American health care is broken and that it is a moral travesty that the United States does not provide universal health care coverage, something I am in complete agreement with. He however does not espouse any one model over another.
He begins the book with a look at how the American health care system currently stands and how we spend more on health care than almost any other developed nation in the world with much worse result and the reasons we have these issues.
He categorizes health care models into 4 types.
The Bismarck Model found in countries such as Germany, France, Japan, and Switzerland has both private providers and private payers with insurance plans usually financed jointly between employers and employees through a payroll deduction. This is similar to what we currently have in the United States with the major difference being that in these other countries the insurance companies are non-profit charities that are required to cover everyone.
The Beveridge Model found in Great Britain, Italy, Spain, and Hong Kong involves the government providing a health care system that is financed through tax payments. Most doctors are government employees working in government owned facilities. Americans use the Beveridge model to run health care through the U.S. Department of Veterans Affairs and the Indian Health Service, which provides government run health care for Native Americans.
The National Health Insurance Model found in countries such as Canada and Taiwan combines elements of the Beveridge and Bismarck models. The health care providers are private entities, but the payer is a government run insurance program that all citizens contribute to. This type of system is used in the United States for Medicare.
The Out-of-Pocket Model is found in the worlds poorer nations. Citizens of these countries have minimal access to health care and the health care they receive must be paid out of their own pockets. Thus generally the only the rich are able to receive medical treatments. For millions of Americans who cannot afford health care or who have been denied access to health care by insurance companies, the out-of-pocket model is the health care system they are living under.
As is evidenced in the previous descriptions the American health care system combines elements of all the major health care models, which Reid claims is part of the problem. Too much overhead and administrative costs go into reconciling all these different forms of health care causing many of our high health care costs.
Much of the book is spent visiting countries who use each of these models in their health care systems. Reid has an issue with his shoulder that he gets looked at in the U.S., France, Germany, Japan, the United Kingdom, Canada, and India. For each country he describes their health care system, the history and culture of the country that led it to the system it currently employs, and his own personal experience as a patient in that country. He is blatantly honest about the benefits and drawbacks of each model. His main point is that no system is perfect and pretty much every system is dealing with rising health care costs, but that of the systems running in the developed nations all of them are doing better than the U.S.
By the end of the book Reid seems much more optimistic than I am about being able to enact meaningful health care reform in the United States. He thinks one of the major failings of health care reform to date is that it has been framed around economics. He believes that if we reframe the debate as a moral issue than meaningful progress would be made. I however am doubtful.
I thought this was an excellent book and think that it should be required reading for anyone with a stake in health care reform. I give it a 9 out of 10.
Read on for my own personal thoughts on health care.
I like Reid fundamentally do believe health care is a moral debate. It honestly boggles my mind to hear people say that our health care system is not broken or essentially that not everyone deserves coverage. I have thought about writing a blog post on this topic for months now and I haven’t been able to do it because it literally pains me to think about.
I am currently lucky that although I have a chronic health condition I am insured. I don’t know what I would do if I wasn’t. I certainly wouldn’t be able to afford my medications or doctors’ appointments. I at this point am healthy enough to work and have a job that is good enough to provide me with affordable health insurance. I am lucky on a secondary level in that at this point should I get sick enough to lose my job and thus my health insurance I have a husband whose insurance I could receive coverage under.
For millions of Americans these things aren’t true. They may not have a job that provides them with health insurance or a spouse they can rely on to provide their coverage. They may have a chronic condition that leaves them uninsurable in the private market. I definitely would be.
We as Americans are basically at this point saying it is ok for us to let people die because we don’t want to have to pay for their insurance. There is such a me mentally that I can’t abide. I think people who say that we can’t cover everyone because there aren’t enough doctors to go around now and they don’t want to have to wait for health care just pain me. If there aren’t enough doctors then we need to change the system so that there are or learn to wait for things that aren’t immediate threats to our lives.
People try to use Canada and Great Britain as examples that “socialized” medicine leaves people standing in line and unable to get health care. Canada does have a long wait, but the average wait times for Great Britain are no longer than I already wait to see specialists here. And I’ve had a lot of interaction with people in Canada who also have Crohn’s disease and not one of them wishes they were in another medical system. You see far more Americans on these list servs complaining about our access to health care than the Canadians. Generally the Canadians feel sorry for us, not the other way around.
As I mentioned I feel less hopeful after reading the book than the author did after writing it because reading about all these other health systems no matter what we might choose in order to effectively work and provide universal coverage would require way to many changes to our current model. And too many powerful people, particularly the doctors and the insurance companies would lose their current way of life. One thing that stood out in all other countries was that doctors make much less money than American doctors and that insurance companies are either government run or private non-profit entities. I don’t see any way that these people will not fight tooth and nail to hang on to their bottom line nor do I see Congress willing to go against them in their fight because obviously money is more important than human life.