Bram's Reviews > The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care

The Healing of America by T.R. Reid
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Sep 23, 09

bookshelves: 2009, medicine
Read in September, 2009

As I set out to write something about this book, I realize that I don't have much input or interest in reviewing nonfiction books. Or maybe just nonfiction books whose primary goal is to educate the reader on some specific issue. That's what The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care is, and Reid does an excellent job of achieving this goal. And by the way, when are we going to decide whether health care is two words or one? This indecisiveness, similar to America's own inability to conclude whether we actually care if tens of thousands of people die every single year because (and only because) they didn't have health care, frustrates me. To paraphrase Princeton health care economist Uwe Reinhardt, "Each country's health care system reflects a nation's basic cultural values." Reading this book and seeing the comparisons to other rich countries, I suddenly realized that the United States is holding onto a fundamental cultural/political/moral/economic viewpoint on health care that is simply out of date, particularly on moral grounds. This probably won't become truly obvious to Americans for a couple of decades (probably around the same time that we realize how ridiculous it is that we still discriminate willy-nilly based on sexual orientation), but let's just say that history won't look unfavorably only at our ridiculous warmongering.

So we're just about almost maybe kinda sorta at the point where we have the political will to cover all Americans with health insurance. That's a start, I suppose. Reid's book examines the health care systems of a number of rich, developed countries to see what we can take from them and also to break up a few myths along the way. The countries he looks at are the UK, France, Germany, Japan, Canada, Switzerland, and Taiwan. All of these countries cover everybody, and only the UK (and maybe Canada, as long as you also call American Medicare "socialized") is really "socialized medicine"--as in, the government pays for and delivers the the health care (insurance and docs are government employees). These countries also spend about half as much on health care as the US (17% of GDP; Switzerland is second in spending at 11%). In many cases they are more privatized than the US, which has public (or partially public) systems for Native Americans, the elderly, (some of) the poor, veterans, those with end-stage renal disease, et al. Needless to say, this doesn't add up--we spend much more to get much less. The US does worse than almost every other developed country in every single measurable health care criterion except for delivery (i.e. our medical professionals give great care as long as you have good insurance and good access--here, we're number 1 according to the WHO).

Reid shies away from outlining solutions, and surprisingly, I found this to be a strength of the book. By just setting out the facts about the health care systems of the US and other rich countries, some of the conclusions become OBVIOUS. For example, 20 cents on every dollar we spend on health care (our premiums) does not go to purchasing actual health care. A small portion (3-5%) is for administrative costs, and the rest goes to insurance company profits (to pay CEOs millions, please shareholders, etc.). Yes, we are the only country with for-profit insurance (even Switzerland gave this up in the 1990s). Baucus's health care plan would mandate that Americans buy insurance…from for-profit insurance companies. Let that sink in for a minute, and this should piss you off regardless of your political bent. Now, a public option (with, say, 5% overhead) would obviously force these companies to clean up their act, but why not just follow the German/France/Japan model (all of whom have only private insurance and private doctors) and mandate that insurance companies be non-profit? Otherwise, we will continue to have insurance companies whose modus operandi is to screw people over (i.e. it saves money to drop people with chronic conditions or to refuse to pay for certain procedures). To have a system set up where health care payers are incentivized to NOT pay for your health care needs is simply perverse. And if you cut this out, you get the added benefit of lowering health care costs significantly (premiums will automatically drop 15%). Add a real choice option, where Americans can pack up and move companies at will, and you suddenly have a privatized system with greater cost-containment and universal coverage. If insurance companies must cover everyone, then suddenly they'll actually start caring about preventative medicine and keeping their customers healthy, and they'll also have incentive to wrestle with technology/pharmaceutical companies to cut prices on prescription drugs. Everybody wins (except for-profit insurance companies/Pharma) and you never have to hear the term "socialized medicine" again. Obviously there are lots of details to be dealt with (such as cutting down on unnecessary procedures/tests), and it's almost impossible to convince our politicians to go against big business at this day and age, but there are good options on the table if we have the political will.

Well, I started out saying I didn't know how to review this book, and I guess that's still true. While this ended up taking the form of a sermon, the background information, numbers, and basic ideas came out of Reid's book at least. If you've been wanting to get a better understanding of this issue for a while, you can't go wrong here--this book is clear, succinct, and highly readable. The only down side is that it will increase your frustration with health care politics ten fold.
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Comments (showing 1-50 of 55) (55 new)


message 1: by Stephen (new)

Stephen Bram, for a man who doesn't like to review non-fiction, I'd say this was one hell of a good review.


message 2: by Bram (last edited Sep 23, 2009 07:10PM) (new) - rated it 4 stars

Bram Thanks Stephen--I think this issue is just too big for a reasonable-length review...


message 3: by trivialchemy (new)

trivialchemy So, I don't understand.

Are you, or are you not, a socialist?


message 4: by Bram (last edited Sep 24, 2009 09:14AM) (new) - rated it 4 stars

Bram Must I commit? When it comes to health care, I think I'm more of an idealistic pragmatist (if that isn't a contradiction in terms). There's no evidence anywhere that health care works within a for-profit capitalistic framework, particularly if you're interested in adequately covering everyone, which I am. Switzerland tried and failed, and we're trying and failing.

I think it's much more likely that the US would adopt the Bismarck model and keep everything privatized and non-profit than the Beveridge model that we currently use in the VA system. So I generally focus on the former, although I think the latter would work well also.


message 5: by Stephen (new)

Stephen If I had health coverage this disease eating my spine wouldn't have developed to the point I can barely walk. As I understand it, the UK system is still a system of best money gets best medicine.


message 6: by trivialchemy (new)

trivialchemy Bram wrote: "Must I commit? When it comes to health care, I think I'm more of an idealistic pragmatist (if that isn't a contradiction in terms). There's no evidence anywhere that health care works within a fo..."

pinko bastard



message 7: by Stephen (new)

Stephen I feel so left out.


Bram Yes, in the UK you can opt out of the NHS and get your own top-of-the-line private care. 3% of the country does this.


message 9: by trivialchemy (new)

trivialchemy Stephen wrote: "I feel so left out."

you're a pinko bastard too, Stephen.


message 10: by Bram (new) - rated it 4 stars

Bram Better a pinko bastard than a heartless one :)


message 11: by trivialchemy (new)

trivialchemy Bram wrote: "Better a pinko bastard than a heartless one :)"

now you just sound like my ex-girlfriends


message 12: by Stephen (new)

Stephen Now I don't feel so left out. How many ex-girlfriends do you have Werewolf Isaiah?


message 13: by Stephen (new)

Stephen Why don't you both go read my review and vote on it, you pinkos


message 14: by Bram (last edited Sep 24, 2009 09:39AM) (new) - rated it 4 stars

Bram Well, as I incoherently laid out above, we can actually become more privatized while covering everyone and cutting costs. But it requires going non-profit with insurance, which, considering the way incentives are set up now, is a moral imperative.


message 15: by Stephen (new)

Stephen Bram has gone Kant on us. Now I feel the call to do my duty.


message 16: by Bram (last edited Sep 24, 2009 09:46AM) (new) - rated it 4 stars

Bram Which review are you speaking of, Stephen?


message 17: by Stephen (new)

Stephen Bram wrote: "But it requires going non-profit with insurance, which, considering the way incentives are set up now, is a moral imperative."

That one.



message 18: by Joshua Nomen-Mutatio (last edited Sep 24, 2009 09:51AM) (new)

Joshua Nomen-Mutatio Where's that big red button for me to push that turns the global socio-economic model into Swedish and Danish versions? Anyone seen that thing lying around lately?

I've recently taken up a label for myself on these issues, and am almost to the point where I'll get the decoder ring and bumper sticker--this is mostly metaphorical of course, unless they really have social democracy (not to be confused with democratic socialism) decoder rings in which case, sign me up.


message 19: by Bram (new) - rated it 4 stars

Bram Stephen wrote: "Why don't you both go read my review and vote on it, you pinkos"

Stephen, I meant this review :)


message 20: by Stephen (new)

Stephen No no, I meant my review of Dying Light. It should have come through your feeds, but I'm probably not listed as a top friend sniff sniff. hehehehehe

As far as your review goes, I was the first to comment.


message 21: by trivialchemy (new)

trivialchemy I'm lost.

And no vote-whoring!


message 22: by Stephen (new)

Stephen You keep saying that. Yet you never even read my reviews. I have to whore. I'm cheap and dirty, you should like that about me.


message 23: by Bram (new) - rated it 4 stars

Bram MyFleshSingsOut wrote: "Where's that big red button for me to push that turns the global socio-economic model into Swedish and Danish versions? Anyone seen that thing lying around lately?

I've recently taken up a label ..."


I need to look into this more...thanks for the link.

What are your thoughts on American health care specifically?


message 24: by trivialchemy (new)

trivialchemy I specifically avoid reviews that have been vote-whored. It's visceral.

Also, what's the big deal with the votes? The review is the review, man. You've exerted your will over a problem, a piece of art, and parametrized it through your personality. That's an accomplishment. Gaze upon your review with satisfaction, with contentment. See what you have done! See how mighty is man! Contrary to what some would have you believe, there is no popularity contest here that I am aware of.


message 25: by Stephen (new)

Stephen I just someone to read it. How else do I know?


message 26: by Bram (last edited Sep 24, 2009 11:00AM) (new) - rated it 4 stars

Bram Isaiah wrote: "I specifically avoid reviews that have been vote-whored. It's visceral.

Also, what's the big deal with the votes? The review is the review, man. You've exerted your will over a problem, a piece o..."


Well-said. Considering how many books I've read of which I remember so little, I find that reviewing is a great way to force the memory into action (while I can still do so). Hopefully, with the extra processing I had to do to spit out a review in addition to having the ability to go back to the words themselves, I'll be able to remember more of what I read down the line. And I get a real kick out of making connections between books, recognizing allusions, etc. while I'm reading.

Reviewing also leads to great discussion, which is the best part of this site.


message 27: by Bram (new) - rated it 4 stars

Bram Stephen wrote: "I just someone to read it. How else do I know?"

I just read it, and you earned it Stephen, although I can't say that the subject matter is really enticing---you have much wider interests than I do, I'm afraid.


message 28: by Stephen (new)

Stephen Well it sure doesn't on my reviews because no one reads them. That is my point. I only know if someone has read it by a vote. No one ever says anything beyond "nice review."


message 29: by Chris (new) - added it

Chris Well, if someone said "nice review," I think it would be reasonable to assume he read it.


message 30: by Stephen (new)

Stephen Thank you Bram.


message 31: by Stephen (new)

Stephen That's true Chris. Thank you.


Joshua Nomen-Mutatio Bram wrote: "What are your thoughts on American health care specifically?"

That we should join the ranks of the rest of the "first world" and stop allowing people to suffer and die needlessly while we pay more money per capita than any other nation for health care, while paradoxically having one of the worst health turnouts, etc, etc. The usual (and important) liberal spiel.

Slightly more specifically, I support something at least along these lines:

http://www.pnhp.org/


message 33: by Joshua Nomen-Mutatio (last edited Sep 24, 2009 11:24AM) (new)

Joshua Nomen-Mutatio Bram wrote: "Reviewing also leads to great discussion, which is the best part of this site."

Amen, brother Bram!


message 34: by Bram (last edited Sep 24, 2009 11:43AM) (new) - rated it 4 stars

Bram MyFleshSingsOut wrote: "Bram wrote: "What are your thoughts on American health care specifically?"

That we should join the ranks of the rest of the "first world" and stop allowing people to suffer and die needlessly whil..."


This sounds about right. I've believed this for a while, but now I'm finally looking into it enough to get some concrete specifics down. Our system is so twisted.


message 35: by Ben (new)

Ben Bram for public office!


message 36: by Bram (new) - rated it 4 stars

Bram For those who have been using this site for a while, do you find that it helps you remember more of what you read? I guess there's no good way to make a comparison (i.e. no control group), but I'm interested just the same.


Jackie "the Librarian" Yes, writing reviews does make the books stick in my memory better, Bram. It engages more of the brain to formulate and write a review, than just reading ever does.


message 38: by Bram (new) - rated it 4 stars

Bram Good to hear--that definitely backs up my hypothesis. I feel that many of the books I read in high school, for example, were "wasted" because I no longer remember them. This can't entirely be true, though, because I suppose that the act of reading them improved my literacy/knowledge/etc. Be that as it may, I still can't remember much of them. I'd like to be able to read as many previously unread books as possible while still remembering what I've read, rather than having to go back and reread certain books every 10 years or so (although I may want to do this anyway).


Joshua Nomen-Mutatio Bram wrote: "This sounds about right. I've believed this for a while, but now I'm finally looking into enough to get some concrete specifics down. Our system is so twisted."

And that's a really great thing. Unfortunately such a large part of the battle is convincing many people that there's even a solvable problem or that universal health care is the morally-superior position worth finding a means to an end for. So proponents have to efficiently split their attention in at least these two directions.


Joshua Nomen-Mutatio Being on this site alone has reminded me of tons and tons of books I'd completely forgotten about reading. I don't write enough reviews, especially even remotely in-depth ones. I need to learn how to write as much in my reviews as I do in the comments sections. I guess I just feed off of conversation more and when I finish a book most of the time I feel like my review wouldn't do the book justice (especially if it's complex non-fiction, which is mostly what I read these days) but I should just get over that, I think.


message 41: by Bram (new) - rated it 4 stars

Bram If there was a "Best Commentor" ranking system, you'd be doing pretty damn well.


message 42: by trivialchemy (new)

trivialchemy Bram wrote: "If there was a "Best Commentor" ranking system, you'd be doing pretty damn well. "

Ha! Agreed.

I have the same problem as MFSO. Especially with really great and complex books, I'm really at a loss as to what I could say after I finish. Some people are very good at digesting and then venting a personal response to all this complex material, but for me it just sort of sinks in. There's no real big need to talk or explain that I have after I finish reading something. I just sort of sit there. But hearing people say something I agree with or disagree with, that makes me want to speak up.


Joshua Nomen-Mutatio Thanks, Bram.


message 44: by Joshua Nomen-Mutatio (last edited Sep 24, 2009 12:55PM) (new)

Joshua Nomen-Mutatio MyFleshSingsOut wrote: "Thanks, Bram."

...and Isaiah (cross-post there).


message 45: by Bram (new) - rated it 4 stars

Bram Well, I'll make sure to ask pointed questions in your comment sections so as to tease all the brilliance out of you guys.

This day is turning into a huge love-fest. I blame David.


Joshua Nomen-Mutatio Nothing brings people closer together than a little Yanni and Throbbing Gristle.


message 47: by Chris (last edited Sep 24, 2009 01:05PM) (new) - added it

Chris You don't need to thank me, MFSO, but I agree with Bram and Isaiah.

Actually, all three of the people named in the above sentence bring a whole hell of a lot of brilliance to this site, whether it be in reviews or in the comments to reviews. In fact, I can often stick with a multiple-comment thread better than a long-ass review, so if you guys just want to keep saving your brain dumps for the comments, that's fine by me.

I guess what I'm trying to say is that I love you guys and want to be invited to the Motel 6.


message 48: by trivialchemy (new)

trivialchemy Chris wrote: "I love you guys and want to be invited to the Motel 6. "

Only if you bring your mom.


message 49: by Stephen (new)

Stephen I guess I don't read important enough books. But I'm still going to the Motel 6.


message 50: by Chris (new) - added it

Chris You seem like a nice enough guy, Stephen, but your "Woe is me" routine is bringing me down, man.

Buck up, little camper.


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