The Healing of America Book

As I set out to write something about this book, I realize that I don't have much input or interest in reviewing nonfiction books. Or maybe just nonfiction books whose primary goal is to educate the reader on some specific issue. That's what The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care is, and Reid does an excellent job of achieving this goal. And by the way, when are we going to decide whether health care is two words or one? This indecisiveness, similar to America's own inability to conclude whether we actually care if tens of thousands of people die every single year because (and only because) they didn't have health care, frustrates me. To paraphrase Princeton health care economist Uwe Reinhardt, "Each country's health care system reflects a nation's basic cultural values." Reading this book and seeing the comparisons to other rich countries, I suddenly realized that the United States is holding onto a fundamental cultural/political/moral/economic viewpoint on health care that is simply out of date, particularly on moral grounds. This probably won't become truly obvious to Americans for a couple of decades (probably around the same time that we realize how ridiculous it is that we still discriminate willy-nilly based on sexual orientation), but let's just say that history won't look unfavorably only at our ridiculous warmongering.

So we're just about almost maybe kinda sorta at the point where we have the political will to cover all Americans with health insurance. That's a start, I suppose. Reid's book examines the health care systems of a number of rich, developed countries to see what we can take from them and also to break up a few myths along the way. The countries he looks at are the UK, France, Germany, Japan, Canada, Switzerland, and Taiwan. All of these countries cover everybody, and only the UK (and maybe Canada, as long as you also call American Medicare "socialized") is really "socialized medicine"--as in, the government pays for and delivers the the health care (insurance and docs are government employees). These countries also spend about half as much on health care as the US (17% of GDP; Switzerland is second in spending at 11%). In many cases they are more privatized than the US, which has public (or partially public) systems for Native Americans, the elderly, (some of) the poor, veterans, those with end-stage renal disease, et al. Needless to say, this doesn't add up--we spend much more to get much less. The US does worse than almost every other developed country in every single measurable health care criterion except for delivery (i.e. our medical professionals give great care as long as you have good insurance and good access--here, we're number 1 according to the WHO).

Reid shies away from outlining solutions, and surprisingly, I found this to be a strength of the book. By just setting out the facts about the health care systems of the US and other rich countries, some of the conclusions become OBVIOUS. For example, 20 cents on every dollar we spend on health care (our premiums) does not go to purchasing actual health care. A small portion (3-5%) is for administrative costs, and the rest goes to insurance company profits (to pay CEOs millions, please shareholders, etc.). Yes, we are the only country with for-profit insurance (even Switzerland gave this up in the 1990s). Baucus's health care plan would mandate that Americans buy insurance…from for-profit insurance companies. Let that sink in for a minute, and this should piss you off regardless of your political bent. Now, a public option (with, say, 5% overhead) would obviously force these companies to clean up their act, but why not just follow the German/France/Japan model (all of whom have only private insurance and private doctors) and mandate that insurance companies be non-profit? Otherwise, we will continue to have insurance companies whose modus operandi is to screw people over (i.e. it saves money to drop people with chronic conditions or to refuse to pay for certain procedures). To have a system set up where health care payers are incentivized to NOT pay for your health care needs is simply perverse. And if you cut this out, you get the added benefit of lowering health care costs significantly (premiums will automatically drop 15%). Add a real choice option, where Americans can pack up and move companies at will, and you suddenly have a privatized system with greater cost-containment and universal coverage. If insurance companies must cover everyone, then suddenly they'll actually start caring about preventative medicine and keeping their customers healthy, and they'll also have incentive to wrestle with technology/pharmaceutical companies to cut prices on prescription drugs. Everybody wins (except for-profit insurance companies/Pharma) and you never have to hear the term "socialized medicine" again. Obviously there are lots of details to be dealt with (such as cutting down on unnecessary procedures/tests), and it's almost impossible to convince our politicians to go against big business at this day and age, but there are good options on the table if we have the political will.

Well, I started out saying I didn't know how to review this book, and I guess that's still true. While this ended up taking the form of a sermon, the background information, numbers, and basic ideas came out of Reid's book at least. If you've been wanting to get a better understanding of this issue for a while, you can't go wrong here--this book is clear, succinct, and highly readable. The only down side is that it will increase your frustration with health care politics ten fold.