It’s important to know before reading “The Healing of America” that the author, T.R. Reid, takes as a given that the health care system in America is broken. This seems pretty uncontroversial to me at this point. Nearly everyone agrees on the diagnosis; it was a big campaign issue for both Democrats and Republicans in 2008. What’s less clear is the treatment.
Atul Gawande argued pretty persuasively in January that health care systems in other countries work best when they build on what already existed: The British fashioned the National Health Service after World War II when, bombed and bedraggled, it had a huge soldier and civilian population to care for. Other countries took different approaches because what existed before was different.
President Barack Obama argued something similar in his speech to a special joint session of Congress last Wednesday night when he said “Since health care represents one-sixth of our economy, I believe it makes more sense to build on what works and fix what doesn’t, rather than try to build an entirely new system from scratch.” And Reid takes the same approach. His book is meant to look at the bits that work well in other countries, the problems other countries face and how those things compare to the polyglot American system, the last in the developed world that doesn’t guarantee basic health care to its populace.
Reid’s medical problem is a perfect one for this investigation. An old shoulder surgery makes him ache and interferes with his golf swing, but doesn’t impede greatly on his quality of life. Treatment can range from physical therapy to radical and expensive shoulder replacement surgery (which is what his American doctor recommended.) How treatment is tackled for such a non-emergency, life-enhancing and potentially expensive problem says a lot about how a country decides to meet everyone’s needs on limited resources.
Unfortunately, a heavy chunk of the beginning of Reid’s book is a fairly boring but probably necessary explanation of the kinds of systems different countries use. I wish he had written the introductions to the systems in the chapters with the relevant country.
But the first chapter explores a question he will come to time and again; whether Americans believe we have a right to health care. Now, of course, the American system treats medical care as a market: you buy what you can afford. We treat it as a right for the very poor, the very old, children and, in some states, the very sick. To illustrate the people who fall through the cracks, Reid introduces us right away to Monique White, a 32-year-old Tennessean who died from lupus because she did not have health insurance to cover necessary treatments. White was too rich for Medicaid, too young for Medicare, and too sick to work. If Reid’s aching shoulder is the perfect kind of ailment through which to look at medical care, White’s death is the perfect case through which to look at what might be wrong with the American health care system.
For the most part, though, the conversation doesn’t revolve around this question and instead addresses the economic and cost-effectiveness problems in American health care. Reid also introduces us to the problems we might already know about: That America spends about 17 percent of its GDP on health care but has a lower-life expectancy, higher infant mortality rates and higher deaths from curable diseases than other industrialized countries. But there are also tidbits you might not know: death from surgical mistakes was highest in the U.S. compared to other rich countries, and we have fewer good years ahead of us once we reach 60 than residents of Japan and much of Europe.
Setting up the case that American medical care needs fixing, he started his journey in France, the country the WHO ranks as highest in health care.
