Whenever politicians talk about health care reform, Americans probably fear most the systems Britain and Canada have. It makes no difference that Reid and many others who have benefited from them extol their virtues. These systems are so different from what the U.S. does that they’re not likely to be implemented soon anyway.*

Britain is one of the few democracies that goes whole-hog: Your health care is paid for through direct taxation by the government, which also employs the doctors and nurses who see you. The downside, of course, is that taxes are high. Britain still spends less on health care than the United States does, but it may not feel that way if you’re paying 17 percent tax on a sandwich at the Pret-a-Manger.

Also, the government has to pay attention to cost, and can act like a gate-keeper on certain kinds of medications. This might feel like it makes more sense when you’re the taxpayer than it does when you’re the sick person who wants a treatment. In any event, Reid was not approved for shoulder surgery, or really any other kind of intervention, except the stiff-upper-lip treatment. Just learn to live with it, they told him.

Both Britain and Canada also install waiting-lists for non-emergency procedures, with the justification that if health care is free for individuals the temptation to overuse it is strong. This is the way a non-market system can internalize a cost on its users. Britain invested a lot of money after true and exaggerated scandals involving their wait lists; tales of patients waiting on gurneys while they slowly died. That’s the upside to government involvement, the government is ultimately answerable to voters. In Canada, the wait-list problem hasn’t been overcome, and that was the only country in which Reid didn’t get to see a specialist because of the wait. The upside, if he’d waited around for about a year, is that everything would have been totally free.

Reid posits that Canada provides the U.S. with another important lesson: Universal health coverage started first in one province, and then after it was proven popular and workable spread to the entire country. It’s called the demonstration effect. Maybe,he says, if more states like Massachusetts could provide universal coverage and actually control costs, the entire country would eventually get on board.

Another benefit, though, is that because both Canada and Britain will have to pay for the entirety of their citizens’ care from birth to death, they have a great incentive to keep you relatively healthy. So it really is care for your health, more than managing your sickness. Something tells me that wouldn’t wash in the U.S., though:  you basically have the government telling you what you should and shouldn’t do.

*Though, as Reid points out, the VA system works just like the British NHS, and Medicare and Medicaid work like the Canadian single-payer system.

Next week is Banned Books week. Sponsored by library, publishing and journalism organizations, this week celebrates, among other concepts, the First Amendment, the right to know, the right to free and open access and the importance of access to unpopular or unorthodox viewpoints.

In 2008, the ALA Office of Intellectual Freedom received reports of  513 challenged books. Check out the Top ten.

For more information check out http://www.bannedbooksweek.org/ which provides a map of book challenges and the ALA site.

This is my first time over at BookEnds, and I’m slowly slogging through T.R. Reid’s “The Healing of America” because I foolishly began reading four books over the past few weeks and I’m only close to finishing one — “The Long Goodbye,” by Raymond Chandler. Yes, cheesy private detective fiction holds my attention longer than both “American Lion,” Jon Meacham’s account of Andrew Jackson in the White House, and “Over the Edge of the World,” Laurence Bergreen’s history of Magellan’s circumnavigation of the Earth. Thankfully for the reader, I’ll save my recent troubles with historical non-fiction for another post. I’m here to talk about French health care, because, simply put, that’s last the chapter I read in “The Healing of America.”

I want a carte vitale — which means “vital card” in English, I think. It’s like a credit card but with a computerized chip that digitizes a patient’s medical record from age 15 onward. As Reid reports, “…it is the secret weapon that makes French medical care so much more efficient than Americans are used to.” French doctors and medical facilities don’t have to keep patient records in file cabinets, because it’s all on the patient’s carte vitale. What’s more, get sick in France or just go to the doctor for a check-up, you take this card with you and it not only tells the doctor all about your past treatments and illnesses, it also tells which private insurance fund covers the patient, how much they paid the doctor, how much the insurance plan pays back to the doctor, etc. It does everything, including eliminate the need for administrative workers so heavily relied upon by doctor’s offices in the United States.

The French carte vitale keeps administrative costs low. Coupled with a national health insurance system that makes it mandatory to be insured — no one is denied coverage — and some top-flight doctors, as Reid reports, the carte vitale is “a symbol of what the French have achieved in designing a health care system to treat the nation’s 61 million residents.” The card is by no means a cure-all. French politicians routinely campaign on health care reform platforms, and many now decry the the cost of their system and say doctors aren’t paid enough. But the carte vitale seems a simple yet effective way to streamline a cumbersome health care system, perhaps one of many first steps in reforming the U.S. system.

I’m often embarassed by the paucity of fiction books on my shelves. I don’t know why I care. But while many I know suck down the latest Oprah book or books at the top of bestseller lists for weeks, like The Kite Runner and anything by Nicholas Sparks, I find out about a new Andrew Jackson biography and I’m distracted again to a non-fiction wasteland where I can discuss what I’m reading only with my former history teacher.

I like what I like, but I’m trying to correct for this. When I picked up our most recent book club choice, I spotted a few fiction gems on a buy 2 get 1 free table, so I took advantage of the deal and got Angela’s Ashes and Olive Kitteridge.* Now a colleague, staff editor Robin Watson, has recommended The Gargoyle by debut novelist Andrew Davidson. But don’t think this in any way is enough to round out my to-read list. So, suggestions welcome.

*The third, I must admit, was this.

Before he takes us to France, T.R. Reid explores all of the things that might increase medical care costs for Americans as opposed to their counterparts in other countries. He disabuses us of two notions right away: that it’s doctors salaries and malpractice insurance. Doctors do get paid more in the U.S. than they do in other countries, but Reid tells us the economists who study the issue calculate that lower doctors’ fees and drug prices wouldn’t save us that much money.

Malpractice costs are a long-time issue for advocates of tort reform that President Barack Obama addressed when he laid out his health care reform proposals. But Reid points to a study from a health care management professor at the Wharton School of Business, Patricia Danzon, to tell us that the more expensive malpractice insurance costs American doctors face add only about 1 percent to our total health care costs.

So what is it? Mainly high administrative costs. Private insurance companies in the U.S. spend about 20 percent of their budgets on non-health care related expenditures. Health insurance companies will tell you that not a lot of that goes to profit, but rather that they spend money mitigating against the free-market problems private companies face. As an undergraduate who was one class shy of an economics minor, I can tell you that I learned that health care markets are special, but I’ll spare you the wonkish details here. You can, if you’re interested, look here and here. Also, you can listen to NPR’S Planet Money podcasts, which document the kinds of information problems health insurance markets face.

So one of the ways countries that rank better both in controlling costs and improving outcomes is by getting rid of the overhead. In countries like France, Germany and Japan, everyone is required to get health insurance and health insurance companies are required to provide it. That gets rid of the people American companies employ to deny claims and investigate patient histories. It forces everyone to pay into the system, so it mitigates against the problem of adverse selection. And doctors don’t have to maintain patient records either. In France, everyone is issued a card to maintain their histories. (Computerizing health care is part of what the stimulus package wanted to accomplish.)

In all of these countries, which use a system started by Otto von Bismarck in Germany, health care providers are private doctors who work for themselves or for officers and hospitals that make a profit. What’s different is that non-profit insurance companies provide the funding, employers help employees pay, governments kick in to help out for people who can’t quite afford their premiums or are self-employed, and the countries control costs by controlling the reimbursement fees paid to doctors and hospitals. So it’s not to say that everything’s perfectly affordable. The doctors in France, Germany and Japan Reid meets are unhappy with the amount of money they receive. But no one Reid meets would change the system they work in entirely.

So how did his shoulder injury fare? In France, the doctor told him he would not recommend surgery because his injury was not that extreme, but if he didn’t like that diagnosis he could go to a doctor, get a new one and probably get the surgery with relatively no waiting time. In Germany, the system ok’ed the surgery, but the doctor told him she wouldn’t necessarily recommend it and told him to talk to a physical therapist before plunging in. In Japan, the doctor said health insurance would pay for Traditional Chinese Medicine, physical therapy, a monthly steroid injection and for the expensive total shoulder surgery, but like every other doctor but the American, he didn’t think the shoulder surgery was the best way to go. All of these doctors told him the surgery was usually reserved for people in pain, and his problem was stiffness. Surgery, too, would cause pain and require time and energy to rehabilitate afterward.

After this, Reid left the systems that are closest to what the American plan will likely end up looking like to visit the system Americans probably fear most, the U.K.’s NHS.

This seems to be the year of John Keats: in July, his house was reopened to the public in Hampstead Heath, London, and this week, “Bright Star”, the new film about Keats’ brief love affair with Fanny Brawne, opens in theatres. Directed by Jane Campion, the movie got a lovely review in the New York Times and I hope that Campion will do for Keats what she did for Henry James in her wonderful adaptation of “The Portrait of a Lady”, one of my favorite books.

Intrigued by the recent Keats renaissance of sorts, I made a trip to the library in search of his poems – thus far, poor Mr. Keats had been rather overshadowed by Percy Shelley and Lord Byron in my modest study of 19th century poets. Reading Keats over the past few weeks, though,  I’ve been struck by how beautifully fresh and almost modern his verse seems, unmarred by the dusty coverlet of nearly two centuries. His words have such a delightful elegance and I’m continually amazed just how much he matured in such a short life — his poems have a depth that’s remarkable when you consider that he was only 25 when he died.

As the Times stated, no movie can ever fully capture the exquisiteness of his poetry as it appears on the page, but I hope that “Bright Star” will at the very least encourage a new generation, like me,  to pick up a volume of his work and appreciate the purity of his genius. I’m certainly inspired to read, in addition to his verse, the Keats biography written by Britain’s former poet laureate, Andrew Motion. And, as I have a weakness for both Romantic poets and romantic movies, “Bright Star” is definitely my must-see film for the fall (it comes to Stamford’s Avon Theater on Friday, Sept. 25).

Here’s a taste of the poem that, I assume, inspired the film’s title. Interestingly, a line from another of Keats’ poems, “Ode to a Nightingale”,  provided the title for F. Scott Fitzgerald’s “Tender is the Night.”

BRIGHT star! would I were steadfast as thou art—                          
Not in lone splendour hung aloft the night,
And watching, with eternal lids apart,
Like Nature’s patient sleepless Eremite,
The moving waters at their priestlike task
Of pure ablution round earth’s human shores,
Or gazing on the new soft fallen mask
Of snow upon the mountains and the moors—
No—yet still steadfast, still unchangeable,
Pillow’d upon my fair love’s ripening breast,
To feel for ever its soft fall and swell,
Awake for ever in a sweet unrest,
Still, still to hear her tender-taken breath,
And so live ever—or else swoon to death.

Philip Hensher’s “The Northern Clemency” is very much about England, set in a city “made by fire out of water.” The primeval description refers to Sheffield, South Yorkshire, circa 1974, when the city was the steel center of England and heaps of coal fed the gaping furnaces of the factories and muddied the rolling, purplish landscape of the pensive moors.”The city made its money from steel; it was driven by its waters; it was built on coal.” Over the course of the novel, Sheffield hovers like a persistent haze, lovingly and forbiddingly evoked by turns, almost a character in itself.

Hensher’s human characters, though, are entrenched in a claustrophobic suburbia, a world of dull cocktail parties fed by vol-au-vents and nosy neighbors obsessed with the Queen. The residents of Rayfield Avenue are, for the most part, bored and dissatisfied, but none quite so much as Katharine Glover, the proverbial desperate housewife with three sullen children and a lifeless marriage. Katharine’s spontaneous decision to try for a job in a newly-opened flower shop triggers a disastrous train of events – her husband Malcolm, assuming she’s having an affair with her charismatic young boss, walks out of the house without a word and Katharine erroneously releases her dismay on her youngest son, Tim. The deeply disturbing scene in which she violently stamps on the head of his illicitly purchased pet snake haunts both Tim and the rest of the book through the final pages.

Each of the characters evolve, over a span of almost twenty years, in the shadow of England’s changing  politics. There are frequent references to the regime of Margaret Thatcher, evocations of the crippling recession that took hold in the ’80s, and a brief but powerful portrayal of the coal miner’s strike that gripped the north of England in 1984.

I enjoyed Hensher’ detailed descriptions, his unusual metaphors and the precision with which he evoked a certain era  — the minutae of everyday life was meticulously catalogued and really gave the reader a sense of time and place, from the description of a public swimming pool to careful mention of iced biscuits and tea in a local, gossip-ridden cafe. The characters, however, were harder to respond to. With a few exceptions, like depressed housewife Katharine and her over-sexed but compassionate son Daniel, I found most of the characters to be depressingly unlikeable. A few of the overlapping storylines were intriguing — surprisingly, I found the side-plot of florist/reluctant drug runner Nick Reynolds and his diabolically sleazy dealer fascinating — but a good deal of the characters left me cold. The most irritating were Sandra Sellers, the emotionally indifferent and destructively promiscuous daughter of the Glovers’ neighbors, and Tim Glover, an eerie child who grows into an annoyingly fervent Marxist, obsessed with Sandra to the point of creepy delusion. Even some of the more appealing characters felt distant and suffused in chilliness— throughout the novel, I felt almost as if they were deliberately held at arms’ length. This might have just been my reaction — another reader might find it easier to get close to them — but I ultimately found the city itself to be more compelling than the people who lived in it, the city made by fire out of water, that seemed to breathe on its own.

I’ve been meaning to share this for some time, but Charles Siebert, an author who had an interesting New York Times Magazine piece about whales in July, also wrote a book about a retirement home for former ape movie stars. I thought the book, The Wauchula Woods Accord: Toward a New Understanding of Animals, might have special resonance here in Stamford.