Health Care is America’s Big Moral Issue

Book review on

The healing of America

by T. R Reid

Reviewed by Martin Lockley , 2009 published in Network Review No 101

According to the World Health Organisation  (WHO)  America spends  far more on health care, as a % of GNP,  than any other developed nation. One might expect good results, but the WHO ranks America only number 36 among the 'best health care systems' in the world. When measuring the 'fairness'  of the system America ranks  54th out of 191, behind Bangladesh and the Maldives, and just 'slightly ahead of Chad and Rwanda.' Worse, the Commonwealth Fund (a private U.S foundation) ranks America 23rd out of 23 among developed nations when it comes to 'universal coverage' (and neonatal infant mortality). In no other developed country are insurance companies allowed to deny coverage, and in no other nation do people go bankrupt as a result of astronomical medical bills. In America 'the annual figure is around 700,000,'  while annual deaths from treatable maladies, as a result of  lack of insurance,  reaches at least 20,000. 

Although the American health care system is in dire straits, and burdened by extraordinary costs, complexity, unfairness, greed, immoral business and lobbying practices and strident political wrangling, The Healing of America is a model of clarity, among the ever-growing list of titles lamenting this strange American sickness. The author T.R. Reid, a former Washington Post chief of both the Tokyo and London bureaus, speaks with considerable authority on comparative health care systems.  Having lived in France and Germany as well as Japan and the UK he structures his book around his personal experience with health care systems in these countries, as well as in India, Canada and the USA.  He used his own old shoulder injury as a controlled experiment, taking it to doctors in a half dozen countries to find out what they would recommend and what it would cost to treat.

The comparisons are revealing rather than odious, and despite the distracting and misleading propaganda  put out through the American media, by special interests, it is clear that Americans are finally aware that they face a political  problem that has reached crisis proportions. They see that other developed countries have better and cheaper systems that give their citizens greater security and significantly increased longevity.  Reid stresses, therefore, that the crisis is fundamentally a moral one. 'Should we guarantee medical treatment to everyone who needs it?  Or should we let Americans ...die from lack of access to health care?' He frequently cites Chinese born Harvard Professor William Hsiao, author of Getting Health Reform Right who specialises in advising countries on setting up health care systems and insists that 'you have to know that country's basic ethical values.'

In making his comparisons Reid gives us interesting potted histories of the origin of health care systems beginning with the German Bismarck system, in 1881, which the famous 'Iron Chancellor' called 'a programme of  applied Christianity' creating a means for the 'more fortunate Germans to care for the least of their brethren.'  As Japan emerged from mid nineteenth century isolationism, emperor Meiji looked around the world for models of reform in agriculture and education,  and by the end of the century had settled on the Bismarck Model for health care.   In describing the origins of the British National Health Service (NHS)  through American eyes  Reid labels it the Beveridge model and credits Lord William Beveridge and Nye Bevan for coming together from the 'opposite poles of the British class divide' so that Beveridge - 'a reforming intellectual' -  could 'design,' and Bevan 'muscle into existence,' an NHS system of which most Brits are 'enormously proud.'  Americans may not know their hit series ER (no connection to the Royal Family) derived from the British TV drama Casualty, and that 'Mills and Boon, the nation's biggest publisher of romance novels, has a division that specialises in NHS love stories.'  Alas, love and pride are in rather short supply in America's health care systems.

For a European, Japanese, Canadian, Indian  or even a Cuban patient living in America it is difficult to understand that the system here is so broken. Americans have been trying to fix it without success since the end of World War II.  Resistance at first came from the doctors, but now mostly comes from the insurance companies and their powerful lobbyists.   Ever since the war, opponents of reform have used the bogus label of  'socialised medicine' to scare a gullible public into thinking that somehow the government will take over and so reverse America's hard won independence. This 'term was popularised by a public relations firm working for the American Medical Association in 1947.'  Ironically, the most popular and efficient American health care programmes are Medicare, the Veteran's Affairs  Dept., and the services provided to Native Americans- all government run programmes!

Thus concludes Reid that America labours under five myths about health care systems overseas. 1)  It's all socialised medicine elsewhere.  2) They ration care and choice creating long waiting lists.  3) They are wasteful, bureaucratic systems. 4) Health insurance companies have to be cruel, and 5) Other systems are too foreign for the USA.  Frankly, as Reid implies, all this is utter nonsense attributable to ignorance on the part of the populace and wilful ignorance on the part of politicians and lobbyists, all reluctant to admit the failure of a system that the rest of the world would never tolerate.

Ironically America already has at least four different systems. For Native Americans, veterans and those in active service America is Britain or Cuba! For those over 65 the USA is Canada. For working people under 65 it is, in principle, Germany, France or Japan. But for the 45 million currently uninsured America is like Cambodia or rural India.  The problem in a nutshell is that 'the United States maintains so many separate systems for separate classes of people ...[and]... relies so heavily on for profit private insurance companies to pay the bills. All other [developed] countries have settled on one model for everybody, on the theory that it is simpler, cheaper and fairer.' This again is doubly ironic in a country that prides itself on having abolished the class system. The problem is evidently the shadow class system and callous greed created by the almighty dollar and unregulated 'free enterprise.' 

Reid brings necessary clarity to this complex problem. If his clear exposition of the problem were understood by enough Americans, who were swayed by the moral imperative of 'fairness' and the benefits of prevention, longevity, increased efficiency and substantial GNP savings, he might just play a part in The Healing of America.    Watch this space for the debate is in full swing, and everyone agrees something must be done. It may just be true as Leonard Cohen once wrote that in America  "the heart has got to open in  fundamental way... [and]... democracy is coming to the USA."

Professor Martin Lockley teaches palaentology and consciousness studies at the University of Colorado.

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