The Healing of America

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

By T.R. Reid
(Penguin Press; 277 pages; $25.95)

Whether journalist T.R. Reid's new book, "The Healing of America," will influence the high-stakes health care debate this fall remains to be seen, but he makes a compelling case that an efficient, effective universal health care system is not pie in the sky.

He reports that every industrialized democracy, except the United States, has figured out how to provide insurance and basic health care to virtually all of its citizens, and argues that the United States should borrow and adapt successful ideas from other countries. In practice, none of these health care systems is problem-free, Reid makes clear, and nearly everywhere escalating costs are a major challenge. But every industrialized democracy spends a far smaller percentage of its wealth on health care than does the United States and gets better results according to standard measures such as life expectancy after birth (the United States ranks 47th) and infant mortality (22nd).

In the United States, more than 40 million are uninsured, a harsh, anti-democratic reality that appalls Reid. In a hypothetical example, he compares two American mothers who are single parents - a well-compensated executive with employer-provided health insurance and a hardworking domestic who has no health insurance but makes too much to qualify for Medicaid. When both women begin to experience symptoms of illness, the woman with health insurance goes to the doctor, and tests reveal early-stage ovarian cancer. She is treated successfully and lives to enjoy her grandchildren. The other woman, fearful she cannot afford out-of-pocket costs for a doctor and tests, delays going for treatment until the symptoms are unbearable. She does not survive her ovarian cancer, and her daughter becomes an orphan. Compared with other democratic countries, only in America are such inequities commonplace.

For this book, which is a lucidly written medical travelogue, Reid visited a dozen countries. At each stop, we get an opening glimpse of the country's medical system and priorities when Reid seeks treatment for his chronically stiff and sore right shoulder. Treatment options ranged from an expensive and possibly ineffective shoulder-joint replacement in the United States, to the Tibetan-trained doctor in Nepal who told Reid: "[I] wouldn't begin a diagnosis of your shoulder until I had tasted your urine. It tells me so much about a patient's health status."

Among the industrialized democracies, there are various concepts for extending medical insurance to all citizens, Reid informs us. Some countries have incorporated elements of the 19th century German model where employers provide insurance to workers and the nonprofit insurance plans pay private medical care providers. In Canada, the single-payer national system is reminiscent of our Medicare program in which the government pays private providers. Here in the United States, veterans who receive medical care at Veterans Affairs hospitals are in a system similar to Britain's National Health Service, in which the government owns the hospitals and pays for it all through taxation.

Regardless of the different concepts, there are two major reasons, Reid maintains, for the comparatively much higher cost of health care in this country. One is that we have a complex, fragmented system. The other, Reid stresses, is that "the United States is the only developed country that relies on profit-making health insurance companies to pay for essential and elective care."

If Reid had a magic wand, he would get rid of profit-making health insurance companies. If we followed the example of other democracies, as Reid's medical travelogue shows, the federal government would cut the fees and payments to other players in the health care system to extend health insurance coverage to all Americans.

When it comes to the next round of debate this fall in Washington on the future of our health care system, Reid believes in this important book that the Golden Rule can trump the cynical adage, "He who has the gold rules." Maybe, but only if President Obama, who promised major health care reform, is willing to take on the health insurance and drug companies - and, most important, to arouse millions of Americans to demand reform