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

T.R. Reid

4.25 · Rating details · 6,434 ratings · 768 reviews

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 wealthy, free market, industrialized democracies like our own—including ...more

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Hardcover, 277 pages

Published August 20th 2009 by Penguin Press (first published 2009)

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Dec 07, 2010 Alex Templeton rated it really liked it

This was one of the most infuriating books I've ever read. This was not because the book was bad, but because the points it laid out were so smart that I can't believe our policy makers and our population can really be so ignorant as to, well, ignore them. Reid visited different countries around the world that offer universal health care to their citizens. He discovers, in a nutshell, that not only are these systems not "socialist", but that they are far more efficient and cost-effective than an ...more

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Sep 11, 2009 Bram rated it really liked it

Shelves: 2009, medicine

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 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. ...more

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Apr 06, 2018 Wen rated it really liked it

This book was published in 2009. yet the author’s major findings still apply today. Strongly recommend for anyone interested in U.S healthcare reform.

The author T.R. Reid travelled to a number of developed countries, France, Germany, Japan, UK, Canada etc. to personally experience their respective healthcare systems, then compare and contrast with that of U.S.
Unlike U.S, these countries all offer some form of universal healthcare (UHC) that covers everyone, and yet they all spend remarkably l This book was published in 2009. yet the author’s major findings still apply today. Strongly recommend for anyone interested in U.S healthcare reform.

The author T.R. Reid travelled to a number of developed countries, France, Germany, Japan, UK, Canada etc. to personally experience their respective healthcare systems, then compare and contrast with that of U.S.
Unlike U.S, these countries all offer some form of universal healthcare (UHC) that covers everyone, and yet they all spend remarkably less as a percentage of GDP. (According to the latest OECD report, U.S spent 17% of GDP in 2016 on healthcare, whereas the countries mentioned above all printed about 12% or less)
So, I followed Mr. Reid on his quest to find out why U.S underperformed the UHC cohort. To get more nuanced finding, Mr. Reid used to seek some relief for his ailing right shoulder as his cover. Ironically, he ultimately found his relief needed in, of all countries, India, where he paid for his treatment all out of his own pocket.
Mr. Reid witnessed that patients resided in the UHC cohort usually had better choices of doctors. Longer waits were cited in some countries, but mostly for non-urgent procedures.

The major flaw of the U.S system is that most of the health insurance companies are for-profit entities who answer primarily to their stockholders, while their counterparts in the UHC cohort are not-for-profit entities. Incentives drive human behaviors, so it’s not difficult to see why the former reduce costs by avoiding sicker patients and denying even legitimate patient claims, and the later do so primarily by improving operational efficiency.
The U.S healthcare system is also a knotted mess of all four major healthcare system types (shown below), while each country in the UHC cohort primarily uses one unified system.

-BISMARCK MODEL providers and payers are private entities Germany, Japan, Switzerland Employer-provided coverage in U.S
-BEVERIDGE MODEL Health care is provided and financed by the government through tax payments, at no cost to the patients. UK, Italy, Spain VHA (for veterans) in U.S
-NATIONAL HEALTH INSURANCE MODEL The providers of health care are private, the payer is government-run insurance that every citizen pays into. Canada, Australia, Taiwan Medicare (for seniors and the disabled) in U.S
-OUT-OF-POCKET MODEL Most medical care is paid for by the patient, without insurance or government plan. Most developing countries The uninsured (about 12% of American in 2017)

On the cost side, U.S doctors sit in the privileged millionaire club, while those in the comp group mostly belong to the cozy middle class. High medical school tuition and medical malpractice insurance premium partially explained the huge doctor earning gap. Additionally, U.S health insurers run several times higher administrative cost as a percentage of premium; they have to spend more money not only to deal with drastically varied prices for the same procedure, but also hiring staff particularly to deny paying for treatments. In the comp group, the price and coverage of a procedure is usually pre-determined and identical across the country or the locale.

The author cited two recent cases, Taiwan and Switzerland, that successfully overcame the political hurdles and adopted universal healthcare. Based on that, he argued that the similar reform is possible in the U.S. Unfortunately, the last 9 years since the book’s publication has given us more than enough data points to rebuff his idealistic conclusion.
That said, I do agree with Mr. Reid that Coverage should be address before cost. Universal equal coverage will require individual mandate. I would add that disintermediation to simplify healthcare supply chain and digitalization of healthcare records are the lowest hanging fruit for now.

The categorization of healthcare systems, and the real-life demonstration of their pros and cons are the main takeaway of this informative book. It also included very enlightening conversations with the doctors in each country, and even gave a brief history of how each country’s healthcare system came about. ...more

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Aug 30, 2009 Julie Christine rated it it was amazing

Recommended to Julie Christine by: Fresh Air podcast

Shelves: social-political-commentary, best-of-2009, read-2009

The upside of reading this book is that you will walk away with a clearer understanding of how different models of health care work, how massive reforms in health care have been undertaken recently and with success, and you will have the knowledge to debunk myths many Americans hold about health care systems outside of the United States.

The downside of reading this book is that you may walk away and want to keep on walking- directly north to Canada, or to don your fins and cross the Atlantic or The upside of reading this book is that you will walk away with a clearer understanding of how different models of health care work, how massive reforms in health care have been undertaken recently and with success, and you will have the knowledge to debunk myths many Americans hold about health care systems outside of the United States.

The downside of reading this book is that you may walk away and want to keep on walking- directly north to Canada, or to don your fins and cross the Atlantic or Pacific to join the ranks of those who receive excellent health care at minimal or no out-of-pocket costs.

All of this, offered in 275 pages of succinct, clear and fascinating text. Anyone familiar with T.R. Reid's NPR commentaries as a correspondent in Japan and the U.K or his articles in the Washington Post will recognize his warm, engaging, self-effacing tone that is both professional and inclusive.

Rather than prescribing solutions, Reid's central theme is that we can and must learn by example. There is nothing in universal coverage that precludes competition, choice, and access. It is highly probable that universal coverage would result in the United States spending less and providing better care, while increasing the quality of life and life expectancy of all. As a portion of GDP, the US spends significantly more than the nations featured in this book, yet ranks well below in life expectancy, and measures of quality, fairness and progressive financing of health care.

Reid demonstrates again and again that the primary difference in the approach to health care between the United States- the only free-market, industrialized nation that relies on an out-of-pocket model- and those which offer universal coverage is a moral one. The countries he features have made the decision that access to health care is a basic human right and that government has a moral imperative to provide the same standard of care to all of its citizens, regardless of economic status.

On the other hand, the United States has determined that only those who can afford health care have a right to it. We continue to support systems (insurance companies) that ration care, cherry-pick their consumers and routinely deny coverage to those who pay into their system, all while placing the burden of coverage on employers. Reid posits that medical facilities and the training of medical personnel in the United States are the best in the world. Too bad over 20,000 Americans die every year because they cannot access this superiority.

We are foolish enough to listen to the pundits and talk-radio celebrities who decry "socialized medicine" without acknowledging that our nation's soldiers, veterans, Native Americans and those over 65 are all provided for by government-run, government-funded health care systems, one of which (Medicare) is a replicate of the Canadian system from which it takes its name.

To those who may think that Reid is preaching to the choir, be assured that he paints a "fair and balanced" picture. The long waiting lists for specialized care in Canada and the underfunded facilities in Japan are two examples of significant stumbles in universal coverage.

There is a bitter irony in pointing out that the same fearmongerers who warned that American life as we know it would be jeopardized if we did not pursue war in Iraq and continue it in Afghanistan are the same voices who cry out that the sky will crash down if we restructure our system to provide an equal standard of and access to health care for all our citizens. The immorality of these brutal stances makes me sick.
...more

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Nov 19, 2012 Eric_W rated it it was amazing

Shelves: current-affairs, economics

"On September 11, 2001, some three thousand Americans were killed by terrorists; our country has spent hundreds of billions of dollars to make sure it doesn’t happen again. But that same year, and every year since then, some twenty thousand Americans died because they couldn’t get health care. That doesn’t happen in any other developed country. Hundreds of thousands of Americans go bankrupt every year because of medical bills. That doesn’t happen in any other developed country either."

This is pr "On September 11, 2001, some three thousand Americans were killed by terrorists; our country has spent hundreds of billions of dollars to make sure it doesn’t happen again. But that same year, and every year since then, some twenty thousand Americans died because they couldn’t get health care. That doesn’t happen in any other developed country. Hundreds of thousands of Americans go bankrupt every year because of medical bills. That doesn’t happen in any other developed country either."

This is probably a book everyone should read. It's a dispassionate look at health care systems throughout the world as Reid travels from one country to another to see how his shoulder would be treated and under what circumstances. To start a couple of basic facts: "most rich countries have better national health statistics—longer life expectancy, lower infant mortality, better recovery rates from major diseases—than the United States does.Yet all the other rich countries spend far less on health care than the United States does. . . .Among the world’s developed nations, the United States stands at or near the bottom in most important rankings of access to and quality of medical care. The Japanese go to the doctor more often than anyone else, yet their system costs only $3,400 per person; in the United States the cost is $7,400 per person annually. In Canada, the nation has decided that to be the most fair, people should have to wait equally. In Britain, the priority is that all health care should be free to everyone.

He begins by identifying the four basic types of mechanisms to pay for health care in the industrialized world. (He discounts the third world since those are all basically pay-as-you-go and available only to the rich.) Conventional wisdom tells us that these other countries depend on "socialized" medicine, yet that is incorrect. Ironically the only pure socialized medical systems exists in Cuba and the United States' VA system which is totally government funded, doctors are paid and employed by the government and veterans pay nothing for its services. Other countries are all a mix of private and public. How they are structured is related to the country's moral fabric.

The four systems are the Bismarck (a mix of public and private as in Japan, Germany, and Switzerland); in the Beveridge model there are no medical bills; rather, medical treatment is a public service, like the fire department or the public library, hospitals and clinics are often owned by the government; some doctors are government employees, but there are also private doctors who collect their fees from the government. These systems tend to have low costs per capita, because the government, as the sole payer, controls what doctors can do and what they can charge. The British system is based on the Beveridge model. Canada's system is the third type, a national insurance plan which has elements of both Bismarck and Beveridge. The providers of health care are private, but the payer is a government-run insurance program that every citizen pays into. The last system is the pay-as-you-go in which there is no insurance and people pay for service out of their own pockets.

The United States has a mix of all. For those under sixty-five is a modified Bismarckian system for those lucky enough to be employed and have an employer-based system. Those over sixty-five have Medicare more similar to the Canadian system, and for many there is only the pay-as-you-go although most municipalities will not refuse treatment for emergencies which simply means the cost is allocated elsewhere, i.e. everyone else. One of the features of the so-called ObamaCare was to eliminate free-loading and have everyone, or most everyone pay for some form of health insurance. For Native Americans, military personnel, and veterans, we’re Britain, or Cuba. "And yet we’re like no other country, because the United States maintains so many separate systems for separate classes of people, and because it relies so heavily on for-profit private insurance plans to pay the bills. All the other countries have settled on one model for everybody, on the theory that this is simpler, cheaper, and fairer. With its fragmented array of providers and payers and overlapping systems, the U.S. health care system doesn’t fit into any of the recognized models."

A common complaint leveled against government health care programs is they ration, yet all systems ration. In this country it's done by insurance companies, in others it's done by ethical committees. Here, the decisions are applied inequality and depend on one's plan (and the quality of one's lawyer.) "made, often in secret, by scores of different insurance companies. One person may get coverage for a potentially life-saving operation, while the next person doesn’t. This may be a boon to the person with the more generous insurance policy, but it’s not particularly fair." Some form of rationing *must* be done in order to reduce costs. "Should the system spend its money to keep a ninety-five-year-old Alzheimer’s patient alive until he’s ninety-six? Should an ailing eighty-four-year-old get the same intensive treatment for breast cancer that is provided to an otherwise healthy forty-four-year-old? Should the health system, or the insurance plan, pay for Viagra? For Botox? In a health care system that offers universal coverage, these decisions tend to be made uniformly for everybody."

The U.S. spends the most on administrative costs and a system that organized everyone into one plan would clearly cut costs. Ironically, the charge that one system would reduce choice is not true. Other countries, in fact, offer patients more choice. Insurance plans in this country have discourage choice by building preferred networks. In most other countries patients can go wherever they want and see whomever they want since the structure for payment is the same throughout the country.

All countries are faced with rising health care costs and all face complaints about their systems. The grass is always greener.... The one constant is complaining. "The American economist Tsung-Mei Cheng has formulated, with tongue only partly in cheek, the Universal Laws of Health Care Systems: 1. “No matter how good the health care in a particular country, people will complain about it.” 2. “No matter how much money is spent on health care, the doctors and hospitals will argue that it is not enough.” 3. “The last reform always failed.”3 Everywhere I went on my global quest, I found that Cheng’s Universal Laws held true. But for all their problems, the other industrialized countries tend to do better than the United States on basic measures of health system performance: coverage, quality, cost control, choice. This was the most surprising and infuriating discovery of my global quest—that the United States of America performs so poorly in this fundamental area of human life. In industry, finance, music, science, arts, academics, athletics,Americans can match or surpass any other country. Why can’t we do that when it comes to health care?"

Read the book for part of the answer. Fascinating, yet ultimately quite depressing. ...more

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Oct 22, 2013 Brian rated it it was amazing

This book was recommended to me by a friend a couple of years ago. After months and months of debating friends about the necessity of "Obamacare" (The PPACA or ACA for short), I decided it was finally time to pick up this book and get an idea of what others were doing in the health care arena. I know what I don't like about our system- cost, lack of access for those who don't have insurance or money. And, I know what I like- the availability of doctors and medicine and procedures as long as you This book was recommended to me by a friend a couple of years ago. After months and months of debating friends about the necessity of "Obamacare" (The PPACA or ACA for short), I decided it was finally time to pick up this book and get an idea of what others were doing in the health care arena. I know what I don't like about our system- cost, lack of access for those who don't have insurance or money. And, I know what I like- the availability of doctors and medicine and procedures as long as you able to pay. What I didn't know other than from some very biased perspectives- my right wing friends who say all "socialized" medicine is horrible with no choice and long lines- and smear jobs like the movie "Sicko" was what are others doing that is better than us? What can we learn from what other countries have done?

T.R. Reid does an excellent and it seems objective job of summarizing the pros and the cons of each medical system he visits. And, there are pros and cons to each. None is perfect. If you're going to cover everyone at an affordable price, you cannot offer every procedure under the sun with no waiting. If you're going to have the absolute best care available with complete choice of doctors, hospitals, etc. you're not going to be able to cover everyone. What every system in the developed world seems to have in common, outside of the United States, is the will the moral imperative, that everyone will be covered.

This book made me both hopeful and discouraged at the same time. Hopeful because other countries have made the change from where we are today to a more equitable and cost effective system where everyone gets covered and outcomes are actually better than they are here. However, I am discouraged because Americans seem to lack the will to cover everyone and American exceptionalism gets in the way of us looking to those who do it better and co-opting their ideas. We demonize the systems that are different from us and scare people about waiting periods or lack of access to certain things while we ignore the thousands who die each year here due to lack of access.

The good news is there is a better way to do things and we don't have to reinvent the wheel. This book clearly lays out what is good and bad about our system and others. While it probably wouldn't make sense to copy anyone's system whole-hog and while we would like to preserve the best things about our system, we can take inspiration from others as we design a better system for us. There will be some sacrifice involved for some, but overall, there is a better way. ...more

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Sep 18, 2010 Sarah rated it it was amazing

Shelves: random-politics

For those of us who have already reached the conclusion that the health care system in this country is laughable (in a devastating way), this little masterpiece beautifully clarifies what we already know. Our system is overly complex, sickeningly unequal and discriminatory, and grossly expensive. As a wealthy country in the industrialized world, we are the only nation that has not adopted universal health care of some kind. We are the only nation that allows for-profit insurance companies result ...more

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Jul 09, 2017 Alex rated it it was amazing

I came across this book by reading the author's other book, A Fine Mess, about tax systems around the world. The conclusion here is similar: US healthcare system as a whole is the worst out of rich countries, on pretty much all dimensions. But that's not new. Where this book shines is adding nuance and technical understanding of benefits and shortcomings of each system. If your view about US healthcare is like mine - shaped by late-night talk show jokes and attention-grabbing headlines - this is ...more

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Aug 09, 2017 Ana T rated it it was ok

Shelves: 2017

The most important conclusion of the book goes ignored by its own author: almost all systems presented in the book are either flat out broke (UK, France) or a ticking time bomb squeezing doctors' pay or service availability to the limit (Japan, Canada). The only system that seems financially healthy is the Swiss - and it is not a coincidence that it is (by far) the most expensive of the ones analyzed. And I am saying this only using information from the book itself.

In addition, not only it ignor ...more

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Aug 04, 2017 Matthew Hall rated it it was amazing

Shelves: policy, 2017, nonfiction

This book was so great. With the conversation around how to fix healthcare in America ascendant, this book was a really great resource for thinking about changes to our system. TR Reid (back in 2009, pre-ACA days) visited seven different countries to investigate how they run their healthcare systems, and to think about ways in which we might overhaul the American healthcare system, which is both the most expensive in the world, and produces society-wide results which are middling at best, even w This book was so great. With the conversation around how to fix healthcare in America ascendant, this book was a really great resource for thinking about changes to our system. TR Reid (back in 2009, pre-ACA days) visited seven different countries to investigate how they run their healthcare systems, and to think about ways in which we might overhaul the American healthcare system, which is both the most expensive in the world, and produces society-wide results which are middling at best, even while people with money can get excellent care.

A few key takeaways:

1) It's a great lesson for people on the left who crow about single-payer everywhere else in the developed world, without realizing that not every developed country has an explicitly single-payer system. True single payer exists (Great Britain, the US's VA system) where the government runs insurance and the hospitals and providers are all government employees, but it's one solution among many, and not necessarily the best.

2) The Germans, French and Japanese (and US citizens with employer-based healthcare) take part in a Bismarckian system (yes, that Bismarck) that has large private non-profit insurance systems (sometimes tied to employers/trades but sometimes just nonprofits or run as unemployment insurance run by the local government). These systems cover everyone (no pre-existing conditions exclusions) but they are not cheap. (Cheaper than the US by GDP though).

3) The French and Germans have an ID card system that has a person's whole medical history and people keep it on themselves like a debit card. This does a great job cutting down on bureaucratic costs to the system. However, I can see libertarians (and women who want to protect the privacy of their medical histories hidden from family/abusive spouses) having a problem with a history of medical procedures on one hackable, goverment-run record. Still, digitized records warrant consideration for cutting down bureaucratic costs.

4) No developed country but the US has a for-profit insurance industry. They're often private, sometimes governmental, but always non-profit. They all spend less per capita and as a percentage of GDP than we do and have better outcomes. No developed country but the US seems to have ideological issues with individual mandates or pre-existing condition clauses.

5) The notion that choice is gone in a single-payer system is only a half-truth. There may be lines in places like Canada or Britain, but in places like France and Germany they have as much choice as we do and there is no rationing of care. These are typically systems with private providers but non-profit/governmental insurers. Canada and the US have the Medicare/Medicaid model which has the government or Province running a single insurance pool, paying private providers/hospitals. These systems are cheaper, but they limit choice a bit.

5) Places with Out-of-Pocket systems pay less as a part of the government budget (next to nothing) but have way worse outcomes. And they don't have our technology. (Reid got a month of Ayurveda treatment for his bum shoulder in India, paid $49 for OOP care and felt it helped more than anything else, so take that as you will.)

The largest problem seems to be that the US healthcare system is suffering from FOMO-- we use iterations of true single-payer (VA) single-payer with private providers (Medicare/Medicaid), Bismarckian (employer-based insurance) and Out-of-Pocket systems (the 27.5 million people post-ACA who are still uninsured.) These uninsured people are driving up costs, but so are for-profit insurance companies. And because we can't just choose one of the other models to run with, we keep over-paying for bad results.

We could expand Medicaid/Medicare or have more Medicaid buy-in programs, or increase subsidies/eligibility for subsidies on the market while simultaneously getting rid of for-profit insurance. Or hell, if you want to live in a sickly, disease-ridden hellscape, we could go to an OOP model. But we just need to choose one. The ACA managed to reduce the number of uninsured people but it was just a first step. ...more

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Feb 20, 2013 Preston Kutney rated it it was amazing

I'm probably just a biased Canadian, but here is an excerpt from a great Malcolm Gladwell article that describes my opinion of the U.S. health care system:

"One of the great mysteries of political life in the United States is why Americans are so devoted to their health-care system. Six times in the past century—during the First World War, during the Depression, during the Truman and Johnson Administrations, in the Senate in the nineteen-seventies, and during the Clinton years—efforts have been I'm probably just a biased Canadian, but here is an excerpt from a great Malcolm Gladwell article that describes my opinion of the U.S. health care system:

"One of the great mysteries of political life in the United States is why Americans are so devoted to their health-care system. Six times in the past century—during the First World War, during the Depression, during the Truman and Johnson Administrations, in the Senate in the nineteen-seventies, and during the Clinton years—efforts have been made to introduce some kind of universal health insurance, and each time the efforts have been rejected. Instead, the United States has opted for a makeshift system of increasing complexity and dysfunction. Americans spend $5,267 per capita on health care every year, almost two and half times the industrialized world's median of $2,193; the extra spending comes to hundreds of billions of dollars a year. What does that extra spending buy us? Americans have fewer doctors per capita than most Western countries. We go to the doctor less than people in other Western countries. We get admitted to the hospital less frequently than people in other Western countries. We are less satisfied with our health care than our counterparts in other countries. American life expectancy is lower than the Western average. Childhood-immunization rates in the United States are lower than average. Infant-mortality rates are in the nineteenth percentile of industrialized nations. Doctors here perform more high-end medical procedures, such as coronary angioplasties, than in other countries, but most of the wealthier Western countries have more CT scanners than the United States does, and Switzerland, Japan, Austria, and Finland all have more MRI machines per capita. Nor is our system more efficient. The United States spends more than a thousand dollars per capita per year—or close to four hundred billion dollars—on health-care-related paperwork and administration, whereas Canada, for example, spends only about three hundred dollars per capita. And, of course, every other country in the industrialized world insures all its citizens; despite those extra hundreds of billions of dollars we spend each year, we leave forty-five million people without any insurance. A country that displays an almost ruthless commitment to efficiency and performance in every aspect of its economy—a country that switched to Japanese cars the moment they were more reliable, and to Chinese T-shirts the moment they were five cents cheaper—has loyally stuck with a health-care system that leaves its citizenry pulling out their teeth with pliers."

In this book, Reid gives an overview of the U.S. medical system, and compares it with other systems around the world. I really enjoyed it, and consider it a must-read for anyone interested in their own health. ...more

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Sep 26, 2019 Thomas Ray rated it it was amazing

Shelves: detailed-reviews, important, politics

The Healing of America, T.R. Reid, 2009, 277pp., ISBN 9781594202346, Dewey 362.10973, Library-of-Congress RA395.A3R435

More than 85% of Americans say medical care is a basic human right. Americans /wrongly/ think anyone who needs care gets it. Each year, 22,000 Americans die of treatable ailments. pp. 217-218 (Also American Journal of Public Health, Dec. 2009, p. 2294 http://pnhp.org/excessdeaths/health-i... )

Prof. Uwe Reinhart wrote a /Journal of the American Medical Association/ article in 199 ...more

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Jan 17, 2019 Katelyn rated it it was amazing

Shelves: favorites

Honestly, this book was just! so! good! and, to me, kind of life-changing. Not many people in the U.S. *actually* understand how healthcare works and we have all these misguided beliefs about how other nations that provide universal healthcare (and, it should be noted, whose healthcare systems are ranked high above our own) practice "socialized medicine" that are "wasteful", and result in "long waiting lists" and "limited choice". Not so! While I was angered and frustrated when exposed to the tr ...more

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Nov 27, 2020 Vincent rated it did not like it

My star ratings are always pretty pointless and arbitrary, but especially so here, mostly because my feelings of this book are extremely conflicted.

Normal review

A great high level overview/primer of healthcare systems both in the US and globally. Somewhat outdated with regards to the US, China, and other minor details. But his high level metrics for evaluating health care systems (focusing on choice, coverage, cost, quality) are sound and still applicable. Furthermore, most of the major flaws he ...more

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Oct 25, 2011 Anna rated it really liked it

Reid examines America's health system within the context of the health systems of France, Germany, Japan, the UK and Canada (all universal systems). He also briefly looks at out-of-pocket systems, i.e. the third world and uninsured Americans. As a political scientist, my take on these issues is pretty much always institutional and political culture. Reid's jumping off point is the moral question "Should we guarantee medical treatment to everyone who needs it?" The answer to this question in a fi Reid examines America's health system within the context of the health systems of France, Germany, Japan, the UK and Canada (all universal systems). He also briefly looks at out-of-pocket systems, i.e. the third world and uninsured Americans. As a political scientist, my take on these issues is pretty much always institutional and political culture. Reid's jumping off point is the moral question "Should we guarantee medical treatment to everyone who needs it?" The answer to this question in a first world modern country should always be yes. It depresses me that the US should answer no to this question. Reid argues that public opinion shows that people in the US believe that all Americans should have access to medical care and that most people believe that everyone does have access (ERs for example). Personally, I don't believe that. From what I see around me there are plenty of people who believe in an old-fashioned concept of deserving and it really pisses me off.

Reid does a nice job of comparing spending costs (the US, in 2005, spent 16.5% of GDP on health care compared to 11% in France, 10.4% in Germany, 10.1% in Canada, 8.4% in the UK and 8.1% in Japan) even though the US has a huge number of uninsured folks. Americans are not healthier nor do they live longer despite the huge expenditures. He also shows that administrative costs in the US are something close to 20% compared to about 6-7% in those other countries. Reid is clear that these other health systems are not socialized - doctors, hospitals, insurance companies are also likely to be private, and many countries include out-of-pocket costs to consumers too. And the most perfect socialized medical system in the world? Veterans in the US.

Profit-making insurance companies are pointed to as much of the cause of the craziness of the American system - the bottom line is not treating people, it is not treating people because every procedure denied helps the profit and makes shareholders happy. It's infuriating that neither culture nor political institutions in the US deal with the inequity and expense of such a stupid system. Finally, as a person who believes that institutions matter, I was interested to read about Taiwan developing a new universal health care system and Switzerland reforming theirs to ensure universal coverage. ...more

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Sep 26, 2009 Sariah rated it it was amazing

This book should be required reading for all Americans, especially the policymakers among us.

In my view, the most succinct way to summarize the problems with health care in our country is misplaced incentives.

For insurance companies (and many hospitals), it's the profit motive--it completely skews what should be the whole point of health care, to help people be healthy. For example, 40,000 Americans die every year because they do not have health insurance, either because it's too expensive or ...more

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Aug 04, 2016 Jenny Leigh rated it it was ok

I started to read this book because I am currently studying comparative health care in Japan and wanted to gain a deeper understanding of its health care system. Reid's book was a bit disappointing for my purposes; it is clearly written by a journalist rather than someone who has worked in the health care field (or who even has above-average familiarity with health care systems). After establishing the primary models of global health care systems, he simply refers back to the model that he obser ...more

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Aug 16, 2011 Sarah rated it it was amazing

I convinced my book club to read this some months (years) ago. I feel like it should be required reading for any thinking American. It's actually quite an entertaining book, though you'd think a journey through the world's health care systems would be a snore. T. R. Reid, a longtime journalist with an affable, slightly rumpled on-air persona (the book was also reshaped as a Frontline special) takes an ailing shoulder to numerous countries for possible treatment. In very accessible terms, he desc ...more

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Jan 14, 2020 Charlie Bray rated it it was amazing

A sober review of the financial and health outcomes of healthcare systems around the world. I enjoyed the fact that the author, however he felt about the issues at hand, refrained from being moralizing and instead implored the reader to observe the facts and question why things must be the way they are in the US system. And by far my favorite aspect of the book was the author's running theme of dispelling the popular mythology of universal healthcare systems with nonprofit financing: that these ...more

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Dec 26, 2018 Rachel rated it it was amazing

OUTSTANDING. This book was so well written, so easy to understand, and so informative. I've always wondered how other industrialized, capitalist nations manage to make their healthcare systems work and this book explains it clearly using different countries as examples. Reid also dismantles all the garbage excuses we come up with about why "it would never work in the US." A fascinating, often enraging, sometimes depressing, and thoroughly engaging work. ...more

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May 31, 2017 C. Scott rated it really liked it

A really excellent bit of comparative analysis. I wish books like this existed for every subject. Reid takes the reader for a global tour of how healthcare works in other countries. The American healthcare system is frankly a disgrace. In the eyes of other developed nations we are a laughingstock. It is a scandal that the richest nation on earth can't find a way to meaningfully address this problem.

Thanks to this book I now have a much clearer understanding of the most popular national healthca A really excellent bit of comparative analysis. I wish books like this existed for every subject. Reid takes the reader for a global tour of how healthcare works in other countries. The American healthcare system is frankly a disgrace. In the eyes of other developed nations we are a laughingstock. It is a scandal that the richest nation on earth can't find a way to meaningfully address this problem.

Thanks to this book I now have a much clearer understanding of the most popular national healthcare systems on our planet: the Beveridge model, the National Health Insurance model, and the Bismarck model. Reid compares and contrasts the strengths and weaknesses of each and how different countries mix and match to find what works best for them. Surprise reveal? There are American examples of all three operating right in our midst. The evil commie Beveridge model (the British system named for William Beveridge where the government owns the hospitals) is basically the VA system used for treating American veterans. The grubby socialist National Health Insurance model (otherwise known as the Canadian single payer system) is how America's hugely popular Medicare system works. The Bismarck model (named for 19th century German conservative statesman Otto von Bismarck) is what the luckiest Americans have - insurance financed jointly by employers and employees. The difference is that in other Bismarck countries like Japan and Germancy insurance companies are non-profit and they must cover everybody.

One interesting chapter deals with how both Switzerland and Taiwan moved from American style healthcare to universal coverage in the mid-1990s. This proves that it is possible to make systemic changes in the modern era.

This is outside the parameters of the book, but I have to say, after reading this I am now certain that it is possible to have universal coverage in the United States that costs less than we are paying now. If it's possible to have better outcomes at a cheaper price who wouldn't take that deal? Any businessman would. Unfortunately it is the business community that provides the biggest barrier to change. Collectivism is viewed as a threat to capitalism. Profits would suffer. Stocks would plummet. We need to ask ourselves what is more important: Wall Street dividends or our health?

The US is the only developed nation that runs healthcare for profit. The idea is that the profit motive and competition are supposed to give us the most efficient outcomes. But look around, is the American healthcare system giving us the best possible outcome? One study cited in this book says that 22,000 Americans a year die because they don't have health insurance. (Imagine for a moment that 22,000 Americans were killed by Al Qaeda every year. Do you think we could find the resources to save these lives then??) How can public health benefit from a system where thefirst priority is on retaining profits for shareholders? How can we have a healthy population when public health is only a secondary consideration?

It is time for change. I feel that the best way to start moving toward that change is to educate yourself on what works and what doesn't. When it comes to understanding America's broken healthcare system and the functioning alternatives that exist in other countries - this book is a great start. ...more

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Aug 20, 2017 gwayle rated it really liked it

Shelves: e-book, post-election-reading-list

Among developed countries, America is a laughingstock when it comes to health care. Our pathetic system is ridiculously expensive—all for less coverage, lower life expectancy, higher infant mortality, more death for treatable illnesses, and more bankruptcy as a result of medical bills (people in other countries are horrified by this cruel fact of American life). Why is this?

1. Universal coverage is a moral issue that America has never addressed head on; politicians always make this out to be an Among developed countries, America is a laughingstock when it comes to health care. Our pathetic system is ridiculously expensive—all for less coverage, lower life expectancy, higher infant mortality, more death for treatable illnesses, and more bankruptcy as a result of medical bills (people in other countries are horrified by this cruel fact of American life). Why is this?

1. Universal coverage is a moral issue that America has never addressed head on; politicians always make this out to be an economic issue. Is health care a right or a commodity? Should poor people die for lack of access to health care? Because that is what happens. You have to be at death's door or in active labor to be guaranteed treatment at an emergency room. In this country, you have no basic right to the tests that will detect your cancer in time for life-saving treatment. So, the very first step is to be crystal clear on this moral issue. And if you want universal coverage, you'd better be prepared to insist on the individual mandate in spite of libertarian squawking.

2. America has too many systems in place (private insurance, Medicare, Medicaid, VA, etc.), which increases doctors' administrative overhead (all the different billing systems) and de-incentivizes preventative care (i.e., why play the long game as a private insurer when you won't realize the savings because 65yos will switch to Medicare?). Conflicting systems also undermine the broad base that is ideal to efficiently fund insurance.

3. For-profit insurance companies are evil. They emphasize shareholders' profit over effective and efficient financing of health care. In other developed countries, insurance is either government-run or the companies remain privatized but are run as nonprofits. For-profit leads to bloated administrative costs with huge departments devoted to denying coverage and rejecting and adjusting claims. 20 cents of every premium dollar you pay doesn't go to care. (Other developed countries keep administrative costs under 10%, sometimes well under.) There is simply no advantage to having for-profit insurance companies—except for the greedy, hell-bound shareholders of those companies. This system does not offer insurers more choices, and it does not operate more efficiently as a result of some magical thinking free market Darwinism.

4. Astronomical medical school tuition, resulting in huge debt loads for young doctors, and an absurdly litigious culture that requires doctors to carry pricey malpractice insurance both skew the economics and result in defensive medicine—to patients' detriment.

The good news is that other countries have worked through all of these issues to provide far less expensive care for all of their citizens. No system is perfect, but many boast more choice, shorter waits, and far better health-related statistics, not to mention patient satisfaction.

As with his excellent book on tax reform, T.R. Reid offers clear explanations and an engaging narrative. I love him! I hope he writes many more nonfiction books on timely issues. ...more

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Mar 08, 2018 Kris rated it really liked it

I read this a few years ago and decided to re-read it since health care in America continues to be debated. Reid does a good job of explaining health care systems around the world. He says "There are some standard building blocks of health care system architecture that all developed countries (except the United States) have agreed on. By studying the blueprints and looking at these common principle, we can learn some important lessons about fixing the problems in our own health care system." I a ...more

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Mar 27, 2010 Rebecca rated it it was amazing

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 hea ...more

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Aug 21, 2009 Ernie.tedeschi rated it liked it

The Healing of America is a quick tromp through the health care systems of several foreign countries, including Canada, France, Japan, and Britain. Author T.R. Reid, using an old Navy shoulder injury as a common device for his worldwide tour, seeks to categorize and inform the reader about how every other industrialized country (and he repeatedly emphasizes America's sad exceptionalism in this regard) tackled the problem of universal health care coverage, and the challenges each system will face The Healing of America is a quick tromp through the health care systems of several foreign countries, including Canada, France, Japan, and Britain. Author T.R. Reid, using an old Navy shoulder injury as a common device for his worldwide tour, seeks to categorize and inform the reader about how every other industrialized country (and he repeatedly emphasizes America's sad exceptionalism in this regard) tackled the problem of universal health care coverage, and the challenges each system will face in the future. We learn about the sickness funds of Germany, the carte vitales of France, the National Health Service of Britain, and the long, long lines of Canada. Along the way, we learn some history (like how Bismarck considered his German health insurance policy "applied Christianity" and how the architect of Canada's Medicare is considered a greater national hero than Wayne Gretzky) and some basic pros and cons for each system.

At its best, The Healing of America succeeds in raising some provocative questions and undermining some widely-held assumptions. We learn rather quickly that not only is the foreign approach to health care more complex than simply "socialized medicine," but also that very few rich countries actually engage in what could accurately be called "socialized medicine." France, Germany, Switzerland, and Japan, among others, all allow for fair amounts of competition and choice, sometimes vigorously so. Even Britain's NHS employs some fiercely entrepreneurial doctors. And many of these countries also rely on employer-offered insurance, another misconception. We also see vividly how the typical state strategy for limiting costs -- fixing prices for each procedure -- is really just a shifting of cost burdens onto doctors and hospitals. As a result, even though the medical professionals are culturally prestigious and respected everywhere, few foreign doctors make as much as their counterparts in America would. This is mitigated by the fact that malpractice insurance costs about a tenth of what it does here, that medical records in France and Canada have been completely digitized, and that foreign doctors don't leave med school with the crippling debt doctors here do. But since differences like med school tuition are probably intractable, it's not clear how America could pursue the exact same strategy. I also enjoyed how Reid contrasted the OECD countries with developing countries, like India and China, who employ an out-of-pocket approach to health care.

About a third of the book delves into the moral case for health care reform, and here the book is at its weakest. T.R. Reid refers repeatedly to the story of Nikki White, a college graduate who died of lupus due to lack of medical insurance, but doesn't delve into the details of her death until the end of the book, where they have less impact. The rest of this "lost third" consists of perfectly respectable moral arguments that nevertheless could have summarized in a page or two. T.R. Reid is a good health care journalist but a weak moral philosopher.

The other main weakness of this work is that the detail is uneven. Reid is generally a balanced observer of the strengths and weaknesses of each system, but France goes oddly uncritiqued. He also spends an inordinate amount of time trying to lump all of America in with the "out-of-pocket" developing countries, even after he makes the insightful point that America is really an amalgamation of several systems: single-payer for the elderly, socialized medicine for soldiers and veterans, employer-based for the employed, and out-of-pocket for the poor. I would have been interested to know how these systems worked, as well. How does America's Medicare compare with Canada's? How good is the care offered at VA and military hospitals? We never find out.

By the last page, I felt like Reid had provoked more questions than he had answered, but at the same time had stimulated my imagination on a topic that, before reading this book, I had little sense of a framework for thinking about. Ultimately, The Healing of America works better as a springboard for the topic than as a piece of advocacy or as an omnibus overview of the issue. ...more

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Aug 31, 2019 Karyn rated it it was amazing

Excellent discussion of what health care looks like around the world (spoiler alert: not all of it is socialized medicine - but much of it is cheaper and more equitably distributed). Only the U.S. spends 20% of cost going to paperwork (which doesn't actually help people heal). (Taiwan = 2%, Canada = 6%). Only the U.S. has made the ethical decision to allow people to die. ...more

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Aug 24, 2010 Jonna Higgins-Freese rated it it was amazing

Reid researches how universal health care works in half a dozen different countries, exploding the myth of "American exceptionalism." The U.S. does NOT have the "best health care in the world" by any measure: not outcomes, not life span, not cost, not number of people covered. Reid points out that every other developed country except the US has answered the question: is health care a human right? with "yes."

In the US, about 20,000 people a year die of treatable conditions because they don't hav ...more

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Jun 01, 2013 Bryan rated it really liked it

I realized how persuaded I was by this book at a recent dinner with a number of our friends in which a few of them expressed decidedly critical views of the new healthcare law. I had just finished this book earlier that afternoon and thus was undoubtedly under its influence, but I kept thinking how I have never read anything or heard anyone argue as persuasively in defense of our nation's current healthcare system as TR Reid does against it.

And I was not just persuaded by it. I learned so much a ...more

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Aug 25, 2009 Nancy marked it as to-read

Okay, I fess up--I haven't read this book yet, but I heard Terry Gross interviewing the author on NPR's Fresh Air last night, and it sounds fascinating. Reid, a Washington Post correspondent, set out to examine health care systems around the world to demystify American fears of socialized medicine, health care rationing, and lack of choice.

Using his bum shoulder as an example (he broke it many years ago in the Navy, had it surgically repaired with a steel pin, and is now suffering pain and lack ...more

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Jun 07, 2015 Stephen Simpson rated it it was amazing

Wavered between four-stars and five-stars. Quality-wise, it's probably four-stars. It is well-researched, well-documented, concise, enjoyable to read, and avoids a lot of the irritating pitfalls of "cause-head" books (demonizing the opposition, writing hagiographies for the good guys, presenting misleading one-sided arguments). All of that said, I'm not sure how re-readable it will be and to me that is a big factor in five stars.

In any case, I think it merits five stars for the fact it is impor ...more

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About T.R. Reid

T.R. Reid

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T.R. Reid is a reporter, documentary film correspondent and author. He is also a frequent guest on NPR's Morning Edition. Through his reporting for The Washington Post, his syndicated weekly column, and his light-hearted commentary from around the world for National Public Radio, he has become one of America’s best-known foreign correspondents.

Reid, a Classics major at Princeton University, served ...more

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“The Universal Laws of Health Care Systems:

1. "No matter how good the health care in a particular country, people will complain about it"
2. "No matter how much money is spent on health care, the doctors and hospitas will argue that it is not enough"
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“A lot of what we "know" about other nations' approach to health care is simply myth.” — 5 likes

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