My 22 year old daughter Abby spent ten hours in an emergency room in Miami Beach over our vacation with a high fever, chills and aches. Malaria symptoms, we assume, from our trip to Haiti. She received three lumbar punctures, several IV’s of morphine and a few blood tests to rule out both malaria and meningitis until, at midnight, the doctors shrugged their shoulders, forgot about the Tropical Disease consult they had ordered and released us with three pain prescriptions despite the fact that no pharmacy in the area opened until 8 the next morning. Ironically, the book in my backpack during this all too familiar story of misguided American medicine was T.R. Reid’s The Healing of America: A Global Quest for Better, Cheaper and Fairer Healthcare.
Mr. Reid has a bum shoulder. His American doctor has suggested a total shoulder replacement. He travels to Canada, France, Germany, Britain, India, China and Japan to seek their diagnoses for his condition and find out what treatment would be available to him under each country’s respective healthcare system. Along the way he provides an intelligent, illuminating, cogent discussion of the many good ways provide healthcare.
First, he dissects each country’s system. Of course, the US system is the only one that really needs to be dissected because we are the only major industrialized country that has multiple systems. Seniors (Medicare), veterans (socialized), really poor (Medicaid), middle class (private insurance) and the 45 million moderately poor (out of pocket) all access independent spheres of healthcare. Mr. Reid argues with conviction that having every major healthcare delivery system operate simultaneously in the United States is the root of our ineffectiveness. And since we spend 17% of our GNP on healthcare (11% is out nearest competitor) yet rank 37th on the WHO ranking of healthcare systems, our ineffectiveness is hard to dispute.
Every other major industrial nation operates only one system and it applies to everybody. It is as simple as that. Some are run by the government (Britain) others are fully private (Germany), and some systems have a larger private sector than our own. Socialized medicine is a divisive political term, not an accurate description of how other countries tend to their ill. The issue is not whether a system is public or private. The issue is – is it accessible to all? Reid makes a compelling case that healthcare reform cannot happen until everyone is covered, because only when there is one system with universal coverage does the emphasis evolve from dodging costs (the US system of denying access and claims) to one of promoting health. As long as we operate multiple systems and their inherent inefficiencies we will be stuck with a medical model of care that stresses treatment over a public health model of care that emphasizes wellness.
Just when I thought the book was plenty satisfying, Reid delivers two wallops in the last chapter. First is a simple, sobering statement. ‘The healthcare of a country reflects the morality of a country.’ As the only industrialized nation that does not provide healthcare to all – what does that say about us?
Second, I found personal comfort in his decision not to proceed with shoulder surgery. He learned how to accommodate his discomfort. The only treatment he received that made a noticeable difference to his shoulder pain was at the Arya Vaidya Chikitsalayam in India. For $42.50 a day he received astrological guidance, herbal remedies, a staunch diet and daily yoga exercises that increased his mobility. He left ten pounds lighter with no pain in his shoulder.
The cost of Abby’s trip to the ED in Miami? $8,500 for a ten hour visit, and she woke up the next morning with every pain intact while I scrambled around Miami looking for a CVS for some pills.
