In The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care, author T.R. Reid describes the methods that other industrialized democracies have used to provide health care for citizens for far less than what is spent for health care in the United States. These countries, in doing so for less money, provide universal coverage for all their citizens.
T.R. Reid describes his purpose in writing this book to “search the developed world for effective health care systems and take lessons from the ones that work best.” Not surprisingly, Reid finds positives and negatives in many of the systems he evaluates in an unbiased fashion. His conclusion that all of these other plans spend less on health care administration than the United States, achieve better outputs than the US system, and cover all citizens within their countries is irrefutable.
Reid couches the issue of the fundamental moral decision to provide health care coverage to all citizens or not. Other democracies that have embraced universal health coverage for their citizens have outperformed the US health care system on indices of cost, quality, and choice – 3 key focal points for discussion in the book. Reid notes that over 20,000 American die yearly because they cannot afford to see a doctor, and quotes that 700,000 individuals must declare bankruptcy due to mounting bills arising from a lack of health insurance coverage.
Reid describes the 4 basic models of health care delivery and insurance. The Beveridge Model (as seen in systems in the United Kingdom, Italy, Spain, and Cuba), the Bismark Model (with examples from Germany, France, Switzerland, Japan), National Health Insurance Model (as present in Canada and Taiwan), and Out-of-pocket Model (US and Cambodia). Reid points out that each of these models is in place in the United States at present. For example, for those on Medicaid in the US, the Beveridge Model applies; for employers and employees sharing payment for insurance premiums, the Bismark Model is in play; for Medicare, the Canadian National Health Insurance Model is pertinent; and for the 45-47 million uninsured, the Out-of-pocket Model is applicable.
In Chapter 13 of this interesting read, the author “explodes” various myths surrounding foreign health care systems, namely:
“It's all socialized medicine out there.”
“They ration care with waiting lists and limited choice.”
“They are wasteful systems run by bloated bureaucracies.”
“Health insurance companies have to be cruel.”
“Those systems are too foreign to work in the USA.”
In conclusion, at a time when the debate over health care reform in the United States has reached fever pitch, filled with emotion, distortion of facts, and many inaccuracies about health care systems abroad, Reid's thoughtful, articulate, and accurate descriptors about foreign health care systems provide complete and unbiased views of systems we could learn from and adapt to meet American needs. He suggests that we in the United States can bring about fundamental changes in our system through borrowing ideas from systems of care delivery and financing elsewhere. None of these comparator systems is perfect, and, to his credit, Reid points out flaws consistently and fairly. For example, he finds long queues in Canada, poorly paid physicians in Japan, undertreated patients in the United Kingdom, and very challenging facilities in France. Reid interviews physicians, governmental regulators, international health care experts, and, finally, patients receiving care.
I definitely recommend this book for pharmacy faculty members and students. It is a great book to use as a reference for personal elucidation, and could easily be an anchoring component of a graduate and undergraduate course dealing with health care reform, health care delivery, public health, and/or public health policy. The book and the manner in which it is written and distilled will provide a great backdrop for stimulating discussion and interchange.