Saturday, November 7, 2009

The Healing of America by T.R. Reid

Cover of The Healing of AmericaI've just finished T.R. Reid's The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care. In it, the veteran foreign correspondent takes his sore shoulder to doctors in countries around the world, each of which administers universal health care in a different systems, from single payer to completely privatized.

Here are the things that stuck with me the most:

  • The fact that there isn't just one form of "socialized medicine," but instead multiple different systems. Beyond the classic idea of everything being state-owned, there are countries with state-owned hospitals but privatized family practitioners, countries that function the same way Medicare does, and countries that run insurance through employers -- except that everyone has to have insurance and people don't lose their insurance when they lose their jobs (with the government picking up the tab for the unemployed).
  • Finding out that several countries have made the transition from an out-of-pocket system to universal health care in the last 20 years... and the change is doable.
  • The sheer financial stupidity of our system. We're paying for multiple health insurance companies to keep track of all the billings and payments, figure out how they can deny our claims, and market their wares, but we're not paying for preventive care. So that a diabetic isn't covered for a $150 visit to a podiatrist, but s/he is covered for the $30,000 amputation needed later after gangrene sets in. And top that off with 700,000 medical bankruptcies each year.
  • The number of people who die in the U.S. because of access inequality. "A U.S. government study found that accident victims who are uninsured are 37 percent more likely to die from their injuries than somebody with insurance... government and academic studies report that more than twenty thousand Americans die each year from treatable diseases" (page 149). There's a huge gulf left unfilled between an uninsured person's right to be treated in an emergency room and health care that catches cancer before it's too late or treats a chronic condition.
  • The moral argument. Why should two people the same age, the same sex, in the same town, who both develop ovarian cancer have completely different outcomes because one has good health insurance and the other has none? Reid presents such a scenario and asks, "Because we have built a health care system that discriminates on the basis of wealth, the American health care system lets one woman live and the other die. Are we willing, as a society, to tolerate that inequality?"
Reid spends several pages of the book presenting the story of a young woman named Nikki White. The details of Nikki's story are all-too familiar, but sickening at the same time. When she finished college, she went off her parents' insurance. First she got a job without insurance, but she started to feel sick, so she changed jobs to one with insurance. She developed severe stomach pain, fatigue and skin lesions, and was diagnosed with lupus. While no picnic, lupus is a treatable chronic condition.

Too sick to continue working, Nikki left her job and was again without insurance. She applied for individual insurance and was turned down because of her preexisting condition. She moved back home to Tennessee, where she could get coverage from TennCare, the local version of Medicaid. She eventually found a doctor who would take the Medicaid payment level, and was prescribed the drug she needed, which requires ongoing testing and followup to prevent side-effects.

Then Tennessee cut back TennCare, and suddenly Nikki had "too much money" to qualify. She tried again to get individual insurance but was denied. After battling bureaucracy for months, she applied for Social Security disability, because if she had that, she would be eligible for Medicaid. Her application was denied.

Finally, Nikki received emergency care when she had a seizure from kidney failure and a perforated intestine. Under federal law, the hospital she entered had to treat her until she was stable. In 10 weeks she had 25 operations, but died anyway at age 32, leaving a large unpaid bill for the hospital.

Reid writes, "If Nikki had received the standard treatment regimen for lupus readily available to any American with heath insurance, she could have lived a normal life span" (page 212).

For this parent of a teenager and aunt of young people in their 20s, Nikki's story made for excruciating reading. Like the Women's Press's Nora's Story from last summer, it can't help but make you shake your head at the infuriating inequality of our system.

On the whole, the book is very thorough, but there were times when I wanted more information. In the systems that use privatized insurance (like Germany), I wish there had been more detail about how young people like Nikki make the transition from being on their parents' plans to their own plans. I wish there had been more information on how undocumented immigrants are covered or not covered in the various systems.

One final thing I discovered from the book -- Thomas Clement Douglas, the father of Canada's health care system, brought the system into being by enacting it in a single province (Saskatchewan -- did you know that? I didn't). Over the next decade, people in the rest of the provinces saw how it worked and wanted it too.

In my American ignorance of most things Canadian, I have never heard of Douglas, but according to Reid, "When the Canadian Broadcasting Corporation polled the nation in 2004 to choose 'the greatest Canadian of all time,' Tommy Douglas won by a landslide, easily beating out the likes of Alexander Graham Bell and Wayne Gretzky" (page 133).


Renee said...

Sounds like an interesting book. Where did you hear about it?

Daughter Number Three said...

I originally read an op-ed Reid had written in the Star Tribune (I wrote about that piece a while ago). Then I saw his book in my favorite bookstore a few weeks ago and snapped it up.