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.
Chapters 10-11Chapter Summaries & Analyses
Chapter 10 Summary: “Too Big to Change?”
Many US presidents, from Theodore Roosevelt to Barack Obama, have taken up the difficult task of trying to reform American health care. In 1992, President Bill Clinton made it a focal point of his campaign, but his attempt “never even came to a vote om Congress” (163-64). President Obama promised that he wouldn’t replace the existing health care system but, simply, build on what the nation already had. What is popularly called “Obamacare” still left tens of millions of people uninsured when it went into full effect in 2015.
Reforming a health care system is difficult but certainly not impossible. Reid visited two countries that managed to perform the task—Taiwan and Switzerland. The former went from a poor country to one of the world’s 25 wealthiest in just 15 years. Rivalry between the liberal, pro-labor Democratic Progressive Party and the pro-business, conservative Nationalist Party that Chiang Kai-shek had founded led the latter to endorse national health care to avoid losing political ground.
To organize the new health care system, the Taiwanese government hired Harvard School of Public Health’s health care economist William Hsiao. Hsiao instituted “a system that uses private hospitals and doctors” who are paid through “a single, government-run insurance plan” (172). This is based on Canada’s National Health Insurance model. However, instead of being funded through taxes, people finance the system by paying premiums. Employers and employees share the cost of premiums. Hsiao’s rationale was that people were more likely to pay for a premium, which felt like paying for a product, than they would be willing “to pay a tax to some huge government entity” (172). The Taiwanese also use an electronic card based on France’s carte vitale, which holds all medical and billing records. Finally, a Bureau of National Health Insurance was set up to set prices for medical care and prescriptions. The bureau has effectively kept prices low.
Taiwan passed its National Health Insurance Law in July 1994 and began offering coverage on March 1, 1995. Suddenly, around 11 million Taiwanese people who had no health insurance quickly had access to a range of medical care. The flood of demand for medical services created a new supply of dentists, clinics, hospitals, labs, and other facilities. Patients had the freedom to choose their own medical providers.
Taiwan’s health care system is now one of the world’s most efficient. It spends only 2% of its GDP on administrative costs and sometimes less. Its total spending on health care is 6% of its GDP. However, the low rate of spending has caused many hospitals and clinics to go into debt. Politicians are reluctant to make patients pay higher premiums or to request copay. If political leaders agree to shift some of the cost burden onto patients, Taiwan will still only end up spending about 8% of its GDP on health care while still providing everyone with coverage.
In the 1990s, Switzerland’s health care system looked much like the one in the US. Swiss people bought health care from insurance companies that were more interested in profits than in providing care to the sick and injured. However, Switzerland realized that national solidarity mattered more than capitalist interests, and its health care model was detrimental to solidarity. In 1993, the Swiss government passed health care legislation based on the Bismarck model. The reform was initially controversial. Predictably, the insurance industry, the drug industry, and much of the business community resisted the reform. In the end, public solidarity prevailed and, now, everyone in Switzerland has health care. The country spends 11% of its GDP on health care—“the second-highest spending rate in the world” (181). The country has resisted efforts to install a single-payer system, preferring its private-sector approach to health care while also guaranteeing that everyone is treated equally regarding health care.
Both Taiwan and Switzerland agreed that nations had a moral obligation to provide health care to all citizens. On the other hand, the US approach to health care reform relies on economics. President Clinton told the public that health care reform was necessary to reduce the deficit. Meanwhile, insurance companies sponsored “Harry and Louise” TV ads to oppose reform efforts. Fifteen years later, President Obama also relied on economic arguments to encourage the public to embrace health care reform. He also assured voters that, if they liked their health insurance, they would keep it. Most people didn’t believe him. Worse, his message focused more on self-interest than the well-being of the collective.
Chapter 11 Summary: “An Apple a Day”
It is just as important to keep people healthy as it is to provide them with health care. Thus, governments also invest in preventative care. In the twentieth century, there were two key discoveries that assisted with preventative care: understanding the structure of DNA and seeing the “statistical correlation between habitual smoking and lung cancer” (190). The latter led to the surgeon general’s warning that appears on every pack of cigarettes. In the US, the surgeon general’s warning first appeared in 1966.
For preventative care, there are two main approaches: the Public Health Model and the Medical Model. The first treats entire populations, while the second deals with individual problems. Poverty, pollution, and stress are proven contributors to health ills. Additionally, a poor diet full of high levels of sodium, sugar, and trans fats contribute to heart disease, diabetes, and other chronic problems. The public health model is meant to address this. In other countries, it also encourages proper dental care and HIV/AIDS prevention.
When educational measures fail to change habits, governments resort to laws. In the US, riders of motorcycles must wear helmets and both drivers and passengers in vehicles must wear seatbelts. Otherwise, they may face fines.
The purpose of public health measures is to encourage personal responsibility as a key aspect of health care. The Medical Model encourages regular testing as a part of preventative care. For example, the yearly Pap smear to detect cervical cancer is a common practice within this model. In some countries, annual physicals are provided within the Medical Model, though this is not the case in Britain, which determined that annual physicals don’t provide enough of a preventative benefit to be worth the cost. There is, in other countries, too, some controversy about which tests are necessary for adequate preventative care.
Instead of sending people to the general practitioner each year, Britain inundates people with print ads, radio announcements, and TV commercials alerting them to a range of preventive services and help lines that can assist. With neonatal care, Britain, like most other European countries, offers more hands-on care. As soon as a woman discovers that she’s pregnant, she gets a range of services, including free medications, house calls from a nurse and midwife, and a choice of where to give birth. All industrialized countries, except for the US, provide expectant mothers with prenatal services. In the US, poor pregnant women do not receive care until they go into labor.
Chapters 10-11 Analysis
In this section, Reid depicts two countries—Taiwan and Switzerland—that have successfully reformed their health care systems and juxtaposes the nascence of their health care reforms with the Clinton Administration’s inability to reform US health care around the same time in the 1990s.
Both Taiwan and Switzerland were plagued by the problems that prevented reform in the United States—political infighting and the prioritization of capitalist interests over the well-being of the citizenry. However, Taiwan’s conservative party used its desire for political advantage to foster a lasting public good, and Switzerland put its national values into action. Though the US was beset by the same problems, it didn’t seem to notice that Taiwan and Switzerland had achieved what the Democrats struggle to accomplish. One could argue that, perhaps, the Clinton Administration was either guilty of the problem of American exceptionalism, which prevented it from using the overseas examples, or that it never occurred to the administration to take the focus off of the economic value of health care reform.
Meanwhile, the Health Insurance Association of America—a health insurance lobbying group—ran its Harry and Louise ads on national television. The ads featured a white, middle-class couple, unhappy with the “future,” in which the couple was forced to choose between a handful of government-mandated health care options—none of which provided the coverage of their pre-reform health care plans. In another ad, the couple complains of a yearly insurance premium that is around triple what they previously paid. The Democratic National Committee ran rebuttal ads that featured other actors as Harry and Louise. In these ads, the committee emphasized the exorbitant costs of hospital bills, even for those with insurance, and the inaccessibility of health care for patients with preexisting conditions. The rebuttal ads made the same key point that Reid makes in The Healing of America: the American health care system doesn’t go far enough in giving Americans the comprehensive care that they need at an affordable cost.
In addition to not providing sufficient treatment, the US could learn a great deal, according to Reid, from other countries about preventive medicine. This is especially true when examining prenatal care, which is often nonexistent for poor, expectant mothers. The visits from nurses and midwives that are standard in other countries would likely be regarded as luxuries in the US.
