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.
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