I have just belatedly finished reading a book I think every American, but particularly every American involved in healthcare (well, which of us isn’t??) should read: The Healing of America by T.R. Reid.
A few years ago, ASHE invited the author to keynote its annual Conference. I remember my wife, Laura, who was then the Executive Director of Hospitals for a Healthy Environment (H2E), express her surprise and admiration for ASHE’s courage in bringing Mr. Reid to the conference (remember that Don Berwick was prevented from becoming head of CMMS because he thought there was something to learn from European countries). In his book, Mr. Reid looks at the various healthcare reimbursement systems around the world; private cash payment only; public funding and private providers; public funding and public providers, and private funding with private providers.
Interestingly, he finds that the US healthcare “system” is actually a combination of all four of the structures, with for-profit insurers predominant and no commitment to healthcare for all. Most countries around the world (a) have one system for the entire country; (b) have non-profit funding for healthcare; and (c) have a commitment to provide at least a basic level of care for everyone. Our system, which is the only one in the world that runs exactly counter to all of these principals, also has much higher costs and much worse outcomes. Causation???
As I read this book over the last couple of weeks, I could not but help to think deeply on this as I read the news… Today, the Gallup organization says that, after eight years of increasing healthcare coverage, now, we have increasing numbers of uninsured.
The Gallup organization also found that the highest drop was among young people, people of color, and people who earn less than $36,000 annually. The implications of this are that premiums will have to rise for the older and sicker. Gallup predicts these trends to continue as the Federal Government continues to chip away at healthcare funding. Gallup also predicts rising healthcare challenges as the uninsured are forced to delay or avoid seeking medical care and as hospitals face higher rates of uncompensated care.And, healthcare organizations in rural America are especially fragile in the face of such threats.
According to Mr. Reid (a few years ago, when he updated the book), every year 20,000 people die needless deaths because they have no access to insurance. He doesn’t say, but I wonder how these deaths are distributed – probably higher, I would guess, among the poor and non-whites?
This isn’t political, exactly. It’s a description of where we are. And, where we are implies the question–Is this what we want for our country? This is the question these facts and Mr. Reid demand of us.
I highly recommend that everyone read the book and think about how you would answer the question.