Rebecca'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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's review
Mar 29, 2010

it was amazing
Read from March 27 to 29, 2010

Read. This. Book.

It's a quick read, so quick you won't believe the amount of information it contains. It's also an easy read. With the central framing device of visiting individual countries to see their recommended course of treatment for a bum shoulder, Reid avoids a lot of dry fact-finding that might plague other books of its kind. Along the way he recounts the health care history of each country (France, Germany, England, Japan, Canada, and India) as well as outlining major points about health care in general.

There are four major types of health care systems:

1. The Beveridge Model - The UK is the prime example. The government pays for everything and it owns everything with doctors as government employees. Health care is a public service like a library or fire department.

2. The Bismarck Model - Began with Germany and spread. Everything is private - both providers and insurers but with heavy regulations that ensure fixed fees and the providers themselves only exist to pay medical bills (i.e. non-profit).

3. National Health Insurance - What we have here in Canada. The government is the insurance company. From a single point of payment, it's easy to set prices. Also not for profit. (Do you see a trend here?)

4. Out of Pocket - What everyone outside of the industrialized world has, excepting the uninsured in the US. Care costs whatever the provider says it costs and you pay for it yourself if you can. If you can't, no care for you.

The US likes all of these models so much it couldn't pick just one so you get to have all four! This means that prices are all over the place and administrative costs are somewhere around 20% of every dollar paid into the system. By contrast, most other countries with a health care system spend about 10% or less on administrative costs.

All of the vignettes about the individual countries are interesting as well. France's carte vitale sounds awesome - I really hope Canada gets its own centralized, electronic medical filing system eventually. In Japan, there's no waiting even though the Japanese apparently love their health care so much that they show up 14 times a year on average for it all the while lingering in hospital longer anyone would ever dare in the West. England's NHS doesn't want you to pay any bills and it also wants you to keep a stiff upper lip when dealing with petty, niggling problems like a bad shoulder. Canada...well, Canada could use some improvements.

Apparently, a Supreme Court (of Canada) ruling has come down in the case Chaoulli v. Quebec saying that yeah, actually, long wait times are in fact a violation of the Charter of Rights and Freedoms - long waits for care are in essence a denial of care and telling people they can't spend their own money for care is unconstitutional. The repercussions of this have not yet been realized for the entire country because the ruling only stands for Quebec right now, but I'm hoping that we'll see some changes soon. I think Canada should allow people to pay for care even though it creates the dreaded two-tier system. One of the main things people line up for here are orthopedic consultations and surgeries. While they may not be an emergency, loss of mobility and pain are still not something to take lightly.

In the end, while different countries have different methods of administering their care, they all stick to a few general rules:

1. Universal Coverage - Everyone is covered regardless of health or age. You cannot be denied care or insurance.

2. Individual Mandate - everyone must buy insurance. Germany allows the richest to opt out of the system but they usually don't. England allows private insurance but only a few people take advantage.

3. The system is there to care for people, not make money.

4. Doctors aren't usually under the burden of giant student loans or crushing malpractice premiums. Most of the doctors in the countries examined had their schooling paid for by the government or (in Canada's case) the tuition is a fraction of what it is in the US. A year's worth of malpractice insurance for other places is about the same as a week's worth for the US and the doctors do not expect to be sued.

5. Everyone still bitches about their own country's medical system even if it's #1.

There's a lot more covered in the book everything from myths about the US system to the role of preventive medicine and keeping costs down. Sadly, Reid's conclusions about what would be best for the US do not match up to the bill that has passed, but maybe once everyone is used to the idea of universal coverage it can be overhauled to a greater extent.
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