2009-10-12

"The Healing of America"

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On the eve of tomorrow’s Senate Finance committee vote, I thought I’d resume my former self-appointed role of unofficial health care linker/commenter. So if that sort of thing doesn’t tickle your fancy, you might want to avoid this site for the immediate future.

Now that we’ve got that out of the way, a few weeks ago a friend sent along a NY Times review of T.R. Reid’s new book The Healing of America. In it, the author describes his adventures into 10 different country's health care systems all in an attempt to treat a stiff shoulder. A storyline that the NY Times refers to as a "gimmick", but admits that "what saves the book from slumping into a sack of anecdotes like Michael Moore’s 2007 documentary “Sicko” is a steel backbone of health policy analysis..." For example:

In Japan, and many European countries, private health insurers — all of them nonprofit — finance visits to private doctors and private hospitals through a system of payroll deductions.

In Canada, South Korea and Taiwan, the insurer is government-run and financed by universal premiums, but doctors and hospitals are private.

In Britain, Italy, Spain and most of Scandinavia, most hospitals are government-owned, and a tax-financed government agency pays doctors’ bills.

In poor countries around the world, private commerce rules: residents pay cash for all health care, which generally means no health care at all.

The book goes into much greater detail about the history of how each system was developed, and reveals that unsurprisingly, the differences in the underlying systems can produce vastly different treatments:
In France, a general practitioner sends him to an orthopedist (out-of-pocket consultation fee: $10) who recommends physical therapy, suggests an easily available second opinion if Mr. Reid really wants that surgery, and notes that the cost of the operation will be entirely covered by insurance (waiting time about a month).

In Germany, the operation is his for the asking the following week, for an out-of-pocket cost of about $30.

In London, a cheerful general practitioner tells Mr. Reid to learn to live with his shoulder. No joint replacement is done in Britain without disability far more serious than his to justify the expense and the risks, and if his golf game is that important, he can go private and foot the bill himself.

In Japan, the foremost orthopedist in the country (waiting time for an appointment, less than a day) offers a range of possible treatments, from steroid injections to surgery, all covered by insurance. (“Think about it, and call me.”)

In an Ayurvedic hospital in India, a regimen of meditation, rice, lentils and massage paid for entirely out of pocket, $42.85 per night, led to “obvious improvement in my frozen joint,” Mr. Reid writes, adding, “To this day, I don’t know why it happened.”

Interesting stuff! And if you are the type of person, like me, who prefers informed opinions over knee-jerk populism, then this might just be the book for you.

Click here for the full review.

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