Health Care: Lessons for AmericaCatherine Arnst
The Healing of America:
A Global Quest for Better, Cheaper, and Fairer Health Care
By T.R. Reid
Penguin Press; 277 pp.; $25.95 In 1994, back when President Bill Clinton's health-care reform effort was going down in flames, there was a quiet revolution in Switzerland. This wealthy federation of 26 state-like cantons, with four official languages, had a fragmented American-style health-care system. In other words, it was costly, with employer-based private insurance that left many Swiss uninsured. But unlike Clinton-era America, Switzerland got its medical act together.
It switched to a system that separates insurance from employment. Each individual or family is required to buy coverage, and insurers must offer a basic package of benefits to all applicants. They can't profit from selling basic coverage, but they can from supplemental plans. Premiums are deducted from paychecks; the unemployed and poor are subsidized.
Despite opposition from insurers, drugmakers, and business, the plan passed by a bare majority and went into effect in 1996. Switzerland now spends 11% of its gross domestic product on health care, just as it did before. But everyone is covered, insurers are more profitable than ever, and its high-quality health care has been maintained.
The lesson, as laid out in The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care, by T.R. Reid, is that "health-care systems can be changed, even in the face of powerful...interests."
Reid's book couldn't be more timely, as Democrats and Republicans do battle over health-care reform proposals that would affect one-sixth of the U.S. economy. If this insightful book were required reading for everyone involved in the debate, the odds of America ending up with a system that measures up to Switzerland's or Japan's or Taiwan's might jump.
Many Americans boast about having the best health care in the world, even though the U.N. ranks the U.S. system 37th, based on a broad range of measurements. Reid, a former Washington Post correspondent, decided to take his reporter's curiosity and examine the health-care systems of higher-ranked nations to determine what works and what doesn't.
He also took his aching shoulder. To give him more movement and less pain, an American surgeon had recommended replacing it with one made of titanium—major surgery with all the attendant risks. The cost, though covered, would be astronomical, and there was no guarantee he would feel any better. So Reid got opinions from top orthopedists in Britain, Canada, France, Germany, India, Japan, Switzerland, and Taiwan. None recommended such a radical solution.
At the same time, he learned that almost all countries use one of four health-care models: Germany's Bismarck system, in which hospitals and insurers are private entities and financing comes from payroll deductions; Britain's Beveridge Model, with the government providing health care financed by taxes; the Canadian plan, where private doctors and hospitals are paid by the government through taxes; and the out-of-pocket care found in most poor nations, where those who can afford care get it, while the rest suffer or die.
Unlike any other country, the U.S. combines all four models. The employer-based coverage most workers get follows the Bismarck Model. Veterans and soldiers are treated under the Beveridge Model (which conservatives often call socialized medicine). Medicare is so similar to Canada's system that they share the name. And the 47 million uninsured do as Cambodians do.
Reid interviewed doctors, politicians, patients, and experts in each country he visited. Everyone had gripes, and all the systems he examined were struggling with rising costs. But countries with universal coverage differ from the U.S. in a striking way—they accept that everyone has a right to medical care and, out of fairness, one system should apply to all. America must ask itself, Reid writes: "Should society guarantee health care the way we guarantee the right to think and pray as you like, to get an education, to vote in free elections? Or is medicine a commodity to be bought and sold?"
The Healing of America could have been a policy-heavy slog, but Reid manages to keep it low on wonkery, crisply paced, and seriously incisive. As for his shoulder, it's much better and remains titanium-free.