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.
Themes
Health Care as a Human Right
One of the fundamental questions in The Healing of America is whether Americans regard health care as a fundamental right to which everyone should have access or as a commercial product that should only be available to those who can afford it. Due to the strong pro-business sentiment in American politics, and the financial influences of the insurance industry, pharmaceutical and healthcare product lobbyists, and the American Medical Association, the United States has avoided providing universal health care, thereby ensuring that every citizen—rich and poor—would have equal access to health care. The United States is the only industrialized nation that does not offer universal health care, as well as the only wealthy nation that has made no effort to create a fairer health care system—that is, one in which everyone has access to necessary health services.
Reid illustrates how the public acts as its own worst enemy on the matter of universal health care, largely due to prejudice. When many Americans think of universal health care, they equate it with socialism and assume that these models will give them fewer health care options and longer wait times to get treatment. While it is true that Canada has been notorious for its queue, and the British NHS has refused treatment for some services to control costs, the countries that operate according to the Bismarck model—particularly France, Japan, and Germany—offer patients an array of services at affordable rates. Reid’s depictions of these models undermine the view that alternatives to American health care would result in lower-quality service.
However, there is also the possibility that many Americans are averse to paying for care that would be distributed equally. When the Princeton University-based health care economist Uwe Reinhardt asked, in an article that appeared in the Journal of the American Medical Association, if poor sick children had as much of a right to treatment as rich sick children, the responses to his question were nearly all negative. A physician accused Reinhardt of trying to invoke class warfare, while a University of Chicago law professor refuted equal care for both children due to the tax burden it would place on the public. As long as health care continues to be regarded as a commercial product rather than a fundamental right, the notion that some are more entitled to treatment than others will prevail. Worse, health care—with the exceptions of the entitlements that exist for the elderly (i.e., Medicare) and veterans—will remain inextricably tied to class in the US.
National Health Care and Solidarity
The United States is not the only country that has struggled with the ethical question of whether to provide its entire population with health care. In the 1990s, while the Clinton administration failed even to bring its health care proposal to Congress for a vote, both Taiwan and Switzerland reformed their respective health care systems, providing universal care to everyone, regardless of income levels. While Taiwan’s conservative party reformed its health care system to get a political edge, Switzerland reformed its own in the interest of fostering national solidarity.
Before its reform effort, Switzerland’s health care system was much like that in the United States—a for-profit network of insurance companies provided plans to the public and emphasized maximizing dividends over providing quality care to the populace. Switzerland, however, decided that national solidarity mattered more than capitalist gains. Similarly, when German statesman Otto von Bismarck invented the network of sickness funds that operated as the first system of nationalized health care in the 19th century, he did so on the principle that a universal health care system would both ensure a healthy workforce and unify the still segmented German state.
Though some might argue that the United States is too heterogeneous to use national solidarity as a unifying concept in reforming health care, there are other nations with racial and ethnic makeups similar to ours that have succeeded. France is an example. It operates a health care system based on the Bismarck Model and provides all citizens with health care on the basis that all French citizens are entitled to health care as a basic right. Even nations that are becoming increasingly diverse, such as Italy, maintain this standard. If national solidarity were to become a basis of universal health care in the United States—where the notion that all men are created equal supposedly prevails—the nation would also have to examine its understanding of what it means to be an American and what the nation’s unifying principles are.
Controlling Health Care Costs
The main argument in favor of universal health care is that it would reign in out-of-control health care costs. The United States spends around 17% of its gross domestic product (GDP) on health care, far more than any other industrialized nation. Switzerland is the second largest big spender, doling out 11% of its GDP for health care. However, this expense is largely due to the nation providing health care coverage to every Swiss citizen. The United States spends an exorbitant sum of money while still leaving tens of millions without health care, even after the passage of the Affordable Care Act.
While many believe that universal health care is too expensive, and that costs must first be brought under control before universalizing the system, this is, in fact, untrue. The key, other countries have found, is in making sure that everyone has health care before they are sick. Treatment of the uninsured costs far more than coverage. In countries that use the Bismarck model, to ensure that insurance companies remain solvent, everyone must sign up for health insurance so that there are enough healthy customers to cover the unhealthy. This is the individual mandate that was so offensive to many conservatives, though it is the only way to keep insurance companies in business. In countries that use the Beveridge or National Health Insurance Models, tax revenue funds health care, and a bureaucratic office determines which treatments the system will pay for.
Whichever model a country chooses, affordability is a key factor—not only to maintain an efficient health care system but also to help patients prepare for potential costs. In the US, health care costs for the same procedure can vary depending on the health care provider. This creates unreliability and unpredictability in the system which, in some cases, leads to dire financial consequences. Thousands of people go bankrupt each year due to an inability to pay medical bills. The lack of control and transparency over health care costs contributes to the inequitable and largely inaccessible system of health care that exists in the United States.
