The answer, then, isn’t to abandon the narrative form that Cohn uses to such advantage. Rather, it’s to extend it so that it get us thinking about solutions as much as it does about problems—and the obvious place to do this is outside the United States, since that’s where alternatives to the U.S. system exist. In fact, the format of Sick almost begs for narratives about overseas health care systems. The book is basically a tour around America, with each of its eight chapters named after the place in which its story unfolds. So why not include chapters on Manchester, Malmö, and Marseilles, each of them highlighting in narrative form both the good and bad points of the British, Swedish, and French systems? At the very least, France deserves special treatment since, as Cohn correctly points out, its health care system is frequently held up as a model. How does the French system, in which waiting lines are nearly nonexistent and everyone is covered, manage to make smart and reasonable choices about cost, achieving enviable results while spending more than the chronically underfunded British system but less than the chronically inefficient American system?
Moreover, since political attacks on national health care proposals often depend on disparaging comparisons to the state-run systems of other countries (the familiar “hip replacements in Canada” trope), overseas is also the best place to see if those attacks are fair. Are waiting lines for hip replacements in Canada really out of control? Do Swedes really have to wait an average of nearly half a year for heart surgery? Do cancer patients really do poorly in Germany? Whether it’s policy or politics you’re interested in (or both), the best place to find the answers is outside the United States.
That all matters more than usual because a decade after the failure of Bill Clinton’s health care reform proposals, it’s looking more and more like national health care is going to be back on the political—and therefore the journalistic—agenda over the next few years. CEOs are increasingly antsy about rising insurance premiums, the ranks of the uninsured continue to grow, medical costs are plainly out of control, and more and more people are starting to realize that tying health care to employment makes little sense in an era where the average worker changes jobs every seven years.
In an increasingly globalized world, the war on terror has sobered us to the dangers of crippling the foreign reporting and institutional memory of all but a handful of national newspapers. Health care may be about to remind us of this in an entirely new context. Anyone for reopening that Stockholm bureau?
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