The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care by T. R. Reid.

4/5 rating. 251 pages.

Book #84 of 2020. Read November 29, 2020.

This is a fascinating book looking at some of the top healthcare systems in the world.

T.R. starts by looking at the sad-state of the American system: 20,000 people die every year from preventable causes because they can’t afford care, and 700,000 go bankrupt because they did get care without adequate insurance. Our system is ranked 37th by the World Health Organization for quality and fairness. We have the highest administrative costs in the world (as high as 4X the amount as those “bureaucratic socialist” countries). And all for $7,400 per person (in 2009), while places like Japan manage to pay less than half that for better care.

T.R. goes to many of the top countries to see what their systems look like and it was eye-opening. Many are less socialized than our system. All of them provide a guarantee of basic care for everyone. Multiple have lower wait-times than us. And none of them have for-profit companies that only care about the bottom line. The even more incredible (and hopeful) part is that in many ways, these systems are just more efficient ways of using the models that the US has in place.

“At the start of the twenty-first century, the world’s richest and most powerful nation does not have the world’s best health care system. But we could. Given our country’s remarkable medical assets—the best-educated doctors and nurses, the most advanced facilities, the most innovative research on earth, a strong infrastructure of preventive medicine—the United States could be, and should be, providing its citizens the finest health care in the world. We can heal America’s ailing health care system—and the world’s other industrialized democracies can show us how to do it.”

The biggest issue with this book is that it is broad overviews of these systems and not in-depth info. Obviously that wouldn’t have been possible to do with a book this size, but it did leave me with so many questions about specific ideas mentioned. This is a perfect overview to see what kind of reforms would be possible, though more research is required for starting that revolution!

Quotes:

“Government and academic studies report that more than twenty thousand Americans die in the prime of life each year from medical problems that could be treated, because they can’t afford to see a doctor.”

“Hundreds of thousands of Americans go bankrupt every year because of medical bills. That doesn’t happen in any other developed country either.”

“Contrary to conventional American wisdom, most developed countries manage health care without resorting to ‘socialized medicine.’”

“We’ve created a health care system that leaves millions of our fellow citizens out in the cold. Beyond the issue of coverage, however, the United States also performs below other wealthy countries in matters of cost, quality, and choice.”

“Japan has the oldest population in the world, and the Japanese go to the doctor more than anybody – about fourteen office visits per year, compared with five for the average American. And yet Japan spends about $3,400 per person on health care each year; we burn through $7,400 per person.”

“The leaders of the health care industry and the medical profession, not to mention the political establishment, have a single, all-purpose response they fall back on whenever somebody suggests that the United States might usefully study foreign health care systems: ‘But it’s socialized medicine!’”

“In short, the universal health care systems in developed countries around the world are not nearly as ‘socialized’ as the health insurance industry and the American Medical Association want you to think.”

“The U.S. Department of Veterans Affairs is one of the world’s purest models of socialized medicine at work. In the Medicare system, covering about 44 million elderly or disabled Americans, the federal government makes the rules and pays the bills. And yet both of these ‘socialized’ health care systems are enormously popular with the people who use them and consistently rate high in surveys of patient satisfaction.”

“The vested interests that are doing well in the health business now—insurance companies, hospital chains, pharmaceutical companies—have blocked significant restructuring of our system.”

“All the developed countries I looked at provide health coverage for every resident, old or young, rich or poor. This is the underlying moral principle of the health care system in every rich country—every one, that is, except the United States.”

“How many people go bankrupt because of medical bills? In Britain, zero. In France, zero. In Japan, Germany, the Netherlands, Canada, Switzerland: zero. In the United States, according to a joint study by Harvard Law School and Harvard Medical School, the annual figure is around 700,000.”

“But out of twenty-three wealthy countries, the American health care system ranks dead last when it comes to keeping newborns alive. Our rate of infant mortality is more than twice as high as the rate in the top-ranked countries, Sweden and Japan. A key reason, as we’ll see in later chapters, is that other rich countries offer free prenatal and neonatal care for every mother and every baby. This is costly—but it’s much less expensive, both economically and emotionally, than the heroic surgical efforts used in the United States to save threatened infants.”

“The United States is the only developed country that relies on profit-making health insurance companies to pay for essential and elective care.”

“According to their filings with the Securities and Exchange Commission, most for-profit insurance companies maintain a medical loss ratio of about 80 percent, which is to say that 20 cents of every dollar people pay in premiums for health insurance doesn’t buy any health care.”

“Americans tend to believe that the private sector can manage any type of business better than government can. This is not the case, though, when it comes to health insurance. Medicare, the government-run single-payer system created by Congress in 1965 to pay for basic health care for the elderly, has administrative costs of about 3 percent; the single-payer government systems run by different provinces in Canada have about the same.”

“The U.S. Government Accountability Office concluded that if the country could get the administrative costs of its medical system down to the Canadian level, the money saved would be enough to pay for health care for all the Americans who are uninsured.”

“France spends about $3,165 per capita each year for a health insurance system that covers everybody; the United States spends more than $7,000 per capita and leaves tens of millions without coverage. France’s spending runs just under 10 percent of its total national wealth (as measured by gross domestic product); the United States is spending about 17 percent of GDP on health care.”

“When the chancellor first proposed his welfare state to the Reichstag, in 1881, he described it as a means for the more fortunate Germans to care for the least of their brethren; public welfare, he said, should be viewed as ‘a program of applied Christianity.’ Defending his medical and unemployment insurance schemes in 1884, Bismarck argued that ‘the greatest burden for the working class is the uncertainty of life. They can never be certain that they will have a job, or that they will have health and the ability to work. We cannot protect a man from all sickness and misfortune. But it is our obligation, as a society, to provide assistance when he encounters these difficulties. . . . A rich society must care for the poor.’”

“Currently, Germans pay about 15 percent of their paycheck for health insurance, split between the worker and the employer. That’s almost exactly equal to what an American worker and his employer pay in Social Security and Medicare taxes. But the German worker gets a better deal. Most American workers also have to pay a health insurance premium, ranging from 2 to 10 percent of pay, in addition to those payroll taxes.”

“‘Americans tend to think that the profit motive is the only driver of competition,’ Karl Lauterbach, a German economist who won a seat in the Bundestag, the national parliament, told me. ‘But our Krankenkassen compete because the executives earn more money, and higher prestige, if they have a larger pool of insured members. So we have universal coverage, and nobody can be turned down because of a preexisting illness.You have the required package of benefits, so the insurer can’t deny a claim for any covered treatment. And then you have this competition to attract more customers.’”

“Everyone in Japan is required to sign up with a health insurance plan. This is what’s known as an ‘individual mandate,’ a concept that has sparked furious debate in the United States. But every nation that relies on health insurance has that requirement—it’s necessary to ensure a viable risk pool for the insurance companies—and in Japan the mandate is not controversial at all. ‘It’s considered an element of personal responsibility, that you insure yourself against health care costs,’ Dr. Ikegami told me. ‘And who can be against personal responsibility?’”

“If people see that we can provide health care to all, free at the point of service, so that any person, rich or poor, can get the medical treatment he needs—if people elsewhere see that, they’ll want it, too.” – Tommy Douglas, father of Canadian health system

“As we saw earlier, rich nations spend a significant share of their gross national product on health care—about 17 percent in the United States, 11 percent in Switzerland, 8 percent in Japan. In Nigeria, in contrast, total medical spending amounts to less than 1 percent of GDP; the country spends $5 per person per year on health care.”

“Universal coverage saves lives, saves money, reduces the rate of abortion. And it promotes preventive medicine. If the health care system covers everybody, then the system has a powerful incentive to keep people healthy. An apple a day keeps the doctor away, and that means universal health care systems have an interest in providing the apples…”

“It is largely because of this extensive preventive intervention before and after birth that all the other wealthy countries report rates of infant mortality (that is, death within the first year of life) that are one-half or one-third as high as America’s.”

“The Americans who suffer and die are not, for the most part, homeless or addicted or desperately poor. Most of those who die for lack of medical treatment in the world’s richest country are working Americans who run afoul of the nation’s complicated and restrictive health insurance labyrinth, both public and private.”

“My global quest demonstrated that America’s approach to health care is unique in the world for a good reason: No other country would dream of doing things the way we do.”

“Some elements of our health care infrastructure are working well—particularly the education and training of doctors, nurses, technicians, and so on, and our state-of-the-art medical research, where America leads the world.”

“In fact, it’s not all socialized medicine out there. Most wealthy countries rely on private-sector mechanisms to provide and/or pay for health care. Indeed, some foreign health care systems are more privatized than ours.”

“America’s for-profit health insurance companies have the highest administrative costs in the world.”

“The fundamental difference here is that foreign health insurance plans exist only to pay people’s medical bills, not to make a profit. The United States is the only nation that lets insurance companies extract a profit from basic health coverage.”

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