A few weeks ago, someone recommended TR Reid’s 2009 book “The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care”. I trusted the person, and was eager to go and pick it up. It would have been an amazing resource to sort out fact from fiction during the recent health reform debate. Just how long are Canada’s waiting lines? Does Britain really practice “socialized medicine”? I was about to find out…
As the title suggests, the book takes a global look at health care. More specifically, it examines the health systems of 5 industrialized countries—England, France, Germany, Japan, and Canada— as the author experiences each of them in pursuit of medical care for an ailing shoulder. He also happens to be a journalist for the Washington Post, so the writing is brilliant. What Reid finds is that each system has its pluses and minuses, but that on balance, it is better to live under any of these 5 systems than to live under the US one.
To be sure, there is no perfect system. There are always tradeoffs. The British don’t pay medical bills, but they pay pretty high taxes, suffer long wait times for non-urgent conditions, and endure pretty stiff regulation (NICE) of what treatments and procedures they can get. The Japanese manage to consume more technology than we do (3x as many MRIs as Americans) while keeping health spending incredibly low, at just around 8% of GDP (if we spent at these levels, we’d have no budget deficit). But to keep spending low, the Japanese government puts strict controls on payments to doctors and hospitals. The tradeoff is a system of aging hospitals and relatively low doctor salaries. Would America’s doctors allow such a thing—just look at all the fights to stave off cuts to Medicare reimbursement.
Canada’s system covers everyone, with a national insurance plan that pays private doctors and hospitals. But Canada’s system is in decline with a serious doctor shortage and long waiting times. In fact, Reid says it would have been a year just to get an orthopedic consult for his shoulder. Other noteworthy health systems are those of France and Germany who along with Japan have non-profit insurers. And France boasts a national health card with the patient’s entire medical record electronically encoded. Reid also takes the reader through the health reform efforts of two countries that are somewhat similar to the United States—Taiwan and Switzerland. He argues that if they can remake their systems into ones that provide universal coverage, so can the US.
In the end, Reid paints a vivid portrait of an industrialized world that has decided that health is a basic human right. This stands in stark contrast to the American model, which in some ways is closer to that of the developing world. He calls this system “out of pocket”, because in poor countries, there really isn’t a health system, patients just pay for medical care out-of-pocket. Right now, nearly 50 million uninsured Americans do the same. The difference, of course, is that the US can afford a better system, but it has chosen not to pay for one. So in sum, compared to these other industrialized countries, the US leaves more people uninsured, spends more, and has poorer health outcomes. The system NOT to live under is clear.
Reid leaves the reader with an important thought, posed by William Hsiao, the economist who designed the Taiwanese system, “before you can set up a health care system for any country, you have to know that country’s basic ethical values”. The question for Americans to ponder is what are our basic ethical values? After passage of the Affordable Care Act, it seems like we believe that health care is a basic human right. But some days it is hard to tell, especially as opponents attempt to defund, dismember, and make the new law illegal.
For a shorter version of the book, check out the documentary, “Sick Across the World”: http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/