- The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care
- The Penguin Press, 288 pp.
Better Than Slovenia
Had you met Nikki White when she was an undergraduate, you would have thought that the world was her oyster: Intelligent, tall and slender, she was an entirely lovely young woman, her sights set on medical school. But early on, she lost her job and thus her insurance. She became ill with systemic lupus erythematosis, a typically controllable autoimmune disease. The following decade was defined by physical deterioration and desperate attempts on her part to obtain help. She worked when able, but was unable to afford medical care. Already moribund, she finally obtained hospital care by admission from an emergency room. She was soon lying quite dead in a pool of blood in that far-too-late hospital bed. She was 32.
In The Healing of America, author T. R. Reid states, “If (she)…had lived in, say, Japan—the world’s second richest nation—or Germany—third richest, or Britain, France, Italy, Spain, Canada, Sweden, etc., the health care system there would have given her the standard treatment for lupus, and she could have lived a normal life span.” Her doctor, Amylyn Crawford, attributes Nikki’s death to, “…the failing American health-care system.”
At its heart The Healing America is a primer on comparative health care. T. R. Reid, a renowned author (e.g. Confucius Lives Next Door. ) and a globe trotting journalist for the Washingon Post and other media outlets, has lived in and received medical care for himself and his famly in Japan and the U.K. He also traveled extensively to investigate healthcare in other industrialized countries, using a chronically painful shoulder as an entrée into the system. Reid is quick to point out that no system is perfect.
In brief summary, the four national health care systems he examines are as follows (Examples of all four are found in the U.S.):
The Bismarck Model: Belgium, France, Germany, Japan, Switzerland and in some form in parts of Latin America. It uses private health insurance plans, typically paid for by employers and employees. Unlike the U.S., the insurance companies are not-for-profit and cover everyone, making care much more affordable. Provision is made for someone who is unemployed. Such systems are tightly controlled by the government in their services and fees. This form was developed during the tenure of Otto Von Bismarck (1815-1898), the mustachioed prime minister whose picklehaub, that spear point topped helmet, tended to give him an opéra bouffe air. For all his ruthless realpolitick, his Blut und Eisen or “blood and iron” rhetoric, the Iron Chancellor had a commanding intelligence and a humanitarian streak that led him to institute worker’s compensation, social security, and, in 1883, “sickness insurance,” a national health care system. Waiting times are minimal as are out-of–pocket expenses. This system has been, with occasional adjustments, a constant through all the political contortions Germany has experienced in the intervening years. The Bismarck health care system is generally beloved by Germans. Reich Chancellor Bismarck characterized his health plan, interestingly enough, as “applied Christianity.”
The Beveridge System: Named for William Henry Beveridge, a British economist and social reformer. Beveridge designed the United Kingdom’s National Health Service. Of the four systems considered, this is the only true example of socialized medicine. It is found, with variations, in Great Britain, Spain, New Zealand, most of Scandinavia and Cuba. Health care is provided by the government and paid for by taxes, like national defense. With rare exceptions, medical facilities are government owned and physicians are government employees. No bills are rendered to the patient. Fees are government mandated as are what procedures are available, keeping costs down. In the United States, the U.S. Department of Veterans Affairs provides an excellent example of socialized medicine. The VA also provides, in this writer’s experience as a patient there, courteous, efficient and world class medical care.
National Health Insurance: Canada, South Korea, Taiwan. Medical bills are paid by a government operated insurance program. There is no expense for marketing, underwriting, or profits. All citizens pay into the system. Government has extensive control of prices and procedures. Services are rationed in part by waiting lines
Out-of-Pocket Model: Generally a third world phenomena, but encompassing a minimum of 17% of U.S. health expenditures, higher if copays and deductibles are factored in. Reid notes that, “The basic rule in such countries is simple and brutal: The rich get medical care; the poor stay sick or die.” This plan, or the lack thereof, provides 91% of Cambodia’s health, India 85%, Egypt, 73%.
If a comparison of different systems and their results is the heart of Healing America, a moral conundrum constitutes the spirit. How is it that the world’s wealthiest country, spending two to three times as much on health care as other industrialized countries with similar values, provides such poor health care results for so many?
The World Health Organization organizes and publishes such measurable and crucial health parameters such as longevity, infant mortality and the treatment of chronic disease. The United States lags behind even that of Dominica and Costa Rica though just before Slovenia and Cuba.
In this great country, for all its goodness, and for all the excellence of the medical care available to the more fortunate, Reid states that 20,000 American citizens die each year due to lack of health insurance and health care. (A more recently released Harvard study indicates more than twice that many.)
The notion we have something to learn from other industrialized, wealthy societies often meets with considerable resistance, not because of the oft touted bugaboo of “socialized medicine,“ but simply because the ideas involved are foreign. Though we are the only industrialized nation that doesn’t provide health care for all of its citizenry, many of our medications, devices and medical procedures come from elsewhere, including nations with government health care programs. For example, Swiss and German pharmaceutical giants have accomplished recent advances in the understanding, care and treatment of lupus. These would have been of great interest to Nikki White. The original surgery to reasssemble T. R. Reid’s shoulder that was badly injured when he was a Navy E-2 was done by a U.S. Navy surgeon using a procedure developed by a French orthopedist. (Later, as a commissioned officer, Reid served on the staff of Admiral Hyman Rickover.) U.S. scientists have also made their notable contributions, but our medical armamentarium would be meager indeed if we were restricted to these alone.
There is much more to Healing America than can be included here. The chapter “An Apple a Day,” for instance, on preventive health, is a jewel. “The Paradox” explores why America, with her phenomenal resources and assets, manages to spend two or three times as much on health care as similar countries with similar values and still end up 37th in the world in terms of results.
The issue of health care reform has provoked heated response, one comparable to that of the Medicare Bill in 1965 or the Civil Rights Bill of 1964. Healing America provides a welcome relief, a well documented and thoroughly referenced work presenting a high level of discourse. Few issues are more deserving of the electorate’s thoughtful and informed consideration. For some, their life may depend on it.
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John R. Guthrie is a former Marine infantry rifleman. He later studied medicine and became the commanding officer of a U.S. Navy Reserve Shock Surgical Group. He practiced family medicine in the Smoky Mountain foothills of Appalachia. His fiction, poetry, and nonfiction has been published widely. He is the editor and publisher of the monthly webzine “The Chickasaw Plum: Politics and the Arts Online.” Tianjin Grand Bridge