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The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care

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I bought this book after reading Jacob Weisberg's review in Newsweek. It is the best thing on the subject for the following reasons: 1. It is well written even funny in places. 2. It is very informative. 3. It presents comparative data both as to health outcomes and also ways of paying for health care 4. It is non-partisan, even though by the end one wonders why we Americans are paying so much for health outcomes that are actually worse than any comparable country. 5. It is revealing as to the complexity of the US; for example, I didn't know that as many as 80 million Americans are already covered by systems nearly identical to the British or Canadian, i.e. medicaid, medicare, military, veterans and Department of Indian Affairs - who would have thought that? But 45 million others are not covered at all. Everyone else is covered, more or less, by insurance and so are the Germans, French and Japanese etc. But what a difference in the insurance systems! In the other countries you get insurance just like here EXCEPT THAT 1. you cannot be denied 2. you cannot be cancelled 3. everyone is covered and 4. your premiums are regulated by government which of course is what the entire debate is about. Because here the insurance industry is for profit and the premiums reflect that fact, the amazing fact that US health is the USA's largest industry by far, larger that the State of California, four times larger that the military, in fact US health would be the world's 8th largest country. No wonder the debate is so fierce. This excellent books set it all out readably and comprehensively.

I am a nursing student. I returned to college after 20 years in hospitality and project management in order to realize my dream of a career focused not on money but on providing care to the most vulnerable. One disturbing pattern has cropped up in my education- the emphasis (when studying the importance of avoiding potentially life threatening errors) placed more on avoiding liability than on the well-being of the patient (or "client" as we are now taught, in this money-driven society). It also strikes me that I have never heard it suggested that a health care professional should be painstaking in her work in order to prevent avoidable errors that would bring dishonor to herself or her profession. The focus is on avoiding "costly" errors.

This is where Mr. Reid's book is a most welcome addition to the conversation on health care in America. He shows us that it is possible to have an excellent health care system that is focused on the well-being of the patient and not the all-mighty dollar. He also breaks down a complicated subject into an enjoyable reading experience, with prose that is clear and intelligent and often humorous.

I find it extremely disappointing that so many Americans blindly buy into the myths about the "poor" health care available in other rich, developed nations (every one of which, with the sole exception of the U.S., provide universal health care) while touting false grandiose statements about the superiority of American medicine.

Mr. Reid explains the reality of the better and cheaper health care systems of nations like Switzerland and Japan in terms (to paraphrase Thomas Jefferson) "so plain and firm as to command their assent." He also introduces us to health care professionals who are driven not by monetary motives but by a desire to heal and prevent illness.

If you believe that access to health care (note, I did not say free health care) is a basic human right, then buy this book. Actually, if you are simply interested in learning the honest facts on the ground- buy this book.

In `The Healing of America' TR Reid gives a tutorial on the basic types of health care systems in place around the world, and then tries to give an evenhanded analysis of what works in these systems and what doesn't. What gives the book its teeth though is his first-hand experience of health care systems in six different countries. In his quest, Reid brings a bum shoulder to these countries to find, as he puts it, `two cures': one for himself and one for the US health care system.

There's no question something needs to be done to fix the US health care system. The idea that the richest and most technologically-advanced country would let people die because they can't get the care they need or go bankrupt because they get sick is absurd. That is why the current debate about health care reform is needed. The problem though is that's it's hard to know what we're looking at when filtered through politicians and the majority of the media coverage. They focus on the extremes, especially those opposed to reform who mischaracterize the systems in other countries as `socialized medicine'. In this context, Reid provides a useful voice to the debate- whether you agree with his prescriptions or not. He de-stigmatizes the systems of other countries and explains why we're not as far removed from them as we think.

He shows us how other countries' systems are different, but also alike. Some `socialist' countries have private insurance and private doctors. In fact, Reid demonstrates how some countries actually have more choice than the US. In Germany for example, one can choose from hundreds of different insurance plans and go to any doctor, whereas US citizens are generally limited to one employer's plan and only `in-network' doctors. Some countries, like Britain, have government-run hospitals but private GPs. Some are single-payer, but most have multiple payers. Some plans are funded by private insurance, some by a government-run insurance fund, and others by general taxation. What is striking about these different variants though is that while some Americans rip these other systems, we here in America have forms of each of them. Medicare is run like Canada's system. Veterans are put through a system like Britain's. Americans with employee-sponsored plans are in a similar system as people in Germany. The difference is that those other countries provide health care more economically and more effectively than we do in America.

Why? The answer lies in what they have in common. They all have a single, unified system, which allows administrative efficiencies. Ours is fragmented and riddled with administrative costs and perverse economic incentives. Their programs are all non-profit, so there's no need for insurance to cut coverage to maintain the bottom line as ours do. And they all provide universal coverage, which provides the economic incentive for preventative medicine. As Reid points out, the first question we need to ask ourselves is, do we think people should die due to lack of coverage? Or should people go bankrupt because they get sick? These are moral questions, and the US is the only rich developed nation that has so far said yes to them.

Reid does gloss over some things though. He pays little attention to costs, seeing it as a problem solved once the profit motive is gone, universal coverage is agreed upon, and government price controls are in place. Besides showing a complete lack of economic understanding, this also skirts the fact that costs in other countries are also increasing. He does point this out but only says that their costs are so much lower than America's they can afford to let them rise. (For a more intelligent and nuanced analysis of the problem of cost in the US health care system and a unique idea for reform, see the article by David Goldhill in the September issue of `The Atlantic'.) He also polarizes the debate (like it needs more polarization) by getting into the `health care as a civil right' question. He was better-off sticking with his stronger, moral point because it's not at all inconsistent to think health care is NOT a civil right, but still have the moral conviction that everyone should have coverage. By putting these in black and white terms, he sounds like the European Socialist Liberal he had managed to avoid sounding like up to that point.

Still, assuming he hasn't misrepresented anything in this book or provided inaccurate facts, this is important stuff. The health care debate is vitally important and I think every American should be armed with as much information as possible. That said, many articles by Reid and about this book have been published that will give you the basic facts outlined here. For most people, those articles should be enough. Only shell out for the book if you're interested in a deep dive on the subject.

I can't vouch for the accuracy of all of Reid's accounts, but as an American expat who lived in Germany and the UK for a total of 28 years, I can confirm that his descriptions of the health care systems in those two countries are both accurate and fair.

The timing of this book is uncanny. Everyone who cares one whit about health care in the US should read it... and LISTEN to what it has to tell us.

Ever since the PBS documentary mentioned Reid's characterization of the different healthcare systems, I have been waiting anxiously for this book. Was well worth the wait.

The fundamental thesis of the book is that the US healthcare system can and must learn and adapt ideas from various other healthcare systems - the idea is not radical at all. What is unique about this book is that Reid systematically and convincingly disproves the common arguments centered on the notions of "socialized medicine". A sub-text of this thesis is perhaps a bit more novel than his original thesis - US doesn't have a healthcare delivery problem, but has a significant problem financing it. This re-framing of the problem, clearly and deliberately divorcing the clinical resources/processes from the administrative (non-clinical) processes, is very helpful in focusing the arguments Reid wants to make. While one could argue that this re-framing is oversimplification and too biased against payers, it becomes to a open-minded reader that, at least in the US context, it is absolutely critical to view the economics side of healthcare first. Reid convincingly makes an argument that the "capitalistic" idealism US markets crave for and swear for are not channeled appropriately or are in fact, have the wrong incentive structure.

Whether you agree with that viewpoint or not, the detailed global journey of Reid and his quasi-functional shoulder, helps a reader lead a vicarious patient life in a wide variety of settings, some more similar to the US than others. (Having grown up entirely in India, I certainly can relate to and think that the author's portrayal of India's healthcare system is accurate and presented in a matter-of-fact manner). The discussions often tends to be on administrative issues - getting an appointment, scheduling surgeries, who bills whom for what, and whether a patient ever sees a bill, etc. For each of the country discussed, Reid also provides a fairly good summary of the historical context of the healthcare systems and sometimes (a little bit tangentially) profiles of key persons involved in shaping that country's system.

While such a narrative is very informative, I think the author missed an excellent opportunity to provide his thoughts on potential solutions (for example, from an information technology perspective - while he lauds the usage of health cards in Taiwan, Germany etc as key to cutting admin costs, he does little to highlight the significant clinical advantages that can be gleaned from the huge database). His focus on addressing the "that's socialized medicine" argument left him little room to take on another common argument theme - patient privacy. A reader would also have significantly benefited if the author had spent more time on analyzing the transformation challenges that countries that adopted significant reform went through and how they addressed them. The policy/ethics framing of the problem and the discussion with the renowned William Hsiao is very informative and thought-provoking. The discussion on the role of preventive medicine is insightful in that Reid makes a convincing argument as to why a healthcare economy with fractured for-profit players has no incentive in preventive medicine. The chapter "apple a day" is in itself well-worth the read.

For a more enterprising reader, a thought exercise centered on the applicability of the ideas from this book with the hypotheses/assertions of The Innovator's Prescription: A Disruptive Solution for Health Care will be rewarding.

Nevertheless, the book, provides a reader engaged in the current (directionless) debate in US on healthcare "reform", an excellent source of providing an unbiased, well-informed context with a very powerful nudge in trying to re-frame the discussion. The book will perhaps be best remembered for its systematic destruction of the "socialized medicine" arguments wide-spread in the US. An excellent read.

Toward the end of the book, the author makes up a story that involves two American women of similar ages, but differing economic levels. Both have malignant tumors in the ovaries. For the woman with health care insurance, the tumor is found early, surgery is performed, and recovery is complete. For the woman without health care insurance, the malignancy is "discovered" at an emergency room examination, but the cancer has spread too far to be treated. The woman is sent home with pain pills to die.

Per the author, no one is suggesting that the United States become an egalitarian society throughout. We expect differences in incomes and living standards. But all developed countries have decided to not tolerate inequality in health care. All except the United States. The result is that more than 20,000 U.S. residents die each year because they do not have health insurance and cannot get the coverage they need to live. This result, in itself, means that the richest nation in the world does not have the best health care system in the world.

But author T.R. Reid feels that "the stars are aligned and the timing is propitious for the United States to establish a new national health care system." And the thesis of his book, he says, is "that we can bring about fundamental change by borrowing ideas from foreign models of health care."

He has a bum shoulder, one that has been operated on and fixed in the past. As a guise to evaluate various health care models around the world, he seeks advice from each for his shoulder. In the end, he gets a variety of advice for his shoulder, but does not find one country that has the perfect system for the United States to adopt. What he does find are four basic models of coverage:

1) The Bismarck Model: Both health care providers and payers are private entities. Private health insurance companies, which are financed by employer and employee contributions, do not make a profit. There are tight controls on the costs of medical services and fees. (Germany, France and Japan use this model.)
2) The Beveridge Model: Health care is provided by the government. It is financed by taxes. All hospitals and clinics are owned by the government. Most doctors work only for the government. (Great Britain, Spain, Italy, most of Scandinavia, Hong Kong and Cuba use this model.)
3) The National Health Insurance Model: The providers of health care are private, but they are paid only by the government; thus, this is a single-payer system. The system is financed by monthly premiums. (Canada, Taiwan and South Korea use this model.)
4) The Out-of-Pocket Model: Those with money pay for medical care; those without money stay sick and/or die. The government is too poor and/or disorganized to provide universal health care. There are few or no private insurance companies or plans. (Approximately 160 countries in the world use this model.)

Reid tells us that the U.S. uses all four models at the same time:
1) The Bismarck Model: Those who have employer-provided health insurance.
2) The Beveridge Model: Members of Congress, Native Americans, Veterans and active military personnel.
3) The National Health Insurance Model: Those under Medicare or Medicaid.
4) The Out-of-Pocket Model: The 45 million uninsured Americans (or more like the 80+plus million Americans who are without health care insurance at least one time in the year).

And, he tells us that the first three models have the following in common:
* There is a "moral imperative" that all residents have guaranteed health care coverage
* All residents are covered by the same system, under the same set of rules
* All are mandated to pay into the system, one way or the other
* Basic health care must not generate any profit
* Costs of services, procedures and drugs are controlled by the national government
* There are health care horror stories under each model and each is challenged to control costs and to finance its system
* The very rich have the means to get whatever health care treatment they want, wherever they want

Per the author, some in the U.S. get the very best medical care possible, but the overall medical system is mediocre by world standards. And that is the rub. But we also pay about double, per resident, what other developed countries pay for our mediocre care. So, how is this possible? First, we pay far more for our doctors, nurses, hospitals and drugs than other countries do. But even if we reduced those costs significantly, he says, that would not be enough. No, per Reid, the biggest reasons for our high costs of health care are "the way we manage health insurance and the complexity of our health care system."

Per Reid, "the U.S. private insurance industry has the highest administrative costs of any health payer in the world." He pegs it at about 20% of total costs and says other countries do it for far less: France: 5%; Canada: 6%; Taiwan: under 2%, as examples.

Is there a simple solution? Per Reid, it's universal coverage, which he says is "an essential tool to control costs and maintain the overall quality of a nation's health." He adds, "The administrative patchwork (of the American insurance system) makes everything about American medicine more complex and more expensive than it needs to be." And he says only a national government has an inherent stake in preventive care. In the U.S., consumers change insurance companies every six years, on average, negating any interest or responsibility by them for preventive care.

Looking at countries individually, he finds that the French go to doctors and take more pills than we do, yet their health care costs are about half of ours, per capita. In France, any resident can go to any doctor in the country; there are no "gatekeepers." Germany has one of the most expensive health care systems, but it is about 40% cheaper than the U.S. The government controls payments to doctors and hospitals. The basic model has been in place for 125 years. The Japanese consume health care like no other country, seeing doctors three times more than Americans, on average. Annual physicals are free, and residents expect to see a doctor without having to make an appointment. In Britain, all hospitals are owned by the government, and the British National Health Service is the largest employer in all of Europe. 85 percent of drugs are free of charge. Doctors do house calls, most health care is free, but there are waits to see doctors, and not all procedures and services are allowed. For example, there are no free annual physicals.

There is no room here to talk about Canada, Taiwan or Switzerland, or the out-of-pocket countries. And, you'll have to read the book to find out what advice each country gives him for his bum shoulder. I can tell you that there is quite a variety of advice given. The bottom line is that the book takes you on a quick trip around the world to look at various health care systems, how they work, what their pluses and minuses might be, and what features each might have that the U.S. could adopt to improve its system. But, as I mentioned above, in the end, he does not find a single country with the model in place for us. And, he does not give us a composite model of what we need to follow, based on his findings from other countries. Sadly, he admits that the task of doing this became harder than he initially thought it might be.

I highly recommend the book for its excellent core information and insight. The author, of course, did the excellent documentary for Frontline, called "Sick Around the World," which can be viewed in its entirety via the Internet. Watch that, if you don't get a chance to read the book.

A non-partisan, factual and well-researched book. Written by a true journalist who does his homework. Knows what he is talking about. To me, this one lays out the case well on why the US and this new administration in DC needs to really "redo" not just "revise" healthcare in America. Let's take our time and really get to the right answer. Not one that is just politically expedient for Obama and 2010 congressional election cycle. He's right it doesn't make sense that our healthcare system is so ineffective and costly - why does ours spend 20c of every dollar on non-medical stuff like paperwork, marketing, admin? Author also makes the point that socialized medicine terminology that has prevented true reform isn't actually true of foreign models. The US is more "socialized" than many of them already. This is a great book and must read if you care about the topic. (Learned a lot more reading this book than than watching the talking heads on CNN, Fox, etc.). BTW I have also read two other of Reid's books, Confucious Lives Next Door Confucius Lives Next Door: What Living in the East Teaches Us About Living in the West and The US of Europe The United States of Europe: The New Superpower and the End of American Supremacy - neither likely as popular given timing of this one - but both excellent reads and similarly well-researched.

This book is not for the demagogically susceptible town-hall scaredy-cat; more than one's limbic system is required to take it in! This book informs the reader about other health care systems around the world. It gives historical accounts of how these other systems evolved into universal coverage systems. The author fairly coveys the pros and cons of the surprisingly different approaches different countries have taken to arrive at universal health care for their citizens. France, Germany, UK, Canada, Japan, Taiwan, and Switzerland are examined. Oh, if we weren't so proud to be able to learn from others....

About a year ago, my mom was diagnosed with Hepatitis C. She contracted it from getting a tattoo, albeit unknown to her, that was put on by a tattoo artist who used a previously used needle. She's since been under the supervision of a doctor who's prescribed her the medicine that, hopefully, will treat/cure her disease. The problem is that the treatments that keep her alive are ridiculously expensive. Consider that when she lost her job due to budget cuts right around the time she was diagnosed, that she lost her health insurance. And her new company can't afford employee-backed health insurance in order to stay competitive w/other companies; she must buy her own, under the COBRA plan. It pays some, but not a lot of her medical expenses...

Therefore, she can't afford rent, barely gas or groceries. And if you're wondering why she doesn't get Medicaid, it's because she "makes too much" to qualify for it. Not to mention besides the point that she's a die-hard conservative that would do anything she could to save taxpayer's money. She's being faced with the dark reality that there's a good possiblity that in a few months, she won't even be able to afford the basic treatment and medication to treat her disease, and that she'll have to come off the medicine and treatment COMPLETELY.

I ask you, is this fair? Is it fair for my mother, the hardest-working, most dedicated Christian woman I know, to be treated like this? To not even afford the basic medicine that will keep her alive and in good health, so that one day, she can see her own kids graduate college, or have kids of their own? My answer is no. IT IS NOT FAIR. It's really not even a question of whether or not it's fair, so much as it is morally wrong. My mom has worked too hard and given too much for her family, and her country. It is beyond me why my mom is near bankruptcy because of medical bills... And it's even more frightening to realize that unless things change, my mom might not afford the care she needs to live. It's ridiculous. Every so often, there are nights that I cry myself to sleep stressing out over my mom's condition.... My mom deserves better. Our fellow AMERICANS deserve better....

We are the only nation in the modern industrialized world, among other free-market democracies that: 1) Doesn't cover every citizen in their basic health care needs, 2) Has the misfortune that if you lose your job, you lose your health insurance; just when you need it the most when you're finances are in disarray, 3) Makes a PROFIT on the basic health care needs of its citizens, to the point where people can't even afford it, and 4) where insurance providers/companies can CANCEL your current insurance, regardless of how long you've been paying into its, because you've contracted a disease/illness that in their eyes, equates to a loss of revenue due to the payouts they'll have to make for your care. So they kick you to the street...

Ask yourself, is this not just plain crazy? WHY are we not trying harder to overhaul a system that is so broken, that nearly 700,000 citizens go bankrupt every year because of it? Or that get health care that ranks, in terms of quality, at the bottom of every world health care ranking, particularly DEAD LAST in infant mortality and avoidable mortality- that is, deaths before age 75 from conditions that can be cured/treated with effective medical care? Or pay for care that is outrageously priced due to the HIGHEST administrative costs of any organization, company, business, charity in the world?

Our system is broken. We need to be humbe enough to realize, that as a total free-market health care system, it DOES NOT WORK. It's too costly, too inefficient, and denies it to the people that need it the most. We need to be humble enough to take a step back and try and find ways to fix it. Even if it means looking at other rich, free-market democracies, that are getting/got their health care systems right. And contrary to what the mainstream media/politicians/medical insurance providers would tell you, we don't even have to have a "socialized medicine"/ totally gov't run sytem to get better care...

Please, I beg you, if you sympathize with my story, or with others that share the same story, educate yourself on this topic. Turn off Fox News/ Glenn Beck/ Hannity, CNN, MSNBC/Olbermann, and read up on the facts.... not what the biased, partisan, fear-mongering media would have you believe.

The best source of information I've found is from T.R. Reid, the well-respected, non-biased, journalist from PBS and often times NPR. His approach on the topic is objective, non-biased, world-canvassing journalism. His first take was his series on PBS' Frontline, "Sick Around The World" (which is still on PBS' website). His new book, "The Healing of America" expands on his research/findings. An absolute MUST read for every American that cares how the health care reform debate is going to shake out.

This book is a must-read for anyone interested in the health care issue (which should include nearly everybody). T.R. Reid travels to several representative countries and explains from both a patient and a provider perspective how health care is actually delivered in those nations. He goes beyond the rhetoric to describe the nuts and bolts of how these other systems function, for example, what is like to actually sit in a doctor's office and receive care. The book also describes how two countries, Taiwan and Switzerland, recently managed a major overhaul in their own health care systems.

The major question that Reid asks throughout the book is why is it that the United States is the only wealthy industrialized nation that fails to provide good health care to all its citizens, why is it that we spend so much and yet still have such inequality and such poor outcomes. His book shows that there are alternatives, and that it is up to us to make the decision if we want to create to a health care system that is fairer, less expensive, and more effective than our current situation.