In honor of the long-awaited health care reform bill that Congress might vote on as soon as Sunday, I’m reading The Healing of America: The Quest for Better, Cheaper, and Fairer Health Care, by Washington Post correspondent and NPR commentator T.R. Reid.
To write this invaluable and remarkably timely book, Reid traveled the world seeking treatment for an old Navy shoulder injury, interviewing health care workers, patients and politicians along the way. His resulting analysis of the world’s best and worst, cheapest and most expensive health care systems offers the sanest and most useful portrait of the American health system that you or I will probably ever encounter.
On the quality of American health care:
“We are mediocre by global standards,” says Reid. Out of 19 wealthy countries, the U.S. ranks 19th (i.e. last) at curing people with curable illnesses. Americans with asthma and diabetes die younger than asthmatics and diabetics in most of the world’s rich countries. By far, America has more deaths due to medical errors than any other rich country. Out of 23 wealthy countries, America also has the worst infant mortality rate.
On the cost of American health care:
We have by far the most expensive health care system of any country in the world. Our doctors make much more money than in any other country, but this is not why American health care is so expensive. Medical malpractice lawsuits and “preventive medicine,” commonly blamed for the high costs of health care, are also not why American health care costs so much (these together only amount to less than 1% of our total health care costs). “Rather,” Reid says, “the major reasons our national medical bill is so much higher than any other country’s are two things that the United States does differently than every other country: the way we manage health insurance and the complexity of our health care system.”
As Reid points out, we are the only developed country to rely on insurance companies who make a profit. Appallingly, only 20% of every dollar we pay in insurance premiums actually goes to health care, while 80% pays for insurance company marketing, underwriting, administration and profit. (Other developed countries that use insurance don’t spend more than 3% total on administrative costs—the same amount, notably, that the American Medicare program spends on administration.)
We are also the only developed country that has not established a single health system for everyone. Rather, we have completely different systems for Americans over 65, for military personnel, for veterans, for Native Americans, for people with end-stage renal failure, and for poor Americans under 16. For everyone else, there are hundreds of different private plans, or no plan at all. The result, Reid notes, is that medical costs are never fixed across the board, and the same operation done 10 times in the same hospital on the same day can have 10 different prices depending on who’s paying. Doctors, hospitals and insurance companies hire middlemen to sort all of this out, and the cost gets passed on to us, the patients.
For America’s sake, I hope that the health care bill currently in Congress will succeed in addressing these major cost issues in a meaningful way. After reading The Healing of America, and finally getting some straight information about how other countries do it so much better (with or without “socialized medicine”), I have the ominous feeling that we aren’t even getting close to a system that really works.