May 18th, 2009 
Guru Jim 
- ISBN13: 9781594202346
- Condition: NEW
- Notes: Brand New from Publisher. No Remainder Mark.
Product Description
Bestselling author T. R. Reid guides a whirlwind tour of successful health care systems worldwide, revealing possible paths toward U.S. reform.
In The Healing of America, New York Times bestselling author T. R. Reid shows how all the other industrialized democracies have achieved something the United States can’t seem to do: provide health care for everybody at a reasonable cost.
In his global quest to find a possible prescription, Reid visits… More >>
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. Rating: 5 / 5
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. Rating: 5 / 5
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.
Rating: 3 / 5
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.
Rating: 5 / 5
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.
Rating: 5 / 5