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 2-3Chapter Summaries & Analyses
Chapter 2 Summary: “Different Models, Common Principles”
Every nation’s health care system reflects their unique “history, politics, economy, and national values” (16). Germany, Japan, Belgium, Switzerland, and Latin American countries have the Bismarck Model of health care in which private insurance plans are financed by both employees and employers and operate like charities. The plans cover everyone, and the insurers don’t make a profit. Costs remain under control through strict regulation of medical services and fees.
Great Britain practices the Beveridge Model. Here, government provides and finances health care. There are no medical bills. Other countries that use this model are Italy, Spain, most of Scandinavia, and Hong Kong. Reid assumes that most Americans have the Beveridge Model in mind when they talk about “socialized medicine,” though the purest forms of the model are only found in Cuba and the US Department of Veterans Affairs. In Britain, there are still private doctors.
A third example is the National Health Insurance (NHI) Model, which incorporates ideas from both the Bismarck and Beveridge systems. In the National Health Insurance system, “the payer is a government-run insurance program that every citizen pays into” (18). The NHI keeps costs low by limiting what services they will pay for and making patients wait for treatment. Canada, Australia, South Korea, and Taiwan have employed variations of the NHI model.
The final model is the Out-of-Pocket Model. This is applied in the world’s poorest countries, where few citizens can afford to pay a doctor. Americans have employed all four models. Most working people under age 65 have something akin to the Bismarck Model of health care—workers and employers share the cost of premiums. Indigenous Americans, veterans, and military personnel have health care that fits within a Beveridge Model. Those over 65 have Medicare, which is like the NHI plan. Those who are uninsured pay out-of-pocket, like patients in rural India or Cambodia.
In his search for ideas and approaches to health care, Reid went to France, Germany, and Japan (Bismarck Models), Britain (Beveridge), and Canada (NHI). He also went to Switzerland and Taiwan to learn from two countries that overcame political obstacles to reform health care. All of the nations that Reid examined offered health coverage for everyone, regardless of social class or age. In the US, this is not the case. Moreover, blacks and Hispanics are more likely than whites to die from treatable diseases. Even with an overhaul to the health care system, someone must decide on who gets access to treatment. In Britain, a government unit decides; in the US, insurance companies decide.
Other issues to consider are quality, cost, and choice. Americans worry that a national health care system would be expensive when it would, in fact, cut costs. Additionally, there are Bismarck systems, such as those in France and Japan, in which patients can visit any hospital or doctor they select. While no model is perfect, every other industrialized nation’s health care system still performs far better than that in the US when measured based on “coverage, quality, cost control, and choice” (27).
Chapter 3 Summary: “The Paradox”
The United States has the world’s best medical professionals and facilities. The nation also leads the world in medical research and sets the standard for the development of pharmaceuticals and medical technology. However, there are tens of millions of Americans who cannot afford access to these outstanding resources. In fact, the US has been ranked last “when it comes to providing universal access to medical care” (30). The World Health Organization has ranked the US health care system 54th out of 191 countries.
According to a 2008 report, the US ranked 19th for curing people with treatable diseases. The number of patients under the age of 75 who die of such illnesses is nearly twice as high as those with similar ailments in France, Japan, and Spain. Americans with asthma and diabetes have far worse survival rates than those in other countries. Conversely, the survival rate for women diagnosed with breast cancer was the best among nine other countries ranked in a study. Arguably, the most tragic aspect of America’s troubled health care system is its high infant mortality rate—that is, babies that die within a year of birth. The US ranks last in terms of keeping infants alive. A major reason for this is that the US doesn’t offer the “free prenatal and neonatal care” that other wealthy countries offer.
Though the US pours money into health care, the nation still fails to provide what others would consider basic services. Part of the reason for this is that American health care providers, including doctors and nurses, make far more money than their colleagues overseas. They also have the burden of paying very high malpractice insurance. This is an occupational hazard due to the American tendency to sue doctors.
The US is also the only industrialized nation that allows for-profit health insurance companies to pay for both “essential and elective care” (36). However, most of the money that people pay for premiums doesn’t go to health care. If insurance companies were to do that, their stock would plummet and they would be unable to afford their CEOs. During the time that Reid wrote this book, in other nations, health insurance companies were legally-bound to provide coverage to everyone; in the US, insurers chose their customers.
Insurance companies employ “armies of adjusters and investigators to go through submitted claims looking for reasons to deny payment” (38-39). Those insurers refuse to pay for around 30% of all claims. In other nations, insurers are required to pay every claim that passes through their hands.
The 2010 Affordable Care Act did nothing to regulate claim payments, which would still allow insurers to deny claims on any grounds. The reform also did nothing to address the inability to access permanent health care. In other countries, people can still access health care even if they lose their jobs.
Another problem in the American system is that there are “countless different payers and fee schedules” (42). Medical providers, naturally seeking to profit, shift the costs toward the payer that will offer the highest dollar. Therefore, in the US, the same operation on the same day in the same hospital can have 10 different prices. On the other hand, in France, there is a fee schedule that shows each patient exactly what they must pay for each procedure. The lack of clarity around payments in the US has created a medical billing industry, which adds to health care costs. The 2010 law also did nothing to address how fragmented and costly US health care is.
Chapters 2-3 Analysis
In these chapters, Reid outlines the world’s existing health care models and explains how they work. He presents them with brief descriptions, as though they were a menu of options to consider. He then contrasts these options with American health care, which he frames as chaotic and bloated with wasteful expenditures. He follows by detailing the severe shortcomings of the US health care system, which are extraordinary for a wealthy nation that boasts access to the best medical technology and facilities.
Reid roots the problem in Americans’ stubborn adherence to the for-profit health care model, which both encourages insurance companies to avoid paying claims and causes doctors to privilege their earnings over offering the best course of treatment to patients, due to their burdens of paying back student loans and expensive malpractice insurance.
