Saturday, November 14, 2009

The Healing of America: Why Fear Learning from Our Friends?

If you never saw the ocean, you might think your local swimming hole is a pretty big body of water.

That's the problem with people who think our American health care system is the best in the world: they have never gone to see if anything is better.

Pride in your local swimming hole is harmless, but health care is life and death. Only an arrogant fool would think that THEY know all the answers, and cannot possibly learn from our friends in Germany, Japan, France, Canada, India and the U.K.. A wise man would go there, try their system, and see what ideas we can borrow for ourselves.

In "The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care", T. R. Reid does every American a great big favor by taking his bad shoulder around the world to be looked at by doctors in six countries. What he finds will surprise anyone who thinks the rest of the world is a socialist hell, burdened by grey bureaucrats staffing drably uniformed Death Panels. He finds is that each of those nations has a different system, tuned to their particular histories, and with strengths and weaknesses. Most are dominated by private suppliers, e.g. doctors who run their own offices. I was shocked to discover that, on average, Japanese visit doctors more than twice as often as Americans; France's information technology makes ours look like a joke; even in much-maligned Britain people's lives are saved because there is no financial barrier to coming to the doctor if you have a suspicious lump. Why are Americans afraid to learn these basic facts? Why not take their ideas to improve our system? Are we just too proud to live?

I suppose pride is part of the problem; the other is that Our existing system has enormous institutional inertia. As Machiavelli said those few who reap great profit from some affair can easily defeat a vastly greater number who have a more diffuse interest. In providing an actual experience of seeking health care around the world, this book suggests that our current arrangements are not the best; but of course, they are the best to those it enriches.  Reid tries to demonstrate that inertia can be overcome, by describing how Taiwan and Switzerland converted their systems around the time that the Clinton initiatives failed. I suspect, unfortunately, that our American system will be a trickier conversion, because the forces arrayed against reform learned from Taiwan and Switzerland, and will fight to keep what they've got; you cannot take a juicy steak away from a pack of hungry dogs without getting bitten.

If you're in a hurry, you will appreciate that this book is a quick read. While it's got plenty of footnotes so you can verify the assertions and learn more, its organization lends itself to grabbing a quick chapter while you can. I especially enjoyed the chapters about each nation; they were like a short story of a visitor seeking help and happened when he did.

However, I found the most surprising chapter entitled "An Apple A Day", which discusses why our current system works against preventative measures. Since your insurer as a youth will not be your insurer in old age, the former has no reason to do anything that would benefit only the latter. If a private insurer can put off dealing with a problem until the patient turns 65, the private insurer may not have to deal with it at all! It is a perfect example of how what is economically efficient in individual health PAYMENT transactions results in systemic inefficiency in the overall health CARE system.

However, the most important chapter may be "The First Question". Ultimately health care is not a financial question; it is a moral question. What kind of nation are we? What kind of people are we?

If we are content that a woman shall live or die depending solely upon whether she is the president of a company or its minimum-wage floor-mopper, then we need do nothing. We have that system already. Of course, we can't be very proud of that; it's basically a return to the hells of Upton Sinclair.

If, however, we are a more decent people, we believe that all of us should have a good chance at life. Life is not a luxury to be reserved, but a necessity to be shared by to all members of our community. And, best of all, as this book shows, we have friends in other nations who can show us how they did it.

It's our choice.

What are we?

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