One-Minute Book Reviews

October 7, 2009

The Moral Failures of U.S. Health Care – T.R. Reid’s ‘The Healing of America’

A specialist in Tibetan herbal medicine wanted to taste T.R. Reid's urine.

The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care. By T. R. Reid. Penguin, 277 pp., $25.95.

By Janice Harayda

This elegant polemic argues that the American health-care crisis is, above all, a moral one: Alone among well-off democracies, the U.S. has never made a moral choice to guarantee health care for all. Americans have decided that everybody has the right to an education and a legal defense, regardless of the cost or difficulty of providing these, T.R. Reid reminds us. But we’ve never decided that everybody has the right to health care. Because we haven’t, the U.S. is the only country in which medical bills can bankrupt people. It’s the only one in which patients who have paid their health insurance premiums for years can — and do — have their policies canceled while they’re fighting for life from a hospital bed.

Fewer than half of all Americans are satisfied with this state of affairs, according to a 2001 study by researchers at the Harvard School of Public Health. But many critics of the system believe that all the alternatives involve conditions too onerous to accept – long waiting lists, the rationing of care, no choice of doctors, or “socialized medicine.”

T.R. Reid offers a powerful rebuttal to that idea with fascinating and well-written portraits of the health-care systems in five countries that have universal coverage: France, Germany, Japan, the U.K. and Canada. Japan, for example, hardly has “socialized medicine.” Its widely admired approach to health care uses private doctors and hospitals and nonprofit insurers. The system involves no gatekeepers, no rationing, and no waiting lists. It offers high-quality care and ample choice for patients. People split the cost of insurance with their employers or if they are unemployed, with their local government. And the Japanese lead the world in life expectancy (85.5 years for women, 78.7 for men).

Reid also evaluates the health care systems in India, Taiwan, Switzerland and other countries. And he found an ingenious way to dramatize some of their differences after an American orthopedist suggested that he have surgery on an injured shoulder. As he traveled around the world, Reid asked foreign doctors how they would treat the problem. In Nepal, he met a specialist in Tibetan herbal medicine who wanted to taste his urine before making a diagnosis. At an Ayurvedic hospital known as “the Mayo Clinic of traditional Indian medicine,” he submitted three times a day to massages of “warm sesame oil laced with forty-six herbs and medications.” These encounters add color and suspense to The Health of America without taking its focus off the moral imperatives of health care reform.

Reid doesn’t urge Americans to adopt any country’s model or a “public option” of care paid for by the government (although he notes that we have a public option in Medicare, a system that its beneficiaries generally like). But he appears to believe we can’t reform the system if we continue to allow insurers to make a profit on basic health care, something no other first-world country permits: The solution lies in a nonprofit model, whether run by the government or a nonprofit group. Reid has suggested in interviews that if Congress can’t enact the needed changes, Americans may have to reform the system on a state-by-state basis, though he damns the Massachusetts approach with faint praise.

The most admirable aspect of The Healing of America is that – like any skilled polemicist
– Reid has an exceptional ability to keep his eye on the ball. He deals forthrightly with the economic and other realities that health care reform would involve, such as controlling costs and creating an effective delivery system. But Reid never allows such issues to transcend the moral dimension of allowing tens of thousands of people each year to die and countless others to suffer needlessly. His powerful indictment shows why health care reform is ultimately not about politics or economics: It is about fairness, justice, and doing what is right for all Americans.

Best line: No. 1: “All developed countries except the United States have decided that every human has a basic right to health care.” No. 2: “ … foreign health insurance plans exist only to pay people’s medical bills, not to make a profit. The United States is the only nation that lets insurance companies extract a profit from basic health coverage.” No. 3: “The design of any nation’s health care system involves political economic, and medical decisions. But the primary issue for any health care system is a moral one.”

Worst line: “British women tend to have their babies at home; Japanese women, in contrast, almost always give birth in the hospital – and mother and child remain there an average of ten days after delivery.” The National Childbirth Trust says that in the U.K., 2.7 percent of women give birth at home.

Editor: Ann Godoff

Published: September 2009

About the author: Reid is a former foreign correspondent for the Washington Post.

Further comments on The Healing of America appeared in the posts “Excuses Aetna, Prudential and Blue Shield Have Used to Deny Claims” and “Going to the Doctor in Japan — Please Don’t Tip the Proctologist.”

Listen to a podcast of T.R. Reid talking about The Healing of America.

© 2009 Janice Harayda. All rights reserved.
www.janiceharayda.com and www.twitter.com/janiceharayda

September 28, 2009

Excuses Used by Aetna, Prudential and Blue Shield to Deny Health-Insurance Claims — From T. R. Reid’s ‘The Healing of America’

I was going to read The Lost Symbol over the weekend but picked up T. R. Reid’s elegant indictment of health care in the U.S., The Healing of America (Penguin, 277 pp., $25.95). And I was hooked after the first sentence: “If Nikki White had been a resident of any other rich country, she would be alive today.”

Reid had his bad shoulder examined by doctors in other well-off democracies that included France, Germany, Great Britain, Japan and Canada. And he uses the results as a springboard for exposing flaws in arguments made by insurers and others against adopting practices that work overseas: “It’s all socialized medicine over there,” “They ration care with waiting lists and limited choice,” “Those systems are too foreign to work in the United States,” and more.

Until I can review The Healing of America, here’s a brief excerpt from the book about the excuses used by major insurers to reject claims:

“In other developed countries, insurers are required to pay every claim. But U.S. insurance companies deny about 30 percent of all claims, although some of these are eventually paid through an appeal process. The reasons cited for denying valid claims can be ingenious. When our family lived in Japan, the friendly adjusters at Prudential used to deny our claims for medical or dental care on the grounds that the bills we submitted were denominated in yen. Somebody at Prudential had determined that the Japanese yen was a foreign currency; that violated the rules. My company later switched our health insurance to Aetna, which employed a similar dodge: The adjuster said she couldn’t pay our claims because she couldn’t call the doctor’s office to verify the bills. It seems that Aetna had a phone system for its adjusters that didn’t allow international calls, so our claims had to be denied.

“The most maddening of all the profit-maximizing mechanisms in the U.S. health insurance industry is the practice known as ‘rescission,’ a legal term that means ‘We’re canceling your coverage.’ This occurs when an injured person who has been paying premiums for months or years has a serious accident or contracts a serious disease, which can mean serious bills for the insurance company to pay. At that point, the insurer’s Rescission Department digs through all the records, looking for a reason to cancel the sick person’s coverage. For example, Steven Hailey, a machinist in Cypress, California, paid his health insurance premium every month. Then he was hit by a truck. He was still being treated for his injuries when Blue Shield of California wrote to tell him that his coverage had been canceled because his weight was too high. He would have to pay the hospital bills himself – about $450,000 worth of bills.”

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