This Little Piggy Went To Market …

I rarely fall in love with books. Like them, yes, admire them, wish I could write with such humor/panache/verve, but fall in love, no, not really.

Every rule has its exceptions, and The Healing of America is mine.

I’ve written before about T. R. Reid’s very readable – even amusing! – survey of universal healthcare systems. The book and I had dated. We’d sipped the initial coffee, taken lunch, watched a movie together. I knew the book was intelligent, thoughtful and witty. It wasn’t dry or long-winded, two no-no’s in a date. I was up for more investigation. Perhaps we could spend time on a walk, lose our way in conversation. This was definitely a book worth spending time with, but I didn’t expect to feel more than that so soon.

“Before you can set up a health system for any country, you have to know that country’s basic ethical values. The first question is: Do people in your country have a right to health care? . . . Your ethics, your sense of justice, determine how you distribute goods and services, including health care. So the first question has to deal with a country’s ethical values.”

That’s American economist William Hsiao, who’s helped design healthcare systems for over a dozen nations.

An economist! Quoted in The Healing of America, talking not just about the bottom line, but saying that the first question, the first, lives in the realm of ethics. Wow. I was head over heels.

We’ve all read the negative comparisons of US healthcare results. Maybe we’ve even skimmed over the rankings: healthy life expectancy, US 24th in the world; the World Health Organization survey, US 37th; Harvard School of Public Health (measuring patient satisfaction in 17 developed countries), US 14th; the Commonwealth Fund (testing 19 developed countries), US 15th.

Terrible numbers, which come at huge, unwieldy, inefficient cost.

But to the first question, the very first? What is our answer? So far, it’s “no”.

As T. R. Reid points out, we Americans don’t even have a healthcare system. What we have is a market, a market in which some people (for example, those who are veterans, over age 65, or members of Congress) are treated according to workable systems adopted from elsewhere in the world, and others struggle with too-expensive premiums and insurance companies that have the right to deny coverage or kick the member out just when that person needs healthcare the most – after a car crash or upon discovery of a tumor. We have a market where health insurance is regarded as a tool to make money for investors, a situation that other nations regard with astonishment and horror.

How can America, they ask, a nation with so much promise and potential, treat its citizens with such contempt?

To those who cry “rationing!”, please. Get a grip. We’re already rationing, just not very logically. We ration healthcare by the one of the worse possible measurements: by the person’s wealth.

Luckily, in changing, we don’t have to reinvent the wheel. All we have to do is borrow the innovations of other developed countries. France’s carte vitale (“card of life”) enormously reduces administrative costs. Germany’s not-for-profit health insurance design takes a scalpel to costly monthly premiums. Canada’s ethic of solidarity among citizens (such as that witnessed in the US during World War II) makes care affordable.

Just as we needed to revamp our policies with regard to the sale and ownership of human beings in the 19th century, we need to reform the way that healthcare reaches both the child of wealthy parents and the child of middle-class or poor ones.

Our ethics, our sense of justice, demand it.

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