One man's stiff shoulder

The Healing of America: A Global Quest for Better, Cheaper, and Fairer Healthcare, by T.J. Reid (Penguin Press, 2009).

I needed a break from reading about the food system. I got tired of reading about how badly school lunch fails, about the size of the average manure lagoon is, etc. I needed new topic.

Health care fit the bill. I guessed that a rundown of the U.S. health care system would be as disheartening as the rundowns of the U.S. food system, but at least it would be new material. I heard an interview with Reid on NPR this summer and the next time his book came onto my radar, I was primed to read it.

Here’s the premise. Journalist T. J Reid took his stiff shoulder to seven industrialized countries to assess their health care systems: Britain, Germany, France, Japan, Canada, and Switzerland and Taiwan (the last two recently to reform managed health care). For those new to health care discussions, he explains the four different models.

1. Beveridge model – the government provides health care and finances it with taxes. Familiar to U.S. veterans.
2. Bismarck model – the private sector provides health care and the government regulates nonprofit insurance companies that cover everyone and that are financed by employers and employees. Familiar to working Americans.
3. National Health Insurance – the private sector provides health care and a government-run insurance program financed by citizens pays the bills. Familiar to Americans over 65.
4. Out-of-Pocket Model – if you have money, then you can see a doctor. If you don’t, you can’t.

A major takeaway point for me was the folly of having for-profit insurance companies. They exist to make money, so sick, expensive patients are bad for business, while denying claims and not covering preexisting conditions is good for business. Meanwhile, healthy, cheap twentysomethings don’t buy much insurance. As I understand it, if we want insurance companies to cover everyone, then everyone needs to pay for insurance (the individual mandate).

One theme was the difficulty of pleasing everyone. When the government regulates health care closely or is the single player, it has the power to negotiate very low prices for procedures and drugs. These low prices are good for patients and the federal budget, but they can squeeze drug companies and physicians something awful. Luckily, doctors in other countries don’t have pay nearly as much for their medical education, if they pay for it at all.

There’s a lot of interesting stuff I could get into, like Reid’s Ayurvedic treatment in India or France’s carte vitale. The book is accessible and entertaining, though, so I’ll just recommend going straight to the source.