T. R. Reid - The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care

Table of Contents

ALSO BY T. R. REID

The United States of Europe
Confucius Lives Next Door
Congressional Odyssey
The Chip
Ski Japan!
Heisei Highs and Lows
Seiko Hoteishiki
Tomu No Me, Tomu No Mimi
For Peopleand for Profit (translator)

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First published in 2009 by The Penguin Press,
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Copyright T. R. Reid, 2009

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Cartoon from The Wall Street Journal. Used by permission of Cartoon Features Syndicate.

Library of Congress Cataloging-in-Publication Data

Reid,T. R.
The healing of America: a global quest for better, cheaper, and fairer health
care / T. R. Reid
p. cm.
Includes bibliographical references and index.

eISBN : 978-1-101-13346-0

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This book is dedicated to
President Dwight D. Eisenhower
for reasons set forth in chapter 1.

Prologue: A Moral Question

IF NIKKI WHITE HAD BEEN A RESIDENT OF ANY OTHER rich country, she would be alive today.

Around the time she graduated from college, Monique A. Nikki White contracted systemic lupus erythematosus; thats a serious disease, but one that modern medicine knows how to manage. If this bright, feisty, dazzling young woman had lived in, say, Japanthe worlds second-richest nationor Germany (third richest), or Britain, France, Italy, Spain, Canada, Sweden, etc., the health care systems there would have given her the standard treatment for lupus, and she could have lived a normal life span. But Nikki White was a citizen of the worlds richest country, the United States of America. Once she was sick, she couldnt get health insurance. Like tens of millions of her fellow Americans, she had too much money to qualify for health care under welfare, but too little money to pay for the drugs and doctors she needed to stay alive. She spent the last months of her life frantically writing letters and filling out forms, pleading for help. When she died, Nikki White was thirty-two years old.

Nikki didnt die from lupus, Dr.Amylyn Crawford told me.Nikki died from complications of the failing American health care system. It was a lack of access to health care that killed Nikki White. Dr. Crawford is a family physician at a no-frills community health center in an old strip mall in a downscale section of Kingsport, Tennessee. She sees lots of hard cases. Still, she couldnt stop sobbing as she recalled her late patient Monique White: I told Nikki that she had lupus. But I also told her that a diagnosis of lupus is not a death sentence. But it turned out, she couldnt pay for the care she needed. If Nikki had not lost her health insurance, shed be alive today.

Later in this book, well take a detailed look at Nikki Whites tragic encounter with Americas health care system. But the larger tragedy is that Ms. White is not alone. Government and academic studies report that more than twenty thousand Americans die in the prime of life each year from medical problems that could be treated, because they cant afford to see a doctor. On September 11, 2001, some three thousand Americans were killed by terrorists; our country has spent hundreds of billions of dollars to make sure it doesnt happen again. But that same year, and every year since then, some twenty thousand Americans died because they couldnt get health care. That doesnt happen in any other developed country. Hundreds of thousands of Americans go bankrupt every year because of medical bills. That doesnt happen in any other developed country either.

Those Americans who die or go broke because they happened to get sick represent a fundamental moral decision our country has made. Despite all the rights and privileges and entitlements that Americans enjoy today, we have never decided to provide medical care for everybody who needs it. In the worlds richest nation, we tolerate a health care system that leads to large numbers of avoidable deaths and bankruptcies among our fellow citizens. Efforts to change the system tend to be derailed by arguments about big government or free enterprise or socialismand the essential moral question gets lost in the shouting.

All the other developed countries on earth have made a different moral decision. All the other countries like usthat is, wealthy, technologically advanced, industrialized democraciesguarantee medical care to anyone who gets sick. Countries that are just as committed as we are to equal opportunity, individual liberty, and the free market have concluded that everybody has a right to health careand they provide it. One result is that most rich countries have better national health statisticslonger life expectancy, lower infant mortality, better recovery rates from major diseasesthan the United States does.Yet all the other rich countries spend far less on health care than the United States does.

Contrary to conventional American wisdom, most developed countries manage health care without resorting to socialized medicine. How do they do it? Thats what this book is about. I set out on a global tour of doctors offices and hospitals and health ministries to see how the other industrialized democracies organize health care systems that are universal, affordable, and effective.

My global quest made it clear that the other wealthy democracies can show us how to build a decent health care systemif thats what we want. The design of any nations health care system involves political, economic, and medical decisions. But the primary issue for any health care system is a moral one. If we want to fix American health care, we first have to answer a basic question: Should we guarantee medical treatment to everyone who needs it? Or should we let Americans like Nikki White die from a lack of access to health care? Once we settle that point, the nations well visit in this book can show us how to manage the mechanics of universal health care. We dont need a carbon copy of any particular countrys health care system; rather, we can draw valuable lessons from each of the models described in this book. If Americans have the will to fix our costly, unfair health care system, the rest of the world can show us the way.