Monday, December 28, 2009

Now Reading: The Healing of America

Anyone who has been following my blog in the last year or who knows me personally knows that health care is the political issue that I am, by far, the most passionate about. As a Canadian who has spent most of her life growing up in the US, I have seen the good and the bad of both systems, and have come to the conclusion that health care is a right for the many, not a privilege to be enjoyed by the few. I have held this opinion for quite a long time in some form or other, but it was strengthened this past summer when it became apparent that the US health care system had contributed to the rapid demise of one of my favorite professors, Fred Holliday. Naturally, I have followed the debates around the country, in the House of Representatives, and in the Senate with some considerable interest, and have also done some reading of my own on the topic.

The most recent book I've picked up on the topic is The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care by T.R. Reid, a correspondent for the Washington Post. During his years at the Post, Reid has served as bureau chief in London and Tokyo, so he experienced the systems in those two nations firsthand. For this book, however, Reid examined the World Health Organization's rankings of health systems, and set out on an exploration of the pros and cons of the different systems that ranked higher than the US-- which is actually a sampling of pretty much every other wealthy industrialized democratic country in the world-- in terms of providing cost-effective, quality, universal health care.

For this book, Reid traveled to France, Germany, Britain, Canada, and India to investigate the cures they each would offer for his personal medical ailment, a stiff and sore shoulder, and to report on the nation's system as a whole. In doing so, he discovered that although each country (with the exception of India) provided universal health care, they each had different methods for doing so. The four systems of universal care that Reid outlined are the Beveridge model (Britain), the Bismarck model (Germany and France), the National Health Insurance model (Canada), and the Out-of-Pocket model (most low-income countries in the world, plus the US, in part). In actuality, Reid points out, the US combines variations of all these models for different elements of society, whereas it would really be most effective to create one unified system for everybody.

Reid has many fascinating anecdotes, facts, statistics, and discoveries that he covers in The Healing of America, and I highly recommend it to anyone interested in learning more about health care systems elsewhere in the world, and about what the US could learn from them. Regardless, however, here are my top 10 takeaways from the book, in quick summary form:
  1. It's basically true that doctors nearly always get screwed by universal health care systems in comparison to what doctors in the US earn...
  2. ...but on the grand scale, they're not exactly badly off in most cases. They usually earn around $100k or more per year and live comfortable middle-class lifestyles...
  3. ...Although this ability is partly because they accumulate much lower (or nonexistent) medical debts from their education, and have to pay so little for malpractice insurance (because there are so few malpractice lawsuits).
  4. The presence of a moral imperative (Is health care a fundamental right?) is an essential part of the discussion around having a universal system. Economic discussions won't get the job done because they don't reach to the core of the issue.
  5. Health care "rationing" is a part of life. In any and every system on earth.
  6. In universal systems (Britain is an especially good example) there is a high incentive for good preventative care and low administrative costs. Not so in the US.
  7. One of the best ways to lower administrative costs is to digitize health records (see: France's carte vitale).
  8. In order for a universal system to work properly, you must have both an individual mandate and a guaranteed issue. In other words, everyone must buy into the system (to create a large enough risk pool, especially if using the Bismarck model) and insurance companies cannot deny a claim or coverage if you pay your premiums on time.
  9. Guaranteed issue is another good way to reduce those hefty administrative costs. No need to pay claims adjusters, etc., when you can't deny claims and must pay them quickly.
  10. No health care system is perfect; all of them have pros and cons. But the US can-- and, in my opinion, must-- do better than it does now.

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