The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care
Author:
Genres: Medicine, Medical Books
Book Type: Paperback
Author:
Genres: Medicine, Medical Books
Book Type: Paperback
Toward the end of the book, the author makes up a story that involves two American women of similar ages, but differing economic levels. Both have malignant tumors in the ovaries. For the woman with health care insurance, the tumor is found early, surgery is performed, and recovery is complete. For the woman without health care insurance, the malignancy is "discovered" at an emergency room examination, but the cancer has spread too far to be treated. The woman is sent home with pain pills to die.
Per the author, no one is suggesting that the United States become an egalitarian society throughout. We expect differences in incomes and living standards. But all developed countries have decided to not tolerate inequality in health care. All except the United States. The result is that more than 20,000 U.S. residents die each year because they do not have health insurance and cannot get the coverage they need to live. This result, in itself, means that the richest nation in the world does not have the best health care system in the world.
But author T.R. Reid feels that "the stars are aligned and the timing is propitious for the United States to establish a new national health care system." And the thesis of his book, he says, is "that we can bring about fundamental change by borrowing ideas from foreign models of health care."
He has a bum shoulder, one that has been operated on and fixed in the past. As a guise to evaluate various health care models around the world, he seeks advice from each for his shoulder. In the end, he gets a variety of advice for his shoulder, but does not find one country that has the perfect system for the United States to adopt. What he does find are four basic models of coverage:
1) The Bismarck Model: Both health care providers and payers are private entities. Private health insurance companies, which are financed by employer and employee contributions, do not make a profit. There are tight controls on the costs of medical services and fees. (Germany, France and Japan use this model.)
2) The Beveridge Model: Health care is provided by the government. It is financed by taxes. All hospitals and clinics are owned by the government. Most doctors work only for the government. (Great Britain, Spain, Italy, most of Scandinavia, Hong Kong and Cuba use this model.)
3) The National Health Insurance Model: The providers of health care are private, but they are paid only by the government; thus, this is a single-payer system. The system is financed by monthly premiums. (Canada, Taiwan and South Korea use this model.)
4) The Out-of-Pocket Model: Those with money pay for medical care; those without money stay sick and/or die. The government is too poor and/or disorganized to provide universal health care. There are few or no private insurance companies or plans. (Approximately 160 countries in the world use this model.)
Reid tells us that the U.S. uses all four models at the same time:
1) The Bismarck Model: Those who have employer-provided health insurance.
2) The Beveridge Model: Members of Congress, Native Americans, Veterans and active military personnel.
3) The National Health Insurance Model: Those under Medicare or Medicaid.
4) The Out-of-Pocket Model: The 45 million uninsured Americans (or more like the 80+plus million Americans who are without health care insurance at least one time in the year).
And, he tells us that the first three models have the following in common:
* There is a "moral imperative" that all residents have guaranteed health care coverage
* All residents are covered by the same system, under the same set of rules
* All are mandated to pay into the system, one way or the other
* Basic health care must not generate any profit
* Costs of services, procedures and drugs are controlled by the national government
* There are health care horror stories under each model and each is challenged to control costs and to finance its system
* The very rich have the means to get whatever health care treatment they want, wherever they want
Per the author, some in the U.S. get the very best medical care possible, but the overall medical system is mediocre by world standards. And that is the rub. But we also pay about double, per resident, what other developed countries pay for our mediocre care. So, how is this possible? First, we pay far more for our doctors, nurses, hospitals and drugs than other countries do. But even if we reduced those costs significantly, he says, that would not be enough. No, per Reid, the biggest reasons for our high costs of health care are "the way we manage health insurance and the complexity of our health care system."
Per Reid, "the U.S. private insurance industry has the highest administrative costs of any health payer in the world." He pegs it at about 20% of total costs and says other countries do it for far less: France: 5%; Canada: 6%; Taiwan: under 2%, as examples.
Is there a simple solution? Per Reid, it's universal coverage, which he says is "an essential tool to control costs and maintain the overall quality of a nation's health." He adds, "The administrative patchwork (of the American insurance system) makes everything about American medicine more complex and more expensive than it needs to be." And he says only a national government has an inherent stake in preventive care. In the U.S., consumers change insurance companies every six years, on average, negating any interest or responsibility by them for preventive care.
Looking at countries individually, he finds that the French go to doctors and take more pills than we do, yet their health care costs are about half of ours, per capita. In France, any resident can go to any doctor in the country; there are no "gatekeepers." Germany has one of the most expensive health care systems, but it is about 40% cheaper than the U.S. The government controls payments to doctors and hospitals. The basic model has been in place for 125 years. The Japanese consume health care like no other country, seeing doctors three times more than Americans, on average. Annual physicals are free, and residents expect to see a doctor without having to make an appointment. In Britain, all hospitals are owned by the government, and the British National Health Service is the largest employer in all of Europe. 85 percent of drugs are free of charge. Doctors do house calls, most health care is free, but there are waits to see doctors, and not all procedures and services are allowed. For example, there are no free annual physicals.
There is no room here to talk about Canada, Taiwan or Switzerland, or the out-of-pocket countries. And, you'll have to read the book to find out what advice each country gives him for his bum shoulder. I can tell you that there is quite a variety of advice given. The bottom line is that the book takes you on a quick trip around the world to look at various health care systems, how they work, what their pluses and minuses might be, and what features each might have that the U.S. could adopt to improve its system. But, as I mentioned above, in the end, he does not find a single country with the model in place for us. And, he does not give us a composite model of what we need to follow, based on his findings from other countries. Sadly, he admits that the task of doing this became harder than he initially thought it might be.
I highly recommend the book for its excellent core information and insight. The author, of course, did the excellent documentary for Frontline, called "Sick Around the World," which can be viewed in its entirety via the Internet. Watch that, if you don't get a chance to read the book.
Per the author, no one is suggesting that the United States become an egalitarian society throughout. We expect differences in incomes and living standards. But all developed countries have decided to not tolerate inequality in health care. All except the United States. The result is that more than 20,000 U.S. residents die each year because they do not have health insurance and cannot get the coverage they need to live. This result, in itself, means that the richest nation in the world does not have the best health care system in the world.
But author T.R. Reid feels that "the stars are aligned and the timing is propitious for the United States to establish a new national health care system." And the thesis of his book, he says, is "that we can bring about fundamental change by borrowing ideas from foreign models of health care."
He has a bum shoulder, one that has been operated on and fixed in the past. As a guise to evaluate various health care models around the world, he seeks advice from each for his shoulder. In the end, he gets a variety of advice for his shoulder, but does not find one country that has the perfect system for the United States to adopt. What he does find are four basic models of coverage:
1) The Bismarck Model: Both health care providers and payers are private entities. Private health insurance companies, which are financed by employer and employee contributions, do not make a profit. There are tight controls on the costs of medical services and fees. (Germany, France and Japan use this model.)
2) The Beveridge Model: Health care is provided by the government. It is financed by taxes. All hospitals and clinics are owned by the government. Most doctors work only for the government. (Great Britain, Spain, Italy, most of Scandinavia, Hong Kong and Cuba use this model.)
3) The National Health Insurance Model: The providers of health care are private, but they are paid only by the government; thus, this is a single-payer system. The system is financed by monthly premiums. (Canada, Taiwan and South Korea use this model.)
4) The Out-of-Pocket Model: Those with money pay for medical care; those without money stay sick and/or die. The government is too poor and/or disorganized to provide universal health care. There are few or no private insurance companies or plans. (Approximately 160 countries in the world use this model.)
Reid tells us that the U.S. uses all four models at the same time:
1) The Bismarck Model: Those who have employer-provided health insurance.
2) The Beveridge Model: Members of Congress, Native Americans, Veterans and active military personnel.
3) The National Health Insurance Model: Those under Medicare or Medicaid.
4) The Out-of-Pocket Model: The 45 million uninsured Americans (or more like the 80+plus million Americans who are without health care insurance at least one time in the year).
And, he tells us that the first three models have the following in common:
* There is a "moral imperative" that all residents have guaranteed health care coverage
* All residents are covered by the same system, under the same set of rules
* All are mandated to pay into the system, one way or the other
* Basic health care must not generate any profit
* Costs of services, procedures and drugs are controlled by the national government
* There are health care horror stories under each model and each is challenged to control costs and to finance its system
* The very rich have the means to get whatever health care treatment they want, wherever they want
Per the author, some in the U.S. get the very best medical care possible, but the overall medical system is mediocre by world standards. And that is the rub. But we also pay about double, per resident, what other developed countries pay for our mediocre care. So, how is this possible? First, we pay far more for our doctors, nurses, hospitals and drugs than other countries do. But even if we reduced those costs significantly, he says, that would not be enough. No, per Reid, the biggest reasons for our high costs of health care are "the way we manage health insurance and the complexity of our health care system."
Per Reid, "the U.S. private insurance industry has the highest administrative costs of any health payer in the world." He pegs it at about 20% of total costs and says other countries do it for far less: France: 5%; Canada: 6%; Taiwan: under 2%, as examples.
Is there a simple solution? Per Reid, it's universal coverage, which he says is "an essential tool to control costs and maintain the overall quality of a nation's health." He adds, "The administrative patchwork (of the American insurance system) makes everything about American medicine more complex and more expensive than it needs to be." And he says only a national government has an inherent stake in preventive care. In the U.S., consumers change insurance companies every six years, on average, negating any interest or responsibility by them for preventive care.
Looking at countries individually, he finds that the French go to doctors and take more pills than we do, yet their health care costs are about half of ours, per capita. In France, any resident can go to any doctor in the country; there are no "gatekeepers." Germany has one of the most expensive health care systems, but it is about 40% cheaper than the U.S. The government controls payments to doctors and hospitals. The basic model has been in place for 125 years. The Japanese consume health care like no other country, seeing doctors three times more than Americans, on average. Annual physicals are free, and residents expect to see a doctor without having to make an appointment. In Britain, all hospitals are owned by the government, and the British National Health Service is the largest employer in all of Europe. 85 percent of drugs are free of charge. Doctors do house calls, most health care is free, but there are waits to see doctors, and not all procedures and services are allowed. For example, there are no free annual physicals.
There is no room here to talk about Canada, Taiwan or Switzerland, or the out-of-pocket countries. And, you'll have to read the book to find out what advice each country gives him for his bum shoulder. I can tell you that there is quite a variety of advice given. The bottom line is that the book takes you on a quick trip around the world to look at various health care systems, how they work, what their pluses and minuses might be, and what features each might have that the U.S. could adopt to improve its system. But, as I mentioned above, in the end, he does not find a single country with the model in place for us. And, he does not give us a composite model of what we need to follow, based on his findings from other countries. Sadly, he admits that the task of doing this became harder than he initially thought it might be.
I highly recommend the book for its excellent core information and insight. The author, of course, did the excellent documentary for Frontline, called "Sick Around the World," which can be viewed in its entirety via the Internet. Watch that, if you don't get a chance to read the book.
