Food for Thought About Health Care Reform in a Book and a Song

Here are a couple of suggestions for those of you who might want to hear or read more about health care reform and related matters. A good friend of mine led me to check out Paul Hipp‘s sarcastic song, “We’re number 37” inspired by the World Health Organization (WHO)’s ranking of nations around the world. If you want to fact-check the song go to this article on PolitiFact.com truth-o-meter “The US ranks 37th in the world for health care.”

Abigail Zuger’s review (“One Injury, 10 Countries: A Journey in Health Care,” The New York Times, 9/14/2009) of T. R. Reid’s new book, The Healing of America, convinced me to buy it (my local library’s waiting list for this book seemed too long). I haven’t read it yet but according to Zuger and others (see the San Francisco Chronicle 09/23/2009 review “A Global Quest for Better, Cheaper, and Fairer Health Care“), it seems like a “must read.” Here are some excerpts from Zuger’s review.

[…] a chronic shoulder problem offered the opportunity for an unusually well-controlled experiment: Mr. Reid decided to present his stiff shoulder for treatment around the world. One shoulder, 10 countries. Admittedly it’s a gimmick, but what saves the book from slumping into a sack of anecdotes like Michael Moore’s 2007 documentary “Sicko” is a steel backbone of health policy analysis that manages to trap immensely complicated concepts in crystalline prose.“The Healing of America” blends subjective and objective into a seamless indictment of our own disastrous system, an eloquent rebuttal against the arguments used to defend it, and appealing alternatives for fixing it.

Mr. Reid starts with a methodical clarification of terms. First: universal health care. Far from a single socialized system, the various plans other countries use to cover all their residents are quite distinct. Some are as private as our own, and most offer considerably more in the way of choice.

In Japan, and many European countries, private health insurers — all of them nonprofit — finance visits to private doctors and private hospitals through a system of payroll deductions. In Canada, South Korea and Taiwan, the insurer is government-run and financed by universal premiums, but doctors and hospitals are private. In Britain, Italy, Spain and most of Scandinavia, most hospitals are government-owned, and a tax-financed government agency pays doctors’ bills. In poor countries around the world, private commerce rules: residents pay cash for all health care, which generally means no health care at all.

Similarly, what Americans often consider a single unique system of health care is an illusion: we exist in a sea of not-so-unique alternatives. Like the citizens of Germany and Japan, workers in the United States share insurance premiums with an employer. Like Canadians, our older, destitute and disabled citizens see private providers with the government paying. Like the British, military veterans and Native Americans receive care in government facilities with the government paying the tab. And like the poor around the world, our uninsured pay cash, finagle charity care, or stay home.

Our archipelago of plans means that those safe on a good island with good insurance can be delighted with the system, even as millions of invisible fellow citizens tread water or drown offshore. It means that those on a mediocre island are stuck there. It also means that not one single piece of the infrastructure — like record keeping, drug pricing and administrative costs — can be streamlined across islands in any meaningful way. Hence the expense, the inequity and the tragedy.

But the comparative merits of different orthopedic philosophies are secondary here: Mr. Reid’s attention is focused on a meticulous deconstruction of the history and philosophy of the policy decisions behind them. Among health policy narratives, this book’s clarity, comprehensiveness and readability are exceptional, and its bottom line is a little different from most. Instead of rationalization and hand-wringing, Mr. Reid offers an array of possible solutions for our crisis.[ …]