This is a great book that takes us on a fun comparative healthcare tour round the world. It talks about the different ways countries structure their universal healthcare systems, the benefits and drawbacks of each system and how different countries deal with the rising costs of healthcare. But most of all, this is a book that doesn’t lose sight of the moral question. That first question is spelled out in an extensive conversation with Dr. Hsio: “Do people in your country have a right to healthcare? If the people believe that medical care is a basic right, you design a system that means anybody who is sick can see a doctor. If a society considers medical care to be an economic commodity, then you set up a system that distributes health care based on the ability to pay.”
Implicit in this is the question: when it comes to healthcare, whose interests should take precedence? Those of the healthcare industry (pharma, hospitals, insurers, doctors, consultants, administrators, investors) or those of the patients? Every developed country (except America) has decided that healthcare is a right of citizenship and their various universal healthcare systems put patients first. America, by contrast, has decided that the business of healthcare is business.
That does not mean that every universal healthcare system is the same. T.R. Reid shows us that every nation’s universal healthcare system is as different as that country’s culture. Germany and Switzerland provide universal healthcare while ensuring that there is more competition between private doctors, insurers, hospitals and pharmaceutical companies than in the United States. When Reid asked Dr. Nakamichi, one of the top orthopedic surgeons in all of Japan, how long he would have to wait if he chose to do a full-scale shoulder-replacement elective surgery, the renowned doctor responded “Tomorrow would be a little difficult. But next week would probably work.” Does your insurance allow you to see a world-renowned doctor at the Mayo Clinic? Can you schedule an elective surgery with a surgeon there next week? Because if you answered in the negative, your insurance isn’t as good as what the Japanese have.
Reid was equally impressed with the French private universal system. The French carte vitale especially blew him away. In fact, the only illustration in this 290-page book is a picture of the card of life. This card contains “the patient’s entire medical record back to 1998. Embedded in the gold square just left of center is a digital record of every doctor visit, operation, X-ray, diagnostic test, prescription warning, etc. together with a report on how much the doctor billed for each visit and how much was paid, by insurance funds and by the patients.” The carte vitale (by now virtually every private universal health care system has one) was invented in the United States. But we can’t use it because here we have denials. Denials, coinsurance, and deductibles don’t happen in carte vitale countries. You pay your premium and co-pay. Full stop. Your doctor knows he will get paid in days or weeks. (How long the depends on the country.) Which is to say—abroad they don’t talk about “patient-centered care”. They do it.
It’s not that these other countries don’t have their problems. No-one has figured out how to contain costs—as we age and our bodies break down and caring for us costs more. It’s just that the major losers in the healthcare systems are “the providers of healthcare—doctors, nurses, therapists, and hospitals” not the patients as in the United States. In Japan, that means spartan clinics and old hospitals; in order-loving Germany, the doctors demonstrated for higher pay. I am not saying that doctors and insurance executives are paupers. They are comfortable in the upper middle class; they are simply not in the country club set. On the flip side, no patient fights with an insurance company to cover a life-saving treatment; no-one declares medical bankruptcy. And (possibly because patients don’t feel that the whole system is out to get them) no doctor worries about getting sued. Many of the doctors Reid talked to were not sure how much they pay for malpractice insurance.
There is no one way to make sure that every single person has a right to see a doctor when he is sick. How we do it will depend on our culture. But before we debate what is the right way to do healthcare, we need to decide whether healthcare is a business that benefits insurance companies, doctors, drug manufacturers, investors, hospitals and the like or if it is a service to which we are entitled because we are Americans.
The first question is a moral one. Do we have to buy life or do we have a right to live?
The Healing of America takes us round the world showing how different countries deliver healthcare to their people but it never loses sight of this basic, moral question. I recommend it.