The healing of America
author T. R. Reid guides a whirlwind tour ofsuccessful health care systems worldwide, revealing possible pathstoward U.S. reformIn The Healing of America, New York Timesbestselling author T. R. Reid shows how all the otherindustrialized democracies have achieved something the UnitedStates can’t seem to do: provide health care for everybody at areasonable cost.In his global quest to find a possible prescription,Reid visits wealthy, free market, industrialized democracieslike our own—including France, Germany, Japan, the U.K.,and Canada—where he finds inspiration in example. Reidshares evidence from doctors, government officials, health careexperts, and patients the world over, finding that foreign healthcare systems give everybody quality care at an affordable cost.And that dreaded monster “socialized medicine”turns out to be a myth. Many developed countries provideuniversal coverage with private doctors, private hospitals, andprivate insurance.In addition to long-established systems, Reid alsostudies countries that have carried out major health carereform. The first question facing these countries—and theUnited States, for that matter—is an ethical issue: Is healthcare a human right?
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- There is a middle ground here. Many European countries do not actually have single-payer, but still perform better than the US.
It's a bit out of date now but the book The Healing of America found that Germany, France, and Japan had world-leading healthcare results, measured by things like survival time after major disease diagnosis, but spent much less of a percentage of their GDP on healthcare. None of them had single-payer. Their systems were pretty close to the ACA, with private insurance companies and a mandate.
They were also different than the US in certain ways. Probably the biggest was a national price list for services. A lot of healthcare isn't really a functioning market; in many cases you're in no position to comparison shop. A result of the price lists was that doctors made a lot less money, but this didn't seem to affect quality.
Other differences included: no claim denials allowed for anything on the price list (which saves a lot of administrative staff), effective national digital records systems (ditto), and the insurance companies had to be nonprofits.
All three countries actually got better bang for the buck than Canada's single-payer system. Japan was the cheapest, spending only 5% of their GDP on healthcare, despite an aging population of heavy smokers. Germany was the most expensive at 13% (compared to US 18%) but covered things like week-long visits to the spa for stress relief.
The author did a spot check on the user experience by seeing a doctor in each country for a shoulder problem, and those three countries worked out really well for him. In Japan the doctor offered surgery the next day, at a very modest cost. They did make do with simpler equipment; the MRI machines were bare-bones but they got the job done and a scan cost $100.
- To quote a great play: “what comes next”?
What’s always missing from these calls to action is: what are you replacing it with? There are a number of healthcare programs across the world and every country has a variety of different problems. There are no silver bullets.
If you want a great read about a few different countries, I recommend The Healing of America by T.R. Reid. It has some suggestions, but in general it is great at illustrating how treating the same illness in different countries can be varied in terms of treatment and cost.
- It's not "both" systems, it's at least four. Canada is private doctors, public insurance. In the UK, the public system includes the doctors as well. France is not single-payer but has a system somewhat similar to the ACA, with private but nonprofit insurance, an effective mandate, a national price list for health services, and a prohibition of claim denials for anything on the list.
A great book comparing eight national systems in The Healing of America by T.R. Reid. It references stats showing the French-style systems get the highest quality results, with reasonable cost. Japan and Germany have similar systems.
- I wish there were a quick/easy answer here (we all prefer would to read those) but the truth is that it's not that simple. Even among the nations with excellent universal healthcare systems, most differ from each other in pretty significant ways. This is in part because no two countries are the same, and every detail can have a big effect on what system would work best for them. There are certainly stats-friendly ones about population, economics, and politics. But there are also equally-important ones that are cultural and harder to quantify--for instance, in some countries the people have a distrust of doctors, or a cultural aversion to visiting the doctor unless absolutely necessary, and that factors into the best design for that country, based on how it would be used.
What I can recommend is a great book that compares all the systems, through the lens of an American with the same question you have, called The Healing of America by T.R. Reid. Highly recommended.
- Similarly, a Frontline episode:
https://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/
An excellent book on the subject ("The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care"):
https://www.amazon.com/Healing-America-Global-Better-Cheaper...
And a comparison by The Commonwealth Fund:
http://international.commonwealthfund.org/
And just a reminder how long the U.S. has been having this argument:
https://en.wikipedia.org/wiki/Clinton_health_care_plan_of_19...
And a quote from that page:
The long-term political effects of a successful... health care bill will be even worse—much worse.... It will revive the reputation of... Democrats as the generous protector of middle-class interests. And it will at the same time strike a punishing blow against Republican claims to defend the middle class by restraining government.
— William Kristol, "Defeating President Clinton's Healthcare Proposal", December 1993
- The book The Healing of America by T.R. Reid, 2010 was a phenomenal look at this subject and the conclusion was this: we are the only developed nation whose government allows for-profit health insurance companies to exist with ZERO regulation to cap healthcare prices. Because of this, we spend 20% of every dollar on "administrative" costs compared to 3%-7% in the European and Asian countries. The goal for American healthcare companies is increasing shareholder value, not reducing costs. IMO healthcare is an obvious example of where a "free market" approach has failed and government oversight is critical.
https://www.amazon.com/Healing-America-Global-Better-Cheaper...
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