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

For going on 40 years, T. R. Reid, a Washington Post correspondent and a regular contributor to National Public Radio, has suffered from pains in the shoulder he injured during his naval service. In The Healing of America, he engagingly recounts the efforts of health services around the world to heal his condition and, in the process, he explains with impressive clarity the variety of ways in which health care can be organized, the informing principles on which the various health systems are based, and the historical and cultural contexts in which they have evolved.

Instructive and entertaining as all this is, Reid's main purpose is the deadly serious one of exposing what he sees as the scandal of health care in America. Reid believes that the failures of American health care are wholly intolerable precisely because they are demonstrably avoidable. With an easy and comfortable fusion of anecdote and comparative policy research, he successfully dismantles many of the misconceptions that damagingly constrict the scope of the American health-care debate, and he highlights those elements from overseas healthcare experience that suggest ways in which America can achieve a more socially just and cost-effective health system.

The exposure of scandal is by far Reid's easiest task, and it is fully accomplished in the book's opening sentence, which asserts that "If Nikki White had been a resident of any other rich country, she would be alive today" (p. 1). Around 10 years ago, White, a native of Tennessee, developed systemic lupus erythematosus—unarguably a serious condition, but one that is treatable to the extent that 80% of American sufferers live a normal life span. Her illness caused her to lose her job, at which point she became one of an estimated 45 million Americans without health insurance.

Because of her lupus diagnosis, she was denied coverage by every for-profit insurance company she approached. Under Tennessee's version of Medicaid—America's health-care safety net for the officially poor—she was not able to obtain the necessary specialist care. Then rule changes aimed at cost reduction disqualified her from Medicaid, and she was forced to end her drug treatment. She made numerous attempts to re-enroll in Medicaid, and to declare herself disabled in order to qualify for help from the Department of Social Security. But this Kafkaesque entanglement in bureaucracy achieved nothing, and White was eventually admitted to an emergency ward from which she could not be turned away, and at which she died several weeks later, aged 32. Clearly, it was not lupus but the lack of health insurance that killed her, and it continues to kill over 20,000 Americans each year.

America's failure to achieve universal coverage is not its only negative distinction in international health-care comparisons. Tens of millions of insured Americans turn out to be under-insured, and Reid cites a joint study by Harvard Law School and Harvard Medical School, according to which an annual total of 700,000 people in America go bankrupt through medical costs. Reid's own findings are that in Britain, France, Japan, Germany, The Netherlands, Canada, and Switzerland, the number of medical bankruptcies each year is zero.

Reid also demonstrates that American health care is "mediocre by global standards" (p. 31). The Commonwealth Fund ranks the United States last among 19 developed countries in terms of avoidable mortality. American diabetics, for example, die younger than diabetics in any other wealthy country. Life expectancy is lower in the United States than in most European countries and in Japan, Taiwan, and Singapore. On the more specific benchmark of "healthy life expectancy at sixty," the United States is tied for last in a study of 23 countries. There is a similarly bleak picture at the other end of the life span. According to the Organisation for Economic Co-operation and Development (OECD), there are 2...