Still on the search for a fix for his sore shoulder, Reid leaves Canada before the end of the book to visit India and pay out of pocket at an ayurvedic clinic. I’ll save you the suspense: After weeks spent eating healthfully, relaxing, and being intensely massaged, Reid’s shoulder felt better and had a better range of movement.

You probably don’t have to believe in prana or doshas to understand that paying such intense attention to your body may serve you better than pills or surgery. But the out-of-pocket model doesn’t do one thing very well, Reid says, and that’s address any sense of fairness. Most of the world’s poorest countries don’t provide health care, and people are left to pay for the care they can afford. Reid points out that that usually means that poor people go without any care at all, and the poorest in the poorest countries can expect today before their 40th birthday.

Reid points to an Institute of Medicine study to show that about 22,000 Americans die each year from otherwise treatable ailments because they can’t afford insurance. He tells us that about 85 percent of Americans believe health care is a fundamental right. So what’s to be done? Reid says we have to decide the moral question first, commit to universal health care, and then worry about how to pay for it. He argues that framing the issue as an economic one was one of the problems in the reform effort of then-President Bill Clinton in 1993, while at the same time Taiwan and Switzerland passed universal health care. That’s because Taiwan and Switzerland framed the issues in ways that resonated within their cultures — national pride and solidarity — Reid says.

Part of what he wants to do in the book is combat some common misconceptions: that every other country has socialized care with wasteful bureaucracies and sacrifice free-market style choice. But the prescription contains elements that may be a hard sell for Americans. Everyone — rich and poor, young and old, healthy and sick — is in it together in countries that make health care universal. That means that the rich subsidize the poor and the healthy subsidize the sick. But it also means the healthy version of yourself subsidizes the version of yourself that inevitably needs medical care. That’s what insurance is meant to be, a bulwark against bad luck.

It also means that in most countries no one makes a profit from health care insurance. That  might have been the biggest obstacle all this time: that really entrenched interests benefit from our current system.

I’ve realized, somewhat belatedly, that in my post about not reading enough fiction I erred in adding Angela’s Ashes by Frank McCourt to the list. My conscious brain realized that it was biography/memoir, but my subconscious brain always confuses McCourt with Ian McEwan, who actually does right fiction.

Angela’s Ashes is still more narrative and novelistic than anything I’ve read in awhile. Which is leading toward a bit of a problem. Young Frank McCourt is so hungry throughout his Irish childhood, lived in grinding poverty, that all he talks about is wanting food. And he rhapsodizes about it so much, repeating the same delicious-sounding phrases over and over, that all I want to eat  now is mashed potatoes with salt and butter, boiled cabbage, ham, milk straight from a cow, fried bread (whatever that is) and apples stolen from an orchard. I broke down and had the potatoes last night, as salty as I could stand them, and see cabbage in my near future. The rest is going to be a little harder to come by.

As you all probably know by now, the Senate Finance Committee, one of five Congressional committees critical to health care reform, rejected two proposals Tuesday that would have created a public insurance plan to compete with private health insurance companies.

The public option has been a constant demand of more liberal lawmakers but is widely seen as a dealbreaker for most Republicans and moderate Democrats. The Finance Committee, as exhibited by Max Baucus’s chairman’s mark, left it out in favor of non-profit health care cooperatives.

As we know now from reading T.R. Reid’s book, France, German, and Japan (along with other countries) use non-profit insurance companies to provide health insurance to their citizens. Citizens then use the insurance companies to obtain care from doctors and hospitals that work for profit. But as Timothy Noah pointed out in Slate, for-profit insurance companies aren’t allowed in those countries. Also, as I think I can channel Reid to say, we don’t really have a model for non-profit health insurance companies in America.* What we do have are to big government-run programs, Medicaid and Medicare, that could be expanded.

But as Brian Lehrer pointed out in Wednesday’s show, none of this means the public option is completely dead.

*At least, not any more.

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.