Book Review 364: The Healing of America

THE HEALING OF AMERICA, by T.R. Reid. 290 pages. Penguin paperback, $16

In the 1950s and ‘60s (and earlier but my memories don’t go further back) it was usual to see people with unreconstructed cleft palates. So common that when I was in high school, mocking the speech of people with a harelip was a frequent theme.

I haven’t seen anyone with an unrepaired harelip in about 50 years. So I called a surgeon I know who repairs cleft palates and asked him, how do all these birth defects get fixed? Surely the same proportion of people without medical insurance (one in 6 before Obamacare) have babies with cleft palates as in the wider population.

He told me that no hospital will release a baby with a cleft palate any more. Even if the mother does not have insurance, Medicaid will take over.

In the same way that it is easier to raise conservation money for charismatic animals like pandas than for dull but equally declining animals like, say, snail darters, there are charismatic diseases that society no longer wishes to have to see. But should a baby have a less visible defect, it will escape the hospital untreated, unless the parent has good enough insurance.

In only one of the rich industrial countries is this allowed to happen. The brutality of the American health care system is unmatched anywhere else.

When newspaperman T.R. Reid set out to find out what health care is like in most rich countries, he came back with a general answer: at some point in their economic advance, each country decided that it was immoral to allow people to live sick or die when they could be healed.

The motive was not to save money, although the United States outspends any other country (per capita or as a percentage of national income) by a vast amount, while every other country provides care for all, while in America the luckless die in the street.

Reid had a bum shoulder, which he presented to physicians in America, France, Canada, Germany, Japan and Britain. He discovered that the way his shoulder would be treated varied considerably, from heroic (shoulder replacement in America) to mild. In each country, except America, he would have been treated no matter his income.

(For comparison, he tested India and ended up using ayurvedic therapy, which was gentle and somewhat effective.)

He also discovered that the lies Americans have been told for generations about socialized medicine were, indeed, lies. All countries ration care – the U.S. in the most brutal way – but in different fashions.

In Canada you wait for an appointment. In Japan no one bothers to make an appointment; they just walk in and get seen that day. In Britain, if you want a shoulder replacement, you will have to go through some rigmarole to get it. In Germany, if you ask for it, it will be scheduled in a couple of days.

In only one country do people die from rationing. The total is in the millions. The lowest estimate of the annual toll here is about 22,000.

Reid’s valuable, hands on survey is an excellent place to start thinking about health care, but it is limited. He does not inquire into drugs or medical engineering, and barely mentions long-term care. Nor does he say much about the medical education systems. And he says nothing about chiropractic and other forms of quackery that absorb lots of money.

He does note that for the vast majority of people, there is no health care at all.

They just die, after some mistreatment by root-doctors if the can afford it.

Just like Americans.