Tuesday, September 8, 2009

The Healing of America: Book Review

The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care by T.R. Reid

My rating: 5 of 5 stars

This is the best book on Health insurance coverage that I have ever read. Anyone who wants to understand what is wrong with the current system of health insurance in the United States and what the genuine options for reform are must read this book.

The well-known facts of the troubles with our health care coverage are here: Millions uninsured, millions more under-insured, homes lost and personal bankruptcies endured even by the fully insured, premiums rising three to four times as fast as wages, more and more claims partially or wholly denied by health insurance companies, and our GDP being eaten up by the huge costs of our private health care system.

Unless one is ideologically blind or simply radically uniformed, these facts are well known, well documented (Kaiser family foundation, various Harvard studies, Commonwealth, WHO, CBO) and all too real to millions of suffering Americans. What is less well known is how other countries provide better insurance companies.

No other country spends anything like what we do on health care. Despite this, nearly every other industrialized country has better outcomes; longer life-spans, more healthy years after 60, less infant mortality, and better treatment for chronic ailments and they do all this while providing basic health care coverage to every man woman and child in their country.

This is where Reid's book makes its best contribution. In the United States both Liberals and Conservatives frame the debate as a contest between "socialized medicine" and our current "free-market" health care system. Liberals point to the abuses of a private-for-profit system and argue that we must have a single-payer system, a system in which the government pays all the bills (though doctors and hospitals are still private). Conservatives rage against this, fearing long waits, rationed care, and diminished quality.

Reid demonstrates that this debate between single-payer and free-market approaches creates a false dilemma. There are a number of ways in which other nations provide universal and affordable health care. Some of these countries use single-payer and some do not. The facts are clearly against the conservative claim that the free-market is best for health care coverage. But equally the evidence strongly suggests that a single-payer is not necessary for universal coverage and quite possibly not even the best way to provide it.

Reid travels to a number of countries: France, Switzerland, Japan, The United Kingdom, and Canada. Each of these countries has better health care outcomes than the United States, covers everyone, and pays far less than we do. But here is the twist: They do not all use "socialized medicine."

The UK is closest to a socialized system with their NHS. This system does have problems with funding and sometimes results in long wait times for elective surgery. But it reports higher satisfaction than the American system. likewise, Canada offers a single-payer model in which doctors and hospitals remain privately owned and operated but the government acts as the sole insurer. This system too has better outcomes than the United States. There are, however, real problems with limited resources, long waits for elective procedures, and underfunding.

A better model is found in France and Germany. Both countries use something called the "Bismark" model. This model relies on private doctors, private hospitals, and even private insurance. But the private insurance in France and Germany is nothing like its American counterpart. In these countries the government controls prices that doctors and hospitals charge, insurance companies are required by law to cover every claim sent to them, and are non-profit social businesses; they don't make money for CEOs and investors. Furthermore, Employers are required by law to cover their employees and everyone is legally required to buy insurance.

France and Germany have far better health outcomes than the United States (and even than England and Canada) for far less costs. Even better, France and Germany have shorter wait times than not only Canada and England, but also the United States. Everyone is covered and patient satisfaction is very high. This is what happens when the profit motive is removed from health care.

Reid concludes with a moral case for Universal and affordable health care. It is, he argues, simply a moral duty for a society to cover all its members. A civilization that allows only those who can afford it access to care is neither democratic or fair. If we wish to fulfill our moral duty we must recognize the right of all to affordable health care.

Reid did a documentary on the same theme as this book for Frontline. It is well worth seeing and can be found in its entirety here

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