"The Healing of America" - required reading

Photo: Courtesy Penguin Press

In “The Healing of America,” T.R. Reid sums up international solutions to the challenges facing  America’s dysfunctional health care delivery and payment system.  He quotes from an ancient and unnamed Chinese philosopher. 

"To find your way in a fog, follow the
tracks of the oxcart ahead of you."

Reid resists prescribing a single remedy for what ails the U.S. and that may be the root of what makes his story-telling so compelling.

Reid has now retired to Denver after a career as a foreign correspondent for “The Washington Post.” He mixes humor with history, an eye for detail, and lots of good information. The writing style is light, engaging, and readable.

In pursuit of a cure for an aching shoulder injured while serving in the military, Reid experiences and illuminates successful health delivery and payment systems from around the world.

Here, presented in a single slim volume, is a wide menu of choices that others have made and which can be mixed and matched to both diagnose and treat America’s peculiar mix of health care symptoms.  "The Healing of America" should be required reading for each of the 535 members of Congress.  This book addresses fundamental solutions instead of  nibbling around the edges of the problem.

Reid reports rather than pontificates.

The author cites four major health care delivery models in use throughout the “rich” world with selected adaptations specific to each country.

The German "Bismarck model"  has been operating successfully since 1883. The goal is to eliminate most government interference between its people and their health care while providing equitable treatment for all.  Variations on the "Bismarck plan" work well in France, Germany, Japan, Spain, Switzerland, and other nations. The pieces that make up the system remain all private within a national framework.  Premiums are split between both employers and workers with the government chipping to bridge periods of individual unemployment.

In the U.K., a system based on "The Beveridge model" is based on the ideas of a British nobleman and a Scottish politician. Most health care is delivered free by a "National Health Service" funded by an array of taxes.  Most doctors and hospitals work for salaries paid by the government.  Prevention is emphasized.  This arrangement works well in Britain, in many of the Scandinavian countries, and oddly enough in Cuba.

A third scheme is "National Health Insurance" as practiced in Canada. A monthly premium is collected by Canadian provinces. Doctors and hospitals are mostly private mostly, but paid by a single payer in each province.  Canadians are challenged by elective surgeries that can take considerable time to get scheduled.

Last on the list, is the “Out-of-Pocket” model. It is exactly what it sounds like. If a patient has money, they are  treated. If not, conditions run their course.

America has adopted parts of each of the four basic methods of organizing health care. Because America has not fully embraced any one of the top three methods, many middle class  Americans die of curable conditions. 

For those with good insurance or cash, America has the best care in the world.  For the very poor, some accomodation is made.  An ever widening breech in the health care safety net for the middle class accounts for America's dismal overall comparable performance. 

"America is the only developed country where basic health care is insured by For Profit entities."

The cost of administering health care in America is two to four times more than in other countries and this ignores the 43 percent of all hospital and doctor's office  personnel not involved in  clinical tasks.

America is the only developed country without universal access and universal mandates for participation. America is the only developed nation with health care related bankruptcies.

America pays double what most other countries pay for health care, but is not near the top perfomers when measured for either life span or preventable deaths.

America pays its doctors much more than any other country, but is the only country where doctors are forced to carry significant debt out of medical school or live in fear of litigation.  Reid notes that doctors of all nations do well financially and all share the complaint they don't earn enough.

T.R. Reid’s “The Healing of America” should go on your “must read list.” It will make you smile, make you mad, help you to be informed, and perhaps teach you “to follow the fresh oxcart tracks through the fog of political debate. "

While America has yet to solve its own health care dilemma, the architect of the relatively new system on Taiwan and in many other nations lives among us.  His name is William Hsiao, a Chinese-American, reared in Queens, former chief actuary of Social Security, and a Professor of Health Finance at Harvard University.

Someone please pick up a phone.
 

Next: Co-pays that profit no one.

As America searches for solutions leading to a reformation of its own health care system, knowing the successes and shortcomings of health care regimes in other developed nations will be essential in negotiating the most palatable and efficient design for all concerned. This series attempts to connect the dots and explode the talking points in hopes that the folks who actually have a vote might come to a conclusion.

Al Portner is a former daily newspaper editor and publisher in seven states and author of the forthcoming “Mark Twain and the Tale of Grant’s Memoir.” Portner is also the proprietor of The Assignment Desk, LLC and provides writers, editors, and photographers for numerous kinds of contract projects from proposals and speeches to public relations and journalism. Reach him at alanportner@gmail.com.