By Allen Johnson, Editorial Page Editor, in the News-Record
Still thoroughly confounded about the state of health care reform in the United States? A good place to start for common-sense answers is T.R. Reid’s brisk and engaging best-seller, The Healing of America: A Global Quest for Better, Cheaper and Fairer Health Care.
First published in 2009, this book essentially is the story of one man, his bum right shoulder, and his determined search across the globe for relief.
Along the way Reid is poked with needles by acupuncturists, given massage therapy, rubbed with burlap bags of rice soaked in boiling milk (“It felt great,” he confesses) and given a urinalysis in which the doctor prefers a firsthand approach. “Certainly, I wouldn’t begin a diagnosis of your shoulder until I had tasted your urine,” the doctor says.
Most treatments in the book are not that, uh, exotic. They involve the type of medicine you’re used to, delivered by quality physicians but administered and paid for in ways that are almost as startlingly different as that Nepalese urinalysis.
Reid’s book has been the subject of a series of community conversations, with Reid himself making a pair of appearances last fall. I was honored to join Cone Health CEO Tim Rice for one of the final two events, a breakfast discussion at the Greensboro Historical Museum. The turnout was a surprise: more than 130 attentive folks at 8 a.m. on a rainy weekday, so this is an issue that clearly resonates with people.
It’s also a testament to the appeal of Reid’s book, which compares U.S. health care to systems in Canada, the United Kingdom, Germany, France, India, China, Taiwan and Japan, among others. The paperback edition also offers a helpful afterword titled “ ‘Obamacare’ Explained”. And it does all this in only 290 pages, counting the index and appendices. (The legal hieroglyphics in the U.S. health reform bill total more than 2,000 pages and 406,887 words.)
Reid, a former foreign correspondent for The Washington Post, concludes that “Obamacare” is an improvement over the status quo but does not go far enough. He also concludes that none of the foreign systems is perfect, either. But most provide coverage to everybody. And most still cost less than what we spend in the U.S., where an estimated 40 million Americans remain uninsured, 85,000 in Guilford County, and counting. (Cone’s Rice noted increasing numbers of local patients who are unable to pay their bills.)
When his journey has ended, with his shoulder pain significantly reduced, if not cured, Reid declares five basic health care myths:
1. Other countries offer “socialized medicine.” Actually, many rely significantly on the private sector.
2. Other countries ration care with waiting lists and limited choice. In many countries, they aren’t. For instance, there’s intense competition in Japan among private providers, and Germans can choose from among more than 200 health care plans. Waiting times in Japan are so short that most patients don’t schedule appointments. They just walk in.
3. Foreign health care systems are bloated bureaucracies. For-profit health insurance companies in the U.S. have the highest administrative costs in the world.
4. Health insurance companies have to be “cruel.” Reid says health coverage mandates in other countries create a large enough “risk pool” so they don’t have to be hard-hearted to be profitable.
5. Other health care systems are too “foreign” to work in the U.S. Reid reminds us, again, that two of the most popular institutions in U.S. health care, Medicare and the VA, were faithfully modeled on foreign systems in Canada and the U.K. The U.S. even appropriated the name “Medicare” from the Canadians.
Reid also touches on the need for more preventive care and notes how digital “Vital Cards” in France all but eliminates the burden of paperwork. But the most compelling theme in the book is a moral question: Does the U.S. want to be a society where people risk dying because they can’t afford health care? Instead of fixing health care reform, some of us would prefer simply to nuke it altogether and to cling to the fabulist notion that we have the best health care system in the world.
We don’t and we won’t until we’re open to learning from other countries how to make it better. And until we’re willing to discuss this mounting crisis honestly and openly.