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The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care Paperback – August 31, 2010
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A New York Times Bestseller, with an updated explanation of the 2010 Health Reform Bill
"Important and powerful . . . a rich tour of health care around the world." —Nicholas Kristof, The New York Times
Bringing to bear his talent for explaining complex issues in a clear, engaging way, New York Times bestselling author T. R. Reid visits industrialized democracies around the world--France, Britain, Germany, Japan, and beyond--to provide a revelatory tour of successful, affordable universal health care systems. Now updated with new statistics and a plain-English explanation of the 2010 health care reform bill, The Healing of America is required reading for all those hoping to understand the state of health care in our country, and around the world.
T. R. Reid's latest book, A Fine Mess: A Global Quest for a Simpler, Fairer, and More Efficient Tax System, is also available from Penguin Press.
- Print length304 pages
- LanguageEnglish
- PublisherPenguin Books
- Publication dateAugust 31, 2010
- Dimensions8.39 x 5.47 x 0.72 inches
- ISBN-100143118218
- ISBN-13978-0143118213
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"You don't necessarily realize it while you're reading, but you're talking Comparative Health Economics 101. With a really fun professor." —Daily Kos
"Not many writers of any ilk . . . can match T.R. Reid's ability to bring a light, witty touch to really serious topics—like health policy around the globe." —New America Foundation
9780143118213
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About the Author
Product details
- Publisher : Penguin Books; Reprint edition (August 31, 2010)
- Language : English
- Paperback : 304 pages
- ISBN-10 : 0143118218
- ISBN-13 : 978-0143118213
- Item Weight : 8.8 ounces
- Dimensions : 8.39 x 5.47 x 0.72 inches
- Best Sellers Rank: #75,385 in Books (See Top 100 in Books)
- #21 in Health Policy (Books)
- #49 in Health Care Delivery (Books)
- #72 in Sociological Study of Medicine
- Customer Reviews:
About the author

T. R. Reid is a longtime correspondent for The Washington Post and former chief of its Tokyo and London bureaus as well as a commentator for National Public Radio. His books include The United States of Europe, The Chip, and Confucius Lives Next Door.
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"The Healing of America" is a must-read book that seeks a cure for our ailing, unfair, and absurdly expensive health care system. Longtime correspondent for the Washington Post, commentator and accomplished author T.R. Reid masterfully goes on a global quest to find the answers to our failing system while simultaneously seeking a cure to his ailing right shoulder. This is one of the most enlightening books I have read on this highly-debated an incendiary topic. This excellent, informative 303-page book includes the following thirteen chapters: 1. A Quest for Two Cures, 2. Different Models, Common Principles, 3. The Paradox, 4. France: The Vital Card, 5. Germany: "Applied Christianity", 6. Japan: Bismarck on Rice, 7. The UK: Universal Coverage, No Bills, 8. Canada: "Sorry to Keep You Waiting", 9. Out of Pocket, 10. Too Big to Change?, 11. An Apple a Day, 12. The First Question, and 13. Major Surgery.
Positives:
1. A well-written, well-researched book on a highly-debated topic. Reid goes over the positives and negatives of each system in an accessible, even-handed, engaging manner.
2. Good use of charts to complement excellent narration.
3. Does a fantastic job of going over the four main health care models in existence around the world and some of it most popular combinations: Bismarck, Beveridge, National health insurance, and out-of-pocket.
4. Makes clear what the American health care system basically is throughout the book. "Americans generally recognize now that our nation's health care system has become excessively expensive, ineffective, and unjust."
5. Succeeds in developing a compelling thesis and works his way to superior solutions. "The thesis of this book is that we can find cost-effective ways to cover every American by borrowing ideas from foreign models of health care."
6. Makes it plainly clear. The American health care system is in reality a health care market. "For anyone with the money--or the insurance policy--to pay for it, American medical treatment ranks with the best on earth."
7. "The shortcomings of our system can be grouped into three basic problems: coverage, quality, and cost." Reid consistently references our system as it compares and relates to other systems around the globe. "All the other developed countries see to it that every person has a right to health care when necessary. We don't."
8. Some statements just speak for themselves and are a recurring theme. "The United States is the only developed country that relies on profit-making health insurance companies to pay for essential and elective care." And as a result..."The United States is the only developed country that allows insurance companies to refuse coverage to people for fear that they might get sick."
9. Introduces quirks in the American system that leads to unnecessary complexity, "The presence of countless different payers and fee schedules drives another unique feature of American health care: the cost shift." "The administrative patchwork makes everything about American medicine more complex and more expensive than it needs to be."
10. France is number one? "Whether or not you agree with the World Health Organization's conclusion that France has the world's No. 1 health care system, all the statistics on national health suggest that France rates near the top of the global rankings. France does a better job than almost any other country both in encouraging health and in treating those who get sick."
11. The three fundamental ways that the German health care system is different than ours.
12. The most prodigious consumer of health care, how their system works. "The Japanese system, in short, provides care to every resident of Japan, for minimal fees, with no waiting lists--and excellent results. This is a good deal for the people of Japan, and they take advantage of it, flocking to clinics and hospitals."
13. A comprehensive look at the British National Health Service system. "Free nationalized health care is such a basic part of British life today that not even the iron lady of British conservatism, Margaret Thatcher, ever dared take on the NHS."
14. The Canadian system. "The most distinctive lesson we could take, though, from Canada's health care system is the key point of the Tommy Douglas saga: Universal health care coverage doesn't have to start at the national level."
15. The reality of the out-of-pocket system. "This pattern also holds in the only wealthy country that uses the Out-of-Pocket Model for a significant portion of the population: the United States."
16. Great examples of countries that successfully overhauled their systems. "In the course of my global quest, I visited two countries that completely revamped their national health care arrangements: Switzerland and Taiwan. Both countries made a national commitment to provide health care to all. Having committed to universal coverage, both democracies were able to bring about the changes necessary to get there."
17. "THERE ARE TWO BASIC APPROACHES to the job of keeping people healthy: the Public Health Model and the Medical Model." How they differ.
18. Understanding the basic ethical questions of health care. "Your ethics, your sense of justice, determine how you distribute goods and services, including health care."
19. The five common American myths about health care systems overseas.
20. Includes an afterword chapter that briefly highlights "Obamacare".
Negatives:
1. It can get a little confusing. Jumping back and forth from different health care models is a little confusing. A reference table summarizing the four models and countries that apply such models would have been helpful.
2. No formal bibliography.
3. Some minor formatting issues visible in the Kindle but nothing major. A misspell (entities) here and a repeated word there (research).
In summary, this is one of the most enlightening books I have ever read. T.R. Reid does an outstanding job of educating the public on the four main health care arrangements around the world. He wisely uses his own ailing shoulder as a reference from which to compare how the various health care systems around the world (France, Germany, Japan, U.K., Canada, Switzerland, Taiwan and India) would address the issue. Most importantly, his global quest is a very successful one as it results in comprehensive answers on how to improve our American health care system. Outstanding book, get it!
Further recommendations: " How We Do Harm: A Doctor Breaks Ranks About Being Sick in America " by Otis Webb Brawley, M.D. with Paul Goldberg, " Landmark: The Inside Story of America's New Health-Care Law-The Affordable Care Act-and What It Means for Us All (Publicaffairs Reports) " by The Washington Post Staff, " Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer " by Shannon Brownlee, " Overdiagnosed: Making People Sick in the Pursuit of Health " by H. Gilbert Welsh, " Overdosed America: The Broken Promise of American Medicine " by John Abramson, " Selling Sickness: How the World's Biggest Pharmaceutical Companies Are Turning Us All Into Patients " by Ray Moynihan, " Unaccountable: What Hospitals Won't Tell You and How Transparency Can Revolutionize Health Care " by Marty Makary, M.D., " Catastrophic Care: How American Health Care Killed My Father--and How We Can Fix It " by David Goldhill, " Sick: The Untold Story of America's Health Care Crisis---and the People Who Pay the Price " by Jonathan Cohn, " Complications: A Surgeon's Notes on an Imperfect Science " by Atul Gawande, and "Every Patient Tells A Story" by Lisa Sanders, M.D..
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.
Top reviews from other countries
Gran aprendizaje de los sistemas médicos y lecciones aprendidades de como otros paises hacen funcionar las cosas
He provides an interesting round the world tour of national health care systems (and sometimes non-systems) showing for example how the French “Carte Vitale” carries a citizens entire medical history – cutting out a mass of expensive medical bureaucracy. The doctor simply slips the card into a reader and has access the patients full history right on the screen.
In Canada a single payer national (or provincial) system allows the government to tightly control all medical cost across the country, with the result that Canadians have the same average level of health as Americans at about half the cost per person.
Reid continues with the examples, making it clear that US healthcare is a disaster on any kind of cost/benefit basis, and what is even worse, he shows the US even failing on basic measures of healthcare output such as infant mortality or the DALE rating (How long an average person can expect to live without serious illness or disability) with the US in 24th position behind most developed countries – despite its sky-high spending.
He quotes Henry Aaron of the Brookings Institution who said, “I look at the U.S. healthcare program and see an administrative monstrosity....”, with the reality being a fine collection of medically related special interests snuggly hooked into, and exploiting a corrupt political process. Like much else to do with the United States government, special interests are looting and impoverishing the country.
So maybe American healthcare is just one example among many, as a well connected élite live in a bubble with world-class service, while the great unwashed (general public) get on a best they can, i.e. T.R.Reid's pessimism is fully justified.
著者は、日本では、最高の医療水準を、最高のアクセスで、最低の料金で受けられることを何度も強調して述べています。そして、そのしわ寄せを受けているのが医者と病院であり、瀕死の状態であることを述べています。
日本のことを書いた部分の最後を引用しておきます。
Our country(米国のこと)spends too much on health care and gets too little in return; Japan gets lots of health care but probably spends too little to make its exellent system sustainable.
このように、せっかく素晴らしいシステムなのに、医療にかける金をけちっていたらシステムが持続可能じゃなくなるといっています。そして、日本の医療従事者と病院については以下のように述べています。
THE BIG LOSERS in the Japanese health care system, the people who come out worst, are the providers of health care--doctors, nurses, therapists, and hospitals.












