BOOK REVIEW: American Exceptionalism Is One of Many Roadblocks to Comprehensive Health Care Reform, T.R. Reid Says in ‘The Healing of America’

Reviewed By David M. Kinchen
Editor’s Note: This review originally ran Oct. 16, 2009, more than two years ago. I’m running it again because Reid’s book remains the best I’ve seen on health care around the world. I’m also running it again because a new report by the Commonwealth Fund (link to story on the report: http://www.nationofchange.org/us-health-care-falls-farther-behind-peers-report-finds-1319043544) said we’re slipping behind the rest of the developed world in longevity because of our broken system of health care. The report noted that in 2010  fully 44 percent of adults age 19-64 didn’t have enough health care insurance coverage for their needs, up from 35 percent in 2003. I’ve long been a fan of offering Medicare to all, which go a long way to fixing the system. This should be combined with price controls on medical procedures and prescription drugs, as Canada implements today.



American exceptionalism will be the death of us — and it is every year to the more than 20,000 Americans who die in the prime of life each year from medical problems that could be treated because they can’t afford to see a doctor.

No other industrialized nation in the world can make that statement, says T.R. Reid in “The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care” (Penguin Press, 288 pages, $25.95). And in no other industrialized country in the world are people bankrupted because they can’t afford medical care rationed by bottom-line-driven insurance companies — which cancel policies when people get sick, refuse to pay doctor bills or deny coverage because of pre-existing conditions.

Washington Post correspondent Reid traveled to about a dozen countries in his quest to fix his aching right shoulder and — more importantly — to find out which system would work to fix our ragged, patchwork quilt health care delivery system.

The numbers tell the story: All the other developed industrial nations spend far less on health care than the U.S., which spends a whopping 15.3 percent of its GDP on health care (in 2005…it’s closer to 17 percent now) and have greater longevity, lower infant mortality and better recovery rates from major diseases than Americans, Reid says, and backs up these statements with statistics from the World Health Organization (WHO) and other agencies.

He says we already have two “foreign” models in operation in the U.S.:

* Medicare, for people 65 and older and those who are disabled, modeled on the Canadian health care system that was adopted in 1961 in Canada and was called Medicare. Our Medicare covers about 44 million elderly and disabled Americans. (I hate that word “elderly,” because my wife and I are both on Medicare!)

* The Department of Veterans Affairs medical programs are the purest example of “Socialized medicine” in the States, he says, even more than the United Kingdom’s National Health Service, because doctors in Britain are private practitioners, while doctors at the VA are government employees.

Both Medicare and the VA programs show we can overcome American Exceptionalism if we put our minds and hearts to it. Both programs are hugely popular with people who are covered. You can take away my Kodachrome, as Kodak has just done, but keep your hands off my Medicare or VA and Tricare, which covers most veterans and their dependents.

Reid traveled to countries as diverse as France, Britain, Germany, Switzerland, Taiwan, Japan and Canada to explore the models of health care delivery that opponents of health care reform in the States blindly — and wrongly — call “Socialized Medicine.”

Reid took his aching right shoulder (more about that later) to these countries and discovered that there are four basic models:

* The Bismarck Model, named after the first chancellor of Germany, who invented the welfare state as part of the unification of Germany in 1871. He also created the old age pension system copied by the U.S. in 1935 that was called Social Security. Under the Bismarck Model, used in Germany since the late 19th Century and used in Japan, France, Belgium, Switzerland and many Latin American countries, private insurance companies and private health care providers, financed by employers and employees deliver health care to all. Coverage doesn’t end with employment, but continues with job changes and retirement.

* The Beveridge Model, named after William Beveridge, who wrote the report that led to the adoption of Britain’s National Health Service on July 5, 1948. This is what most people think of when they yell “Socialized Medicine!” The Beveridge Model is used in most Scandinavian countries, Hong Kong (a former British colony), Italy, Spain and Cuba — and the VA.

* The National Health Insurance Model, developed first in the Canadian province of Saskatchewan in 1944 and adopted throughout Canada in 1961 as Medicare. South Korea and Taiwan use forms of this model.

* The Out-Of-Pocket Model, used by most of the countries in the world, including the most populous, China, which once had a national health service. Reid notes that only about 40 of the world’s 200 or so nations have established health care payment systems. Out-of-pocket expenses account for 91 percent of health care payments in Cambodia, 85 percent in India — the world’s second most populous country — and 73 percent in Egypt. In Britain, it’s 3 percent and in the U.S., with 45 million uninsured, it’s about 17 percent funded out-of-pocket.

So, essentially, in the States we’re Germany or France if you’re a working person under 65 and have health insurance. We’re England if you go to the nearest VA hospital. We’re Canada if you’re 65 and older or disabled. We’re India or China if you lack health insurance because you can’t afford insurance or have been denied coverage because of pre-existing conditions. At some stage in our lives, many if not most of us go through all four models.

About that shoulder: Reid had injured it while he was a seaman, 2nd class in the Navy. It was literally screwed back into place in 1972 by a Navy surgeon. It’s been acting up, so wherever he went, he asked health care providers what to do to ease the occasional pain. In London he was told to keep a stiff upper lip, because invasive surgery to repair the shoulder wouldn’t be covered under NHS. In Canada, he was told he would have to wait a year or so to get an appointment to see a specialist — and another six months or more for the surgery. In Japan, he was told he could probably get admitted for surgery in a week or two. And he received traditional treatment at an Ayurvedic clinic in India. I won’t say which option he took because I want everyone to read this book, but I was pleased because it involved a form of treatment not all that different from what cured my similar bout of tennis elbow brought about by excessive computer use.

This is simply the best, most readable book I’ve read on health care and I wish all those members of Congress who enjoy the best health care in the world and deny it to the voters and taxpayers in their districts would read it and discover that health care for everyone is a moral imperative and right — especially in country that considers itself “exceptional.” “The Healing of America” is outstanding, documented and heartfelt reportage.

About the author: T.R. Reid is a long-time correspondent for The Washington Post and the former bureau chief of its London and Tokyo bureaus. He is now the Post’s Rocky Mountain Bureau Chief, based in Denver. His books include “The United States of Europe,” “The Chip,” and “Confucius Lives Next Door.”

Publisher’s web site: www.penguin.com


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