Sometime in the next four years, the health care delivery system in the United States is going to change. That’s a given because the current patchwork—costly and unreliable private health insurance, overcrowded and underfunded hospital emergency rooms, technophilic and procedure-incentivized physicians—is coming apart at the seams. Whatever solution the 44th president and the 111th Congress enact may or may not prove adequate. But rest assured they’ll change something.
What that means for you, reader, is you need to set aside a little time between now and Nov. 4 to catch up on the American health care policy debate (assuming you haven’t already done so). Your future health may depend on it.
The pithiest overview of the problem is an essay that Paul Krugman, the Princeton economist and New York Times columnist, wrote in collaboration with his wife, Robin Wells, for the New York Review of Books in 2006, titled “The Health Care Crisis and What To Do About It.” Krugman and Wells write in the spirit of economists seeking the most rational and cost-effective solution (as opposed to the most politically salable one). Their conclusion—which I find bulletproof—is that the federal government, which already provides taxpayer-funded health insurance to the elderly, the destitute, and, increasingly, to minors, should extend health-care coverage to everyone.
My only complaint about Krugman and Wells is that they give short shrift to the question of cost containment, which will remain a challenge even (perhaps especially) if the government provides health care coverage to all. To fill this gap, read “Options for Slowing the Growth of Health Care Costs,” an article by James J. Mongan, Timothy G. Ferris, and Thomas H. Lee, reprinted from the April 3 issue of the New England Journal of Medicine (which does an excellent job covering the health care policy debate). Mongan, Ferris, and Lee evaluate the various cost-savings proposals currently under discussion from the standpoint of inherent practicality and political achievability.
Got a little time to surf the Internet? Then check out the Web site for Health Care for America NOW!, a coalition of labor unions and other liberal groups lobbying for universal health care. Of particular interest here is the “insurance nightmares” blog, which links to a recent news story about a Tampa Bay, Fla., teenager whose health insurer refused to pay for … brain surgery. (They finally relented under pressure.) Check out the Web site for the insurer-funded Campaign for an American Solution to learn why brain surgery is actually a foolish indulgence. (OK, it doesn’t actually say that.) The health care proposals of Barack Obama and John McCain present the most challenging reading on this list because they’re written with politics rather than clarity in mind. To avoid getting conned, I’d advise you to read my “Health Care Primary” analyses (here and here) first.
Insurance horror stories abound in Michael Moore’s 2007 documentary, Sicko. Moore is sometimes accused of exaggerating for effect, but his gothic tales of patients denied health insurance coverage require (and, for the most part, receive) no exaggeration at all. Supplement your DVD rental with “Health Care for All,” a listening tour of other countries’ collectivized health care systems from National Public Radio. It’s more reliable than Moore’s (though similarly favorable).
The single best book I’ve encountered about the centurylong evolution of the American health care crisis is Sick: The Untold Story of America’s Health Care Crisis—and the People Who Pay the Price by Jonathan Cohn, a senior editor at the New Republic. A wonkier overview can be found in Healthcare, Guaranteed by Ezekiel Emanuel, a bioethicist at the National Institutes of Health (and brother of Illinois Rep. Rahm Emanuel). I’m not entirely persuaded by Brother Zeke’s proposed solution of government-funded private insurance vouchers, but his criticisms of direct government health insurance can’t be ignored. Best Care Anywhere: Why VA Health Care Is Better Than Yours,by Phillip Longman, makes the counterintuitive but wholly persuasive case that the Veterans Administration, in spite of its recent difficulties serving Iraq war veterans, provides an extremely successful model for socialized medicine. (Full disclosure: I wrote the introduction.) Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer, by Shannon Brownlee, explains why those patients who do have access to treatment receive it to excess, to the detriment of their own health. Brownlee and Longman are both fellows at the New America Foundation. A principal reason for overtreatment is that doctors are usually unsalaried professionals who get paid based on the number of procedures they perform and tests they order up. Arnold Relman, a former editor of the New England Journal of Medicine, explores this problem (and more generally how health care has been corrupted by increasing commercialization) in A Second Opinion: Rescuing America’s Health Care. In The Cure: How Capitalism Can Save American Health Care, David Gratzer makes the conservative case for a free-market solution to the health care mess. He’s lucid—but wrong.
The political lessons of Hillary Clinton’s failed 1994 health care plan are documented comprehensively in The System: The American Way of Politics at the Breaking Point,a 684-page narrative by the Washington Post’s Haynes Johnson and David Broder. Theda Skocpol, a Harvard sociologist, provides a more analytic and svelte (240-page) account in Boomerang: Health Care Reform and the Turn Against Government. In general, though, the demise of Hillarycare has been overstudied in Washington. Both the politics and the problem itself have changed a lot since then.
If all this reading gives you a headache, take two aspirin, and I’ll call you in the morning.