By Phillip Longman
Sunday, September 27, 2009
THE HEALING OF AMERICA
A Global Quest For Better, Cheaper, and Fairer Health Care
By T.R. Reid
Penguin Press. 277 pp. $25.95
During last year's Republican presidential primary season, candidate Rudy Giuliani succinctly captured what millions of Americans think about health care abroad. "These countries that say they provide universal coverage -- they pay a price for it, you know," Giuliani told his audience. "They do it by rationing care, by long waiting lines, and by limiting, or I should say eliminating a patient's choice."
T.R. Reid has done a service to his nation by showing in his latest book just how uninformed this conventional wisdom is. Based on his own experience and research, "The Healing of America" is both readable and informative.
Many decades ago, Reid suffered an accident while in the Navy that left him with a bum shoulder, a condition that, while not acutely painful, became increasingly bothersome as he aged. During his long career working as a foreign correspondent for The Washington Post, he and his family received high-quality, routine care from doctors in places like Tokyo and London. These two circumstances provided Reid with the inspiration for his book and set him off on "a quest for two cures." He traveled around the world, visiting doctors in places as diverse as Taiwan, France and India to see how their health care systems would approach treating his shoulder pain, and in the process he searched for insights to cure the U.S. health care crisis.
Reid checked himself into the famous Arya Vaidya Chikitsalayam, an institution that he describes as the Mayo Clinic of traditional Indian medicine, and was surprised when a haughty astrologer and her retinue used a collection of shells, rocks and statuettes of Hindu gods to divine whether the stars were aligned to favor his treatment. It turned out they were. Reid then underwent a regime that involved drinking "a vile assortment of herbal medicines, most of which tasted like spoiled greens or aging mud," as well as a diet of gruel and performance of poojah, or reverence, to the Hindu god of healing, Dhanwanthari. Yet perhaps more helpfully, strong, skillful therapists went to work three times a day slathering him with spiced sesame oil and messaging his whole body, with special attention to his sore shoulder. After weeks of this treatment, Reid lost nine pounds and became a very mellow man. He also discovered that the pain in his shoulder was gone and that he had much greater mobility in his arm. The cost of this therapy came to $42.85 per day -- far less than that of the invasive total-shoulder anthroplastic surgery recommended by Reid's American doctor, who couldn't say what replacing his shoulder might cost after the various insurance adjusters were done. Reid would have paid even less had he purchased Indian insurance, which typically covers the treatment that fixed his shoulder, including the cost of the astrologer.
Elsewhere on his journey, Reid discovered other curious truths about health care abroad that Americans don't know. For example, Germany and Switzerland manage to provide universal coverage while preserving a greater role for competing private-sector doctors and insurance companies than the United States does. In those countries, it is true that government regulation and price controls also play a big role. However, in Britain, a supposed bastion of "socialized medicine," most doctors are in business for themselves and are often highly entrepreneurial in seeking new patients; some even make house calls. Reid learned that Britain's National Health Service would not pay for the anthroplasty his American doctor recommended unless he was in acute pain, but as his Indian experience proved, he didn't need the operation.
Similarly, in France and Japan, consumers have quicker access to a broader range of providers than most Americans do (no cost for going "out of network"). And no one is ever denied an insurance claim or thrown into medical bankruptcy. What's more, per capita health care costs are far lower than in the United States and health care outcomes better. Canada does have long waiting lists for elective procedures, but other nations such as Germany, France, Sweden and Denmark outperform the United States in providing quick access to specialists. Reid was able to make an appointment with one of Japan's top orthopedic surgeons the same afternoon he made his first call.
Reid acknowledges that the health systems in the countries he studied have their own problems. He also admits that none has figured out how to contain the global long-term trend toward higher costs as populations age, the spread of Western lifestyle and diet causes an epidemic of chronic illness, and as expensive new medical technologies become available. But he does demonstrate that Guiliani and like-minded Americans put forward a distorted image when they contend that other industrialized countries ration health care and constrain patients' choice of doctors, deny effective care and, in essence, provide socialized medicine. Reid shows us how other advanced countries easily combine universal coverage and government regulation with entrepreneurialism and respect for market forces to produce high quality, low cost health care -- a simple empirical truth we can no longer afford to ignore.
Phillip Longman, a senior research fellow at the New America Foundation, is the author of "Best Care Anywhere: Why VA Health Care is Better than Yours."