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 8-9Chapter Summaries & Analyses
Chapter 8 Summary: “Canada: ‘Sorry to Keep You Waiting’”
In 1961, Canada created its single-payer health care system which covered “all medical and psychiatric care, in or out of the hospital” based on the model that Saskatchewan premier Tommy Douglas instituted in his province (127). In 1965, when the US government decided to provide health care to all citizens over 65, they used Canada’s National Insurance Model and gave their new program the name that Douglas had coined—Medicare.
By the 2000s, the Canadian health care system was struggling to maintain its services, but Canadian patients still reported higher levels of satisfaction than American ones. Furthermore, Canada still has longer life expectancy and lower rates of infant mortality than the US. It manages this while paying half of what the US does for health care—10% of its GDP. The problem is that its rate of spending can’t keep up with the rising costs of care. The disinclination to pay for health care has made it a less desirable profession, leading to a dearth of medical providers. For Reid’s shoulder problem, the waiting list for a specialist was so long that he never got a chance to see either an orthopedist or a physical therapist. He was told that it would take about a year to get an appointment for a consultation and another six to eight months for possible surgery. Waiting periods also varied between provinces.
The dreaded waiting list has led to rumors that Canadians go to the US for treatment, but this is largely untrue. In fact, far more Americans go north for affordable drugs and treatments. Canadians, Reid was told, don’t mind the waiting list so much as long as the rich and poor wait for the same length of time to get treatment.
Douglas instituted the National Health Insurance system on January 1, 1947. After that date, all hospital care was free. Many doctors moved to Saskatchewan to fulfill the demand for medical care, which was based on a system in which government paid private providers’ bills. In 1961, during his fifth term as premier, Douglas created Medicare, which ensured that anyone could get medical treatment without receiving a bill. Many doctors revolted and went on strike, while the public sided with Douglas. After 23 days, the doctors gave up. Soon, the rest of Canada followed Saskatchewan’s example on the basis of the principle that human life was worth far more than financial gain.
Though Canada’s Medicare program is often called a single-payer system, it is, in fact, a 13-payer system. All 10 provinces and three territories have their own Medicare plans with slight differences and rules of operation. Medicare negotiates fees with medical providers and pharmaceutical companies, which is why Canadians pay far less for drugs than Americans do.
The Canada Health Act of 1984 provides the framework for Medicare, which operates according to five key principles: health care is nonprofit; each plan must pay for medical necessities; everyone must have the same access to drugs and treatments; the plan must pay for coverage anywhere within Canada; and everyone gets the same fee for treatment. The act established uniformity in health care.
Many Canadians use the Medicare system but also maintain private insurance to pay for things such as dental care, Lamaze classes, and private hospital rooms. There has been concern that this practice will lead more rich people to turn away from Medicare, or that there would be a two-tier system in which some get better care than others. To avoid this problem, it is illegal for patients to pay for any medical service covered by Medicare with a private plan.
Canadian doctors complain that they aren’t paid enough for their work. They make about half of what an American doctor would earn. Still, they live comfortably and needn’t worry about the cost of malpractice insurance because the premium is paid by the provincial government. They also don’t have to worry about maintaining records or billing departments. Finally, medical school tuition is half of what it costs at a public American university.
Canada’s “coordinated system of payment” offers a powerful lesson, according to Reid, about what the US can do to get more control over health care costs (141). However, penny-pinching can also lead to the kinds of waiting lists that make it more difficult for many Canadians to get treatment.
Chapter 9 Summary: “Out of Pocket”
In much of Southeast Asia, Africa, and South America, only the rich, military personnel, and government workers get medical care while others get sick and die, often of treatable illnesses. Those who cannot pay for treatment themselves will not have access to doctors. In some countries, people turn to local healers to help with broken bones or snake bites. If a person makes it to a doctor but cannot pay with cash, they might pay with farm products or by offering useful services. Others get lucky enough to see a doctor who works with a charity organization.
Those who get treatment within out-of-pocket systems must also pay cash for drugs. The inability of many people to pay for drugs is why many people in developing countries don’t have access to modern medications. As a result, there are millions of deaths each year in Southeast Asia, Africa, and Latin America from preventable illnesses that no longer exist in the developing world, such as polio and malaria. Worse, countries that use the out-of-pocket model for health care “have the world’s shortest life expectancy” (147).
In the US, those who are uninsured are more likely than the insured to get sick and remain sick than those who have health insurance. Also, uninsured accident victims “are 37 percent more likely to die from their injuries than somebody with insurance” (150). Usually, those in wealthy countries live longer and healthier lives. Cuba is the exception to this rule. Life expectancy on the island of 11 million is 77 years. The main reason for this is, unlike other poor countries, Cuba has universal health care with no copay expenditures. Cuba’s health care system operates according to the Beveridge model but was inspired by the state-run health care system that existed in the former Soviet Union.
In Cuba, all hospitals are owned by the government, and medical providers are government employees. Medical bills are paid with tax revenue. Cuba’s Medical Diplomacy program provides free medical education for foreign students and exports trained doctors to Latin American countries. Cuba ranks high for fairness but scores low on preventative medicine and the quality of its treatment facilities, which are conditions of its poverty.
Most developing nations lose the out-of-pocket health care model after they become wealthy. China, however, is an exception. As late as 2005, Chinese patients paid 60% of their health care fees out-of-pocket. In the cities, medical care is excellent and facilitated in “clean, modern hospitals” (152). In rural areas, millions of Chinese people die due to in-access to such facilities. It is no wonder, then, that so many people rely on alternative treatments.
Alternative medicine has also become popular in the US. The National Center for Complementary and Alternative Medicine (NCCAM) was founded to run studies that determine if these treatments work as effectively as standard Western medicine. Usually, insurance will only cover standard medical care, but some state legislatures have mandated that insurance companies must also cover alternative treatments, such as massage and acupuncture.
For his bad shoulder, Reid traveled to the Solu-Khumbu region of Nepal, where the Sherpas live. He visited the Tibetan herbal doctor Dr. Tenzin who offered to concoct some herbal pills but then told Reid that he would have to taste his urine to make a proper assessment of Reid’s health. After doing this, he assured Reid that the herbal medicine would increase movement in his shoulder and reduce pain. However, Reid also had to recite a mantra while taking the medication, which cost $4 for two weeks’ worth of pills. Reid followed the doctor’s orders, but it made no difference in his shoulder.
In India, Dr. Ram Manohar told Reid that no doctor could ever heal his shoulder. Instead, the body would heal itself through yoga practice and Ayurvedic massage. Reid embarked on a few weeks of treatment and began to feel better. His shoulder wasn’t completely healed, but his range of motion had increased and he felt less pain. More importantly, he had gotten the treatment he needed without either the expense or invasiveness of total shoulder arthroplasty.
Chapters 8-9 Analysis
In Chapter Eight, Reid focuses on the country that embodies the third primary health care model—Canada and its National Health Insurance Model. Canada’s health care system is just as unpopular with American conservatives as the Beveridge Model. However, Canada, like Great Britain, still meets more health care targets than the United States does. Canada’s system of nationalized health care started as a provincial system in Saskatchewan. This mirrors the start of the Affordable Care Act—or “Obamacare”—which was modeled after the Massachusetts Health Care Reform Act, nicknamed “Romneycare,” after then governor Mitt Romney. Ironically, Romney would disavow his own template when running against President Obama as the Republican presidential nominee in 2012.
In the next chapter, Reid presents the Out-of-Pocket Model that exists when a country is too poor or disinclined to provide its population with health care options. While Reid emphasizes that this model is far from ideal, he also illustrates the how some developing countries have retained centuries-old methods of treatment in response to a dearth of medical technology. While some methods, such as the Tibetan herbal pills that he takes, appear to be only placebos, the yoga and massage treatments—more universally adapted methods of maintaining wellness—ameliorated Reid’s shoulder pain and discomfort.
