National Nurses United

Books:1 copy 9/2/09 3:34 PM Page 12 Summer The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care By T.R. Reid; The Penguin Press f there's one refrain you hear from politicians and policy wonks grappling with ways to avoid supporting a single-payer, Medicare-for-all healthcare reform, it's how we need a "uniquely American" system. Well, the reviews are in, and they are not kind to our "uniquely American" approach, as T.R. Reid reminds us in a new book. Many people have heard how the United States ranked just 37th in the World Health Organization's overall scorecard earlier this decade. Or how the Commonwealth Fund listed the United States last year as last among 19 industrial nations in preventable deaths. But how about this one: When the WHO assessed 191 countries on the barometer of "fairness," the United States stumbled in at a bare 54th, barely beating out the impoverished African nations of Chad and Rwanda, but still behind Bangladesh and the Maldives. Not exactly a badge of honor. Can we do better? Of course we can, just by learning from the experiences of the rest of the world, especially those other comparable industrial nations which all have some form of national healthcare system—one in which their citizens' health is not held hostage by profit-making private insurance companies. Reid, the correspondent of a much-praised PBS series last year Sick Around the World, who then resigned from a follow-up show this year when it trumped the badly flawed Massachusetts law as a model for U.S. reform, chronicles his travel experiences in the new book. He concludes that "most rich countries have better national health statistics—longer life expectancy, lower infant mortality, better recovery rates from major diseases" than does the United States. And they also perform better in presenting patients "a greater choice of doctors, hospitals, and procedures." For those who say we should not taint our borders by emulating France or Germany or Canada, Reid offers this retort. "We have borrowed numerous foreign innovations that have become staples of American daily life: public broadcasting, text messaging, pizza, sushi, yoga, reality TV, The Office, and even American Idol." Apparently we consider our health to be less important. Reid also provides a useful service in knocking down most of the myths about other national systems that are common grist for the likes of Fox TV and the conservative think tanks. One example is that "they ration care with waiting list and limited choices." In fact the data varies widely among other countries, and if you want to I 12 REGISTERED NURSE Book Review see really hideous waits, rationing of care, and limited choices, check out most American ERs and insurance network restrictions. Or the canard about "wasteful systems run by bloated bureaucracies." Administrative costs in Canada and France run about 5 percent, compared to private insurance companies in the United States, which devote from 20 to 30 percent for marketing, executive compensation, profits, and the massive paperwork they employ mostly to deny medical care they don't want to pay. If there's one crucial difference between the United States and all the other countries he surveyed, says Reid, it's the moral dimension. Whether a society should "guarantee health care, the way we guarantee the right to think and pray as you like, to get an education, to vote in free elections? Or is medicine a commodity to be bought and sold, a product like a car, a computer, or a camera?" Apparently, the latter approach is what makes our system "uniquely American." As Reid puts it, "all the developed countries except the United States have decided that every human has a basic right to health care." We don't, despite the pronouncement by President Obama last fall that he, too, agreed that healthcare should be a right. Obama, who notably described himself as a single-payer advocate in 2003, now says that's the way he would go if we were "starting from scratch," but it would be too disruptive to the present system to do that now. Well, a lot of people believe our system needs some good disruption. There are plenty of examples abroad that you can remake your healthcare system, and make it better. Britain and Canada did after World War II. And, there's a more recent, interesting example. When the limited Clinton plan was running aground from 1993 to 1994, Taiwan went the other direction, jettisoning its own broken system and searching for a better model. Taiwan scoured the world, and in 1994 adopted a new national healthcare system guaranteeing coverage for all its residents. Almost overnight, Reid notes, every resident of Taiwan, in their new national single-payer system, had access to doctors and hospitals, and complete choice of provider, cut administrative costs to a mere 2 percent, and experienced striking improvements in patient outcomes. While Taiwan, like some other national systems, has some problems today, mostly with underfunding, it has a much more equitable healthcare infrastructure, and provides cost effective coverage for everyone. There's a critical lesson for us in that, if we choose it. —charles idelson Impaired: A Nurse's Story of Addiction and Recovery By Patricia Holloran; Kaplan Publishing A ll of us should rightly be concerned about the danger registered nurses who suffer from substance abuse pose to the nursing profession and to the public. Nobody wants a compromised nurse caring for them or a loved one. Nurses with drug problems have popped up in the W W W. C A L N U R S E S . O R G J U LY | A U G U S T 2 0 0 9

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