America, Heal Thyself

Shannon Brownlee: "the United States has the most expensive health care system in the world. We spend nearly twice as much per person as do other developed countries for health outcomes that are no better and in some cases much worse. Moreover, the citizens of most other countries, including Canada and the U.K., who are routinely reviled by opponents of 'socialized' medicine, express greater satisfaction with their health care systems than we do with ours.

All of which adds up to an obvious conclusion to author T. R. Reid: we have a lot to learn from these foreigners. 'We can bring about fundamental change [in our system] by borrowing ideas from foreign models of health care,' he writes. Part analysis, part amusing travelogue, The Healing of America represents an admirable mission, as Reid travels the globe in an effort to understand why our care is so much more expensive—and less effective—compared to that of other countries. Along the way, he takes his bum shoulder, the result of an injury sustained while serving in the military in the 1970s, to a series of doctors and healers in far-flung cities, to illustrate how different caregivers approach the treatment of joint stiffness and pain. Reid may be right that there are lessons to be learned from other systems that could inform the debate we’re now having about the quality and cost of our own health care, but they are not the lessons that are put forth in this book.

In trying to explain the root causes of our astronomically expensive system, Reid falls back on two widely held but inadequate assumptions about what’s driving American health care spending. The first is the price we pay for each medical service compared with prices for the same service in other countries. At each stop in his tour of foreign health care systems, Reid hammers this point home. We learn that an MRI of the head costs $105 in Japan versus anywhere from $1,000 to $1,400 in the U.S. A visit to the orthopedist to look at his shoulder in France costs $34, versus three to four times that in the United States.

Reid is right that we pay more for many individual treatments than do citizens of other countries. But in his relentless litany of price differentials he fails to convey the simple but vital point that costs in medicine, as in any industry, are a function of both price and volume. What also distinguishes us from other countries is the amount of health care we consume, especially of the most expensive kinds of care. We undergo three times more MRI scans than the OECD average. Our doctors prescribe more brand-name
drugs and fewer generics. We undergo more elective surgeries than citizens of France, Switzerland, and Germany. We run to the specialist at the drop of a hat, partly because we have more specialists and fewer primary care physicians. That specialist is often quick to recommend an expensive procedure or surgery when physical therapy, painkillers, or some other, less invasive form of treatment will work just as well or better. Reid’s own story about his aching shoulder illustrates this point. His American doctor immediately recommended a complete shoulder replacement, while every other doctor he saw in other countries suggested he try less draconian remedies first.

Reid’s second explanation for high American health care costs is the mammoth overhead built into our private health insurance market. '[I]nsurance firms … soak up a significant share of the premium dollar to cover the costs of marketing, underwriting, and administration, as well as their profit,' he writes. 'Economists agree that this is about the most expensive possible way to pay for a nation’s health care.'"