56 pages • 1 hour read
T.R. ReidThe Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care
Nonfiction | Book | Adult | Published in 2009A modern alternative to SparkNotes and CliffsNotes, SuperSummary offers high-quality Study Guides with detailed chapter summaries and analysis of major themes, characters, and more.
Afterword-AppendixChapter Summaries & Analyses
Afterword Summary
On March 23, 2010, President Barack Obama signed the Patient Protection and Affordable Care Act, commonly known as “Obamacare.” The legislation levied billions in new taxes, primarily on the rich; it increased the salaries of primary care physicians; and it forced fast food restaurants to provide calorie counts for menu options. However, the law did nothing to streamline the US health care system and it doesn’t offer universal coverage. Instead, it has expanded coverage through Medicaid and private insurance offered through “exchanges” that provide options based on what people can afford. One of the most important provisions is that insurance companies can no longer refuse coverage to those with preexisting conditions. Additionally, the law offers subsidies to “seniors who can’t afford to pay for their prescriptions under Medicare” (250). The act has also set up a new federal agency, The Independent Payment Advisory Board, to make recommendations regarding how much Medicare should pay doctors and hospitals for treatments.
The most controversial part of the legislation is the individual mandate—that is, that everyone is required to sign up for health insurance to create a large enough pool of healthy consumers to fund those who are sick or injured. Conservatives argued that this was unconstitutional on the basis that no government should dictate what a citizen buys. Reid argues that there are already mandates to buy things. It is, for example, illegal to appear nude in public. This standard enforces a mandate to purchase clothes.
As ambitious as the Affordable Care Act is, it’s also complicated. Unfortunately, it has also not gotten Americans any closer to cheaper, universal care.
Appendix Summary: “The Best Health Care System in the World”
When Reid started on his quest both to cure his shoulder and America’s health care ills, he thought that it would be easy to find a good health care model based on cost control, fairer access, and longer life expectancy. However, most industrialized countries, he realized, had health care systems which met these measures. Life expectancy, he realized, wasn’t always a useful measure. A woman in her nineties with an assortment of diseases will be kept alive for as long as medical science can sustain her. This tells us nothing about the quality of a nation’s health care—only about its access to technology.
One important metric for understanding quality of health care is the DALE (Disability-Adjusted Life Expectancy) index. The DALE determines how long someone can expect to live before succumbing to the common ailments that creep with old age, such as hearing loss, heart disease, back pain, and Alzheimer’s. If a nation ranks high on the DALE, it has good health habits and provides good access to health care for both prevention and treatment. Japan ranks highest for life expectancy. The U.S ranks 24th in the world.
Other metrics are the QALY (quality-adjusted life year) and DALY (disability-adjusted life year) indexes. These measure how many years one gains as a result of getting treatment for illnesses. However, these measures, too, could be subjective. Reid uses the examples of someone in a wheelchair. A paraplegic is more likely to adjust to life in a wheelchair than a former athlete, who might find this condition unbearable.
When the World Health Organization ranked the world’s national health care systems, the US came in 37th. The U.S fared poorly on its ability to keep its population healthy and on its ability to treat the rich and poor equally. On the other hand, Japan, France, Italy, and Spain ranked high and are regarded among the world’s best health care systems.
When studies measure public satisfaction, Denmark ranks the highest—91% of Danes love their health care. Meanwhile, only 40% of American patients report satisfaction, meaning that the nation ranks even lower when it factors in public sentiments about health care.
Afterword-Appendix Analysis
In the afterword, which was added a year after the book’s publication, Reid outlines the shortcomings of the much anticipated Affordable Care Act. Though President Obama was ushered into office with the hope that his administration would bring in much-needed reforms to pull the country out of its catastrophic financial crisis, Reid is pessimistic about the merits of what the reform act frequently called “Obamacare.” The law is mired in legalese and not nearly as straightforward or comprehensive as the other systems outlined in The Healing of America.
In the Appendix, Reid relies more on statistics than he does anywhere else on the book to show America’s failure to meet basic standards that determine quality care and patient satisfaction. The numbers and rankings reveal the tragic irony of operating such an expensive health care system. Reid, however, acknowledges that some quality measures are subjective. Still, there is no question that all other industrialized nations—and even some that are not as developed—outperform the United States in their abilities to keep people healthy and alive longer.
