T R Reid - The Healing of America[Welcome T. R. Reid, and Host Merrill Goozner - bev]

The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care

T.R. (Tom) Reid, the former Washington Post foreign correspondent whom I came to know and admire in the early 1990s when we were both stationed in Tokyo (I for the Chicago Tribune), is the ultimate medical tourist. Only instead of looking for cheaper health care, he went looking for cheaper, more effective and universal health care systems.

Regular visitors to this website won’t be surprised by what he found. Every other country in the advanced industrial world — and quite a few in the developing world — do a better job than us, and for a lot less money. The U.S. not only ranks near the bottom for every standard indicator of health (longevity, years of good health, infant mortality), it pays nearly twice as much for the privilege. And for all that money ($2.4 trillion and counting), it fails to cover everyone, leaves millions of Americans in medical bankruptcy after receiving care, and kills well over a hundred thousand people a year through easily avoidable medical errors and the delayed and denied care that results from lack of coverage.

Okay. You knew all that. What is unique about “The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care” (and the PBS documentary “Sick Around the World” made from his travels) is his insistence that there isn’t a single solution to America’s health care woes. He found that there are a host of alternatives models that could serve our polyglot nation well, whether single-payer or competitive insurance markets on the payer side, or government-run or privately-delivered care on the provider side.

But other nations have one thing in common that America doesn’t have. Most foreign countries start from the moral imperative that health care is a right. Everyone has to be covered by the national system, whatever it is. “Having made that decision, the other nations have organized health care systems to meet that fundamental moral goal,” he writes near the end of his journey. “If the United States made the same moral choice to provide universal coverage, then we, too could design a fair, efficient, and high-quality health care system for all Americans.”

I’m not surprised Tom returned from his globe-spanning quest talking about values and morals. There has always been an aw-shucks common touch to his witty and entertaining dispatches from foreign shores, whether in print or on the air. There are plenty of charts and data sprinkled through the book (and even an appendix where you’ll learn the difference between a quality-adjusted life year and a disability-adjusted life year). But he understands that the road to changing a person’s heart goes through neither their wallet nor a cost-benefit analysis.

He poses as the naïve wanderer, who willingly suspends disbelief and his preconceived biases to see what others too often miss when discussing foreign “models” of providing health care. What the U.S. dialogue is missing, he repeatedly finds, is that health care is a social good, like education or picking up the garbage or providing clean water. And until the politicians treat it like a social good and not like a market commodity, the nation will never solve its health care mess.

Tom starts his journey by taking his bum shoulder, injured in 1972 while in the Navy, to his American orthopedist, who recommended total shoulder arthroplasty. Lamenting the fact it would cost tens of thousands of dollars (exactly how much remains opaque in our system) and involve months if not years of rehab, our intrepid correspondent then takes his shoulder through a good cross-section of the world’s health care systems: from India with its massage therapists to Germany with its range of options, including the same total replacement if he wanted it, to Great Britain’s stiff upper lip. Some worked, some didn’t. Each had flaws. He found waiting lines in Canada. Poorly paid physicians in Japan. Expensive policies in Switzerland. But everywhere there was a high degree of satisfaction because of one basic principle: everyone had equal access to whatever care was being offered.

Let me finish this introduction by highlighting one other important message in his book, which deserves special attention because it has been largely overlooked or dismissed in this year’s debate. Unlike far too many health care pundits, he learns through his visits to other countries about the close connection between universal coverage, disease prevention and overall population health. In our non-system, people shift insurers with every change in jobs and they eventually wind up in a government program — Medicare — when they hit their medically high-cost years. That means private insurers have no incentive to keep people well. Prevention is an extra cost whose benefits will be reaped by a different insurer.

But in other countries, where a person is either covered by the government or is likely to remain with the same insurer for life, everyone has an incentive to invest in prevention — the patient, the doctor, and the insurer. And the result is better overall population health.

With both the Senate and House nearing a crescendo of activity on this all-important issue, it’s timely that we’re spending our Saturday evening discussing health care and Tom’s new book. Welcome, Tom, to FDL’s book salon. Care to make an opening comment?