Well, a spoonful of sugar makes the medicine go down, and by the time you get to the answers, which are woven in throughout the chapter, you’re actually interested in reading about them. And by presenting the explanatory policy and history segments in small chunks (usually not much more than four or five pages at a time), Cohn makes them easily digestible. At about the time a reader might be tempted to start skimming ahead, the wonkishness stops and the storytelling picks up again.
It helps that Cohn is a terrific storyteller, as well as one who doesn’t insist on twisting his tales into polemics. The story of the Sampsons is typical. Their lives were never threatened. By hook or by crook they always managed to get the treatment they needed. They had to sell their retirement home, but they were never reduced to poverty by medical bills. What’s more, Cohn even makes clear that Morrell’s decision, as brutal as it was, was driven by competitive forces in the meat-processing industry that were mostly beyond the company’s control. Morrell was caught in the middle of the same screwy, jury-rigged health care system that all the rest of us are caught in, too.
This makes Sick an honest read. It’s hard not to come away appalled by the American health care system, but it’s also hard not to come away thinking that, one way or another, it does mostly work. Sort of. For the most part, it’s not that people die or literally fail to get lifesaving treatment—though that happens more often than it should—but that chronic conditions (like diabetes or hypertension) are frequently undertreated, while people treated for serious conditions too often end up alive but in penury. And all this despite the fact that American health care is far more expensive than any other health care on the planet. There must be a better way.
It’s at this point that we’re brought face-to-face with the drawbacks of narrative journalism. As good as Sick is—and it’s very good—one can’t help but notice that after more than two hundred pages of diagnosing the ills of the U.S. health care system, Cohn devotes little space at the end of his book to suggesting solutions. And while authors may have a legitimate beef with reviewers who spend time essentially complaining that the author didn’t write the book they wanted written, in this case the criticism is hard to escape. It’s glaringly anticlimactic to get to the end of Sick and discover little more than a few paragraphs suggesting that, yes, universal health care would be a good idea, and perhaps it could take the form of Medicare for everyone. Or maybe we should emulate the French system. Or something.
What to do? This dilemma is displayed in high relief by comparing Sick to The Health Care Mess: How We Got Into It and What It Will Take To Get Out, by Julius Richmond and Rashi Fein, originally published in 2005 but recently released in paperback. Both books cover much of the same ground (though Richmond and Fein spend a lot of time on issues of medical education, a subject not likely to interest many laymen), but if Sick is like a high school class in the history of American health care, The Health Care Mess is more like a college course. (The graduate seminar version would be one of those indigestible Brookings tomes.) Richmond and Fein spend a fair amount of time explaining how the incentives of the American health care system work mostly in the direction of making care more expensive, and the result is that by the time they start talking about solutions in their final chapter we’re better prepared to understand both the substantive tradeoffs between different plans as well as the political lay of the land for getting any of them implemented.
Unfortunately, not many people will get to that final chapter. In taking the usual policymaker’s approach to book writing, Richmond and Fein have produced a treatise that few ordinary citizens—even smart, engaged citizens—will ever pick up. Where Sick reads like a novel, The Health Care Mess reads like a white paper.
I find the rhetoric some use to disparage the Canadian health-care system laughable. I am a 40-year-old man who has had bladder cancer; my father has had multiple cancer diagnoses as well as an abdominal aortic aneurysm, emphysema, and circulation problems in his legs; my mother has respiratory difficulties and has a fractured vertebra from a fall; and I have had friends who have had kidney transplants and who have fought cancer, in one case for 10 years.
Neither I nor any of these people suffered an unacceptable wait. Treatment has been effective and prompt.
I hear the propaganda -- 'socialized medicine', bare-bones care, nightmare -- and I'd laugh if it weren't so pathetic.
I'm not a health-care expert; but right wing policy shops in the United States (and Canada) must not be looking at the same health-care system that I'm part of.
Posted by Bob LeDrew - Flacklife
on Thu 2 Aug 2007 at 11:57 AM
Canada and the other countries mentioned in the review are different from the U.S. in that none of them neighbor a Third World country. In fact, there are 500 million people to the south of the U.S., almost all of whom are very poor. Combined with a power-mad Democratic party that fully supports massive illegal immigration and you've got a recipe for disaster.
And, Dem bloggers and others who try to sell UHC consistently fail to discuss that side of this issue or handwave it away. Do either of the books discuss that side of the issue? Oddly enough, that's not in the review, but then again I wouldn't expect it to be since Drum is not only one of those handwavers, but comments trying to discuss illegal immigration's impact on UHC were deleted from his site.
Perhaps the CJR could provide us with a review of these books from someone who's more skeptical about UHC or at least someone who's not afraid to discuss everything involved in its implementation.
Posted by NoMoreBlatherDotCom
on Thu 2 Aug 2007 at 10:59 PM
Few health care reform proposals give much more than a nod, if that, to preventive medicine and --heaven forbid-- public health. There is still a public health system, but it receives only 2 cents of every dollar spent on health.
In this vein, we as a nation are fairly overweight, dependent upon the auto, etc. and we over consume many things.
Couple this to the emerging energy crisis --hospitals are enormous energy sinks-- and you've got a truly unsustainable system. It is most likely to crack, however portions of it may react to reflect the reality of a post peak oil world --and include global warming as a second driving force.
The future of health care is in taking preventive care seriously and universal care (all current red herrings and canards for preserving the status quo will lose credibility) for all.
Wonks almost never place health care in an ecological context, the one that really matters.
Posted by Danb
on Sat 4 Aug 2007 at 09:00 AM
NoMoreBlather fails to live up to his screen name when he cites illegal immigration as a significant argument against universal health care. The other countries that do not "border a Third World country" nevertheless have a lot of poor and disenfranchised immigrants in their population. These people managed to arrive in places like Canada, Britain, Germany and France despite their inability to "walk across the border." There are these things called boats, trains and airplanes that make it possible. You think it's really all that difficult for poor Africans to catch a boat to France or cross the Strait of Gibraltar into Spain? Migration from the Middle East into Western Europe is mostly a land trip. Ever occur to you that universal health care might offer another opportunity to double and triple check immigrants' legal status?
As for blaming the Democratic party for illegal immigration, it was the Bush administration that sharply cut workplace green-card enforcement when it came to town. Prosecutions went from the thousands in 1998 to something like the low hundreds in 2002. The Bush administration has only recently rushed to replace funding to border patrols that it sharply cut in its first term.
Posted by SalHepatica
on Sun 5 Aug 2007 at 01:34 PM