I chose to read this book because it was featured on the PBS Newshour in one of their "Book Conversation" segments in which they interview the author. I was impressed by the author, and reading this book seemed like an effective and interesting way to frame thinking about the health care issue in American politics. It was written while the debate over the Affordable Health Care Act ("Obamacare") was being shaped and debated prior to the enactment of the legislation in March 2010.
T. R. Reid is a journalist who writes with a journalist's engaging style. He sets out to compare health care in the U.S. with health care in other affluent democratic countries as a way of thinking about health care in the United States on several dimensions:
- Coverage, access, and choice (who gets covered or left out; what level of access and choice of health care provider and health care funder - insurance - is there)
- Quality (measured by infant mortality rates, life expectancy at age 60, as well as by less tangible measures such as patient satisfaction)
- Cost (measured by percentage of GDP spent on health care, and by cost to patients)
These are the most significant observations and conclusions I took away from the book:
- One out of every six Americans (about 45-50 million persons) has no health care insurance. All of the other affluent democracies in the world cover everyone.
- We already have health care "rationing" in the U.S. On average, 22,000 Americans die every year from treatable health conditions because there was no mechanism in the U.S. system to pay for their care. The book begins with the case of Nikki White, a college graduate - employed with health insurance until her health condition kept her from continuing to work - who died at age 32 of lupus and would have lived a longer, healthier life in any other of the affluent democratic countries in the comparison.
- People in all the comparison countries had much greater choice of health care provider and, in places like France and Germany, much more choice of health care funder (insurer).
- In groupings of 19 (or sometimes 23) comparison nations, the U.S. ranked dead last or near last on an array of measures of health care quality, including infant mortality and life expectancy at age 60.
- People in all the comparison countries had much higher patient satisfaction - measured by surveys - with the health care they received.
- In terms of percentage of GDP spent on health care, the U.S. spent 17% of its GDP on health care, substantially higher than any other nation on the planet and two or three times what was spent in France or Japan, although everyone is covered there.
- 20% of what Americans spend on health care is spent on administrative costs of health insurance companies. Other countries spend 3-5% on administrative costs.
- No other country has "for profit" health insurance companies to fund health care, which means that paying health care bills is actually reckoned as a "loss" to be minimized so that profits can be maximized for stockholders. This explains why Americans spend 20% of total health care costs on administration; health insurers employ substantial bureaucracies to process claims and find ways not to pay health care bills.
- In other countries there are set fees for the broad array of health care services and procedures, posted in every doctor's office and hospital. Everyone knows what it costs. In the U.S. five different patients having the same operation with the same surgeon in the same hospital on the same day will likely pay widely disparate amounts, depending on who is paying.
- Out-of-pocket expenses to the patient in all the comparison countries were typically much less than that for Americans. For the one out of six Americans with no health care coverage, they pay out of pocket like the citizens of poor, third world countries. If they can't pay, they stay sick or die.
- The U.S. health care "system" is actually multiple systems with features from all the other countries. Socialized medicine? The U.S. Department of Veterans Affairs is run just like the British National Health Service. Medicare and Medicaid operates on the same single payer model as Canada. Health insurance through the workplace through employer and employee funded insurance operates like the systems in France and Germany, except Americans have a lot less choice. And then there's "out-of-pocket" for 45-50 million Americans, just like Ethiopia.
I would recommend this book as a starting place for anyone who wants to develop an understanding of health care in America. The author makes no recommendations about what should be done, other than that Americans can learn from what other countries are doing and fashion a health care system that covers everyone, costs less, and delivers better results. Whether you favor or oppose the Affordable Health Care Act of 2010, this book will enrich your understanding of health care in the U.S.
What else am I reading?
I'm otherwise reading historical scholarship in my academic field, particularly books from a series on the Social History of Africa, published by Heinemann. For fun I like to read a variety of novels; novels by African writers; novels by Charles Dickens, Jane Austen, and the like; novels in historical settings; David Baldacci and Ken Follett novels; and recently Alexander McCall Smith's little novels about a woman private detective in Botswana.
Dr. Steven Edgington is Dean of the College of Arts & Sciences; Professor, College of Arts & Sciences. He has worked at Hope International University for 22+ years as Professor and Dean.
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