In his book The Healing of America: A Global Quest for Better, Cheaper and Fairer Healthcare, journalist T.R. Reid does what I had hoped for some time that our national leaders would do: he undertook to study (through first-hand experience), contrast and compare the healthcare systems of other “first world” nations. (He included a couple of developing countries in his study as well.)
In the book, he details the main features of each system profiled, and shows how the systems compare. He looks at the upsides and downsides of each system and even walks through the process by which the representative countries came by the systems they have. He also profiles how two other countries (Taiwan and Switzerland) made drastic changes to their healthcare in the 1990s—basically redesigning it from the ground up based on a study of what other countries were doing that worked and didn’t work. Mr. Reid lays out his findings clearly in plain English, without polemics or hyperbole. That, in itself, was refreshing.
I’d like to share some of what I learned from his book, but first I want to make something absolutely clear: This is not a political issue to me, it is a moral issue. It is not about capitalism or the free market; it is not about conservatism or liberalism; it is about being human.
I am a Bahá’í. This means I do not belong to a political party and don’t give a rat’s patoot for anybody’s party line. It also means that my feelings about my fellow human beings are informed by the teachings of Bahá’u’lláh:
“The remedy the world needeth in its present-day afflictions can never be the same as that which a subsequent age may require. Be anxiously concerned with the needs of the age ye live in and center your deliberations on its exigencies and requirements.”
Let’s consider the needs of the age. Here’s what I learned from The Healing of America:
- Of all the wealthy nations, the United States is the only one that does not provide medical care for all the people who live its territories.
- The USA is also the only developed nation with a healthcare system that has, as its purpose, paying dividends to shareholders rather than insuring healthcare to its citizens.
- The World Health Organization has ranked the nations based on such key indicators as infant mortality, life expectancy and the number of people who die of preventable or treatable diseases. The US—the richest nation on earth—ranks 37th. That puts us behind the Dominican Republic and Costa Rica and just ahead of Cuba. (You may ignore this appeal to national pride if that’s not what motivates you. If that’s what motivates you, feel free to be appalled.)
- In the US every year, around 20,000 people die because they do not have access to healthcare and thousands go bankrupt because of medical expenses. That does not happen in any other developed country.
- Nations that have created universal healthcare systems provide care to ALL of their citizens for far less than we spend to insure only some of ours. To put this into perspective, the USA spends 17% of its Gross Domestic Product on healthcare. Taiwan, which revamped its “out-of-pocket” non-system in 1994-1995, spends 6% of its GDP. To look at a it a different way, France spends a little over $3,000 annually per capita for healthcare; we spend over twice that.
- Though most universal healthcare systems are struggling with the rising cost of care (as are we), the problems they’re having are less complex than ours because their systems are already doing what they’re designed to do—insuring everybody. Here’s what this means “on the ground”: My family spends hundreds of dollars per month on insurance premiums, yet still has to cover things out-of-pocket. Last year I paid over $700 for dental work. I almost didn’t get it done because we really couldn’t afford it. Our health plan is considered excellent, but it paid only 50% of the most expensive work. Our co-pays range from $20 for office visits to $60 for prescriptions. With the advent of the ACA/Obamacare, we no longer pay for cleanings and other preventive care. In Taiwan, for example, monthly premiums are $150; co-pays are $7 and there is no other out-of-pocket expense. Taiwan could raise its outlay to 8% of its GDP and double premiums and co-pays to save its admittedly under-funded system and still not come anywhere close to what we spend.
- Most universal healthcare systems are NOT “socialized” (be that good, bad or indifferent). The German system—whose founder, Otto Von Bismarck (yes, THAT von Bismarck) referred to it as “applied Christianity”—relies on about 200 private “sickness funds” that German citizens can choose from. They compete for those citizens, too, because the more they have the more they earn. The Taiwanese didn’t like the inefficiencies of that—they opted for a single National Health Fund. It’s true, the German system is more expensive—11% of their GDP (reminder: we spend 17%).
- Not all universal healthcare systems ration healthcare—at least not in any way that compares with the rationing that Americans experience: We don’t cover that. Or We only cover 50% of it. Either translates to: I can’t afford it.
- Not all universal healthcare systems involve long waits for healthcare and none make people wait for urgent care. German citizens, for example, wait no longer for any treatment than US citizens do (that is, those of us who can afford coverage).
- Malpractice insurance is a major cost in our system. Doctors in the universal systems pay annually for malpractice insurance what our doctors pay in a week. And law suits are vanishingly rare. I have my own theories about why that is.
What’s wrong with this picture?
The “wrongest” thing with this picture, in my opinion, is that there are people who think there’s nothing wrong with this picture. I am appalled that there are people who are not morally offended by the idea that people should only receive medical care if they can afford to pay for it.
It’s been suggested by some that one of the impediments to universal healthcare in the US is people like me whose families have healthcare through an employer and who don’t want anything to change. The idea is that we are willing to condemn others to having NO healthcare so we’re sure to get ours. Personally, I find it insulting that my elected representatives assume Americans are that selfish and short-sighted.
I would love to believe I live in the greatest nation on earth. I think that would be truly wonderful. So, my question is: how do we become that? How do we become not just the richest nation, but the most compassionate, the most responsible, the most truly egalitarian? How do we build a healthcare system that rises to our high ideals?
If thine eyes be turned towards mercy, forsake the things that profit thee, and cleave unto that which will profit mankind. And if thine eyes be turned towards justice, choose thou for thy neighbor that which thou choosest for thyself. — Bahá’u’lláh