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

White was a 32-year-old woman who received a diagnosis for systemic lupus erythematosus—a disease that is treatable, if one receives consistent health care. White made too much money to receive Medicaid, the form of health care provided to American citizens on welfare, and yet was too poor to pay for health insurance, as well as the doctors and medications that she needed to stay alive. Reid uses White’s case to illustrate how the American health care system is too inept to cure treatable diseases. He also uses White’s case to address the fundamental ethical problem confronting the American public regarding health care: Should the US health care system provide treatment to everyone regardless of income?

Reid describes White as a “[t]all, slender, athletic” young woman who was raised in a middle-class family in Bristol, Tennessee (211). Her parents worked as middle managers at corporations, and she used their health insurance until she graduated from college in 1999. White earned a degree in psychology from the University of Texas, Austin. She soon found work at a hospital and enrolled on the employee health insurance plan. Not long after starting her new job, White felt too ill to go to work. She experienced severe fatigue, stomach pains, and noticed skin lesions on her body. These were symptoms of systemic lupus erythematosus—a condition that mainly afflicts women. In 2001, White had to quit her job. Unfortunately, she made too much money to qualify for Medicaid. Also, during these years before Obamacare, insurers had the right to refuse her health care due to her condition, which occurred every time White tried to get coverage.

White didn’t receive care until she neared the end of her life. In November 2005, she was suffering from kidney failure and a perforated intestine. She had a seizure and was admitted into an emergency ward in her hometown. Under federal law, the hospital had to provide her care until her condition stabilized. However, White’s body was too ravaged by the disease for her to recover. She died in the spring of 2006 at age 32. Her cause of death is listed as “complications of lupus” (213). Reid argues that the true cause of death was the health care system’s inability to care for White.

Nicknamed the “Iron Chancellor,” Otto Eduard Leopold von Bismarck unified Germany and turned it into “an industrial and military powerhouse at the center of Europe” (66). In 1862, he joined 12 “fiefdoms and principalities” to form a single German nation (66). Bismarck ruled for 30 years and, during his rule, established the Sickness Insurance Law in 1883—“the world’s first national health care system” (67). Everyone was required to have the insurance, which was paid for through premiums, paid for by both employers and employees. As is the case today, the employee’s share of the premium was withheld from his salary.

Bismarck was born in 1815 into a prominent family. He was proficient in Greek, Latin, French, English, and Russian. He studied at the University of Göttingen, where he cared less about his studies than he did about dueling, womanizing, gambling, and drinking. He was an epicurean with a short temper and a great deal of ambition. He joined the Prussian legislature, rising to become a top diplomat in the German kingdom. In 1862, Bismarck became the Prussian ambassador in Paris. Soon thereafter, he became prime minister of Prussia. To create a single Germany, Bismarck launched a series of wars and annexed territories. By January 1871, the new German nation was born. It included all of the Germany recognized in contemporary borders, as well as parts of what are now France, Poland, and Denmark. Bismarck has been compared to Napoleon, due to the strength of his dominance on the European continent.

Not everyone, however, supported Bismarck’s rule. He had enemies in the Catholic Church as well as among Socialists. Bismarck swiftly addressed adversity by deporting priests, jailing enemies, and shutting down newspapers that spoke against him. He also rejected policy ideas with which he didn’t agree. Sometimes, he reacted sharply if a policy affected him personally. For instance, he threatened to move the capital out of Berlin if the city would not reduce his property tax. He had difficulty managing public spending, due to his stubborn insistence on financing the government with the funds from import taxes.

Among his other achievements were a worker’s compensation system and a social security system for the elderly. Some historians have since wondered why Bismarck—a Prussian aristocrat—instituted such a large welfare system. The consensus is that he needed healthy workers to run factories in an industrializing national economy. Another view is that he offered welfare to avoid the obligation to provide civil rights. By the end of the 1880s, Bismarck became reclusive, spending most of his time at his country manor. In 1890, his conservative government lost power. He died in 1898, believing that his socialist programs would become entrenched, even if the German Empire endured upheaval in the next century. 

Beveridge was a wealthy aristocrat born to “a senior official of the British Raj” (107). He spent the first part of his childhood in Darjeeling, India then moved to a country mansion near Dover, England. In 1897, he enrolled at Oxford. After graduating, he embarked on the study of law with a London barrister, but he quit after several months and embarked on a career in social reform. He first worked in a settlement house in East London in 1903. There, he witnessed hungry children, women dying in childbirth, and men too sick to go to work. Beveridge used his influence to write newspaper columns that depicted the lives of those suffering and offered solutions, including a national health service available to all “for prevention and comprehensive treatment” (107).

In the 1940s, Beveridge led the Committee on Social Insurance and Allied Services—a bureaucratic wing created by Churchill’s government. In 1942, he outlined how the National Health Service would work—payment would come through general taxation—in his book, Social Insurance and Allied Services, nicknamed “the Beveridge Report.” The book sold 100,000 copies in its first month. Around this time, Beveridge traveled to the US, sponsored by the Rockefeller Foundation, and gave 100 speeches about his plan for universal health care. His book sold another 50,000 copies in the US. When he returned to Britain, Beveridge was made a lord and became Baron Beveridge of Tuggal. He served for many years in the House of Lords. He died in 1963 at age 84. 

Bevan was born and raised “in the Welsh coalfields at the dawn of the twentieth century” (106). Chronic illnesses were common in his family. Four of his siblings died during childhood, and his father died of untreated pneumoconiosis—an inflammatory disease caused by the inhalation of dust. Bevan was “[t]he grandson, son, nephew, and brother of coal miners” (108). He was born in a cottage near a pit at Tredegar—a mining valley. He, like his siblings, went to school for a few years before entering the coal mines. Nye began working full-time in the coal pits when he was 13.

As an adolescent, he joined the South Wales Miners’ Federation and quickly assumed leadership in the organization. He studied the works of Karl Marx and American socialist Eugene V. Debs. He concluded that socialism would eliminate “the basic unfairness of the British class system” (109). When he was 32, he became a member of Parliament in the House of Commons. He represented the coal valley of Ebbw Vale and belonged to the Labour Party. He became a vociferous opponent of the Tories, particularly Winston Churchill. After Churchill’s coalition was voted out in the summer of 1945, the new Labour prime minister, Clement Attlee, made Bevan minister of health. Bevan’s chief task was to provide the British populace with socialized medicine, as laid out in the Beveridge Report. Bevan is regarded as the father of the NHS.