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

May 20, 2007

National Book Critics Circle Award and Man Booker Prize Reality Check, Kiran Desai’s ‘The Inheritance of Loss’ (Books I Didn’t Finish)

This is the third in an occasional series of posts on whether the winners and finalists for major book awards deserved their honors.

Title: The Inheritance of Loss. By Kiran Desai. Grove, 357 pp., $14, paperback.

What it is: A novel about a cynical Indian judge and his orphaned granddaughter who live with their dog and cook in a Himalayan village that sinks into violence and terror in the 1980s when Nepalese insurgents “demand their own country, or at least their own state.”

Winner of … the most recent National Book Critics Circle Award for fiction and Man Booker Prize (formerly the Booker Prize).

How much I read: About 60 pages (the first two chapters and the last eight.)

Why I stopped: Desai evokes deftly the “voluptuous green” terrain of Himalayan foothills awarm black cobras as thick as a biscuit jar. But I agree with Lee Langley, who wrote in the Spectator that her Indians come across “as figures in a landscape rather than characters we are gripped by,” except for the cook and his son. (“Life on the Brink,” The Spectator www.specatator.co.uk, Sept. 9, 2006.) Because her novel involves an orphan and her grandfather living in isolation in the mountains, I also kept thinking, irrationally, that it read like a postcolonial Heidi as envisioned by Salman Rushie, which is unfair not just to Desai and Rushdie but to Johanna Spyri.

Was this one of those book awards that made you wonder if the judges were on Class B controlled substances? Or if the publisher had pornographic videos of all of them? No. But the ten chapters I read were no match for such great Booker winners as Kazuo Ishiguro’s The Remains of the Day.

Best line in the pages I read: “Could fulfillment ever be felt as deeply as loss?”

Worst line in the pages I read: “Chuckling, the boys stepped off the veranda and out into the fog carrying the two trunks.”

Reading group guide: The paperback edition includes a grim three-page reading group that reads as though it had been written by an SAT examiner. The “questions” often bark orders at you beginning, “Explain,” “Discuss” or “Compare and contrast … ” The author of this one seems unaware that many people go to book clubs to have fun, not to feel as though they’re being grilled by an eighth-grade English teacher. Masochists can find the guide online at www.groveatlantic.com (though the page for The Inheritance of Loss is, at this writing, out of date and does not mention that the novel won the NBCC fiction award more than two months ago).

Published: January 2006 (Atlantic Monthly press hardcover) and August 2006 (Grove paperback.)

Links: See the March 7 post on www.bookcriticscircle.blogspot.com for an interview with Desai and other posts on the site for information on her NBCC fiction award.

© 2007 Janice Harayda. All rights reserved.

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