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Fixing America's Health Care System

Brown, Theresa, PhD, RN

AJN The American Journal of Nursing: November 2018 - Volume 118 - Issue 11 - p 62
doi: 10.1097/01.NAJ.0000547668.15711.cc
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In The Healing of America, journalist T.R. Reid considers what other countries’ health care systems can teach us.

Theresa Brown is a hospice nurse and a frequent contributor to the New York Times, as well as the author of The Shift: One Nurse, Twelve Hours, Four Patients’ Lives (Algonquin Books, 2015). Contact author: theresabrownrn@gmail.com. The author has disclosed no potential conflicts of interest, financial or otherwise.

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It's common for both patients and clinicians to describe the American health care system as broken. Patients suffer from lack of care coordination and expensive copays. Clinicians struggle with increasing bureaucratic demands and the ultimatum of the bottom line. The problems are so endemic and the system so huge that imagining a fix is difficult. But it's not impossible, as T.R. Reid shows in his book The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care (The Penguin Press, 2009).

Reid, a well-respected journalist, studied foreign health care systems to learn how other industrialized countries manage to provide low-cost, high-quality health care to their citizens while spending vastly less than America does. As Reid notes, the United States is the richest country in the world; yet it allows its citizens to be heavily burdened by medical costs, and even to die for lack of affordable care.

In Reid's view, the issue is fundamentally a moral one: “Should we guarantee medical treatment to everyone who needs it? Or should we let Americans… die from ‘lack of access to health care?’”

During the ongoing debate over the Affordable Care Act, countless patient stories have shown that getting medical treatment often depends on whether a person qualifies for, and can afford, health insurance. The Healing of America begins with one such story. Nikki White was a woman with lupus who couldn't get health insurance once she became sick. Reid writes, “Like tens of millions of her fellow Americans, she had too much money to qualify for health care under welfare, but too little money to pay for the drugs and doctors she needed to stay alive.” Unable to secure treatment, Nikki White died when she was 32 years old.

Reid believes that this country should provide affordable health care for all its citizens. He argues that we can do so if we're willing to learn from foreign models of care. The usual negative response to that suggestion is to label such approaches “socialized medicine”—a murky term from the Cold War era. But most of the foreign health care systems that Reid investigated rely not only on government support but also on private-sector physicians, hospitals, and insurance companies. Furthermore, America already has many government-run programs, including Medicare and the Veterans Health Administration, that are “enormously popular.”

Reid also notes that other industrialized countries have more unified health care systems; the same rules generally apply to all patients, hospitals, and providers. In contrast, U.S. health care is fragmented, a “crazy quilt”:

“There's one system for Americans over sixty-five. There's one for military personnel, and a different one for veterans. There's a separate system for Native Americans and yet another for people with end-stage renal failure…. Members of Congress have provided themselves with a terrific health care system of their own…. And there are scores, perhaps hundreds, of different private insurance plans.”

Having a unified system means that time isn't wasted on wrangling over payments, procedures, and medications. More money thus goes into care itself, less into administrative costs.

Lastly, Reid argues that the high profits garnered by health insurance companies are largely responsible for making U.S. health care so expensive: “The United States is the only developed country that relies on profit-making health insurance companies to pay for essential and elective care.”

The Healing of America is highly readable and informative, and for Reid, its writing was also personal. As part of his exploration of foreign health care systems, Reid sought care for an injured shoulder. The personal touch reminds readers that, above all, health care is about individuals. Arguments over economics and “socialized” care can obscure the fact that we're talking about real people like Nikki White—and any of us could find ourselves in her shoes. This book makes it clear that no more Americans need die for lack of affordable health care. We simply must find the will to fix what ails our health care system.

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