Saturday, August 29, 2009

Jacob Weisberg, T.R. Reid, and Serious Medicine Strategy

Jake Weisberg, the always thoughtful writer-turned-editor at, wrote a thoughtful piece on health care last month that I belatedly just read. It starts out as a review of T.R. Reid's new book, The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care, to which Weisberg adds plenty of his own thinking:

In his new book The Healing of America, the journalist T.R. Reid employs a clever device for surveying the world's health systems: He takes an old shoulder injury to doctors in various countries. In the United States, a top orthopedist recommends a major joint-replacement operation, costing tens of thousands of dollars. In France and Germany, general practitioners offer him the same surgical option, at little or no cost, but steer him instead toward a regimen of physical therapy. In Britain, the doctor is unimpressed with his injury and tells him to go home. In Canada, he is offered a place in line, where he will wait a year just to consult a specialist. In India, he is sent to an ayurvedic clinic, where he is treated, quite effectively, with herbs, massage, and meditation.

OK, now that's interesting. The world is, well, multicultural. Different peoples do things differently. But then Weisberg both agrees and disagrees with Reid. Weisberg is willing to accept some of Reid's critique, but not Reid's solution:

America's system has become wildly unfair and expensive. In fixing it, Reid says, we should follow other countries where health care is fairer, cheaper, and produces better results. He's right that we can learn much from practices elsewhere—why, for instance, can't we have those nifty smart cards the French use instead of paper records? But the lesson I took away from Reid's book was somewhat different: Health care systems are not just policy choices but expressions of national character and values. The alternatives he describes work better than ours not just because they're well-designed and competently managed but because they reflect the expectations and traditions of their societies.

And then Weisberg goes further, channeling an argument made more than 20 years ago by James Fallows, a patron saint of thoughtful liberalism:

America's evolved, undesigned system is also an expression of our culture at its best and it worst. Health care in the United States is innovative, entrepreneurial, expensive, litigious, and wasteful. It is decentralized, driven by self-interest, excellent at the high end, and increasingly unequal. It resists acknowledging trade-offs or limits and is characterized by shocking gaps in basic care. As we plunge into a long-overdue comprehensive overhaul, it's useful to think not just about how we can build on what works in this hodgepodge but about how we can bring health care into better alignment with our own national identity. In reforming our system, we need to create something that is "more like us," in the phrase of the journalist James Fallows—not more like what the French, Finns, or Swiss have, as appealing as that might sound.

We Americans have the system we have because we are who we are. That's not nationalistic chest-beating, that's just anthropological observation. America is different because it is, well, different. And as we have seen yet again in 2009, attempts to remake the United States in the image of the European Union are perpetually popular among the chattering classes, and perpetually unpopular among the mass of ordinary Americans, the kind of folks who are more likely to take their cues from Oprah Winfrey or Sarah Palin than from Gloria Steinem or Gail Collins.

Weisberg, a thoughtful liberal himself, clearly sympathizes, viscerally, with Reid and his why-can't-we-be-like-Sweden ethos. But intellectually, Weisberg is smart enough to see that the Sweden-ification of the U.S. is not about to happen:

We might as well admit that we're going to continue spending more of our national income on health care than anybody else. We are a rich country, we want the best treatment available, and we're prepared to pay for it.

Weisberg seems to regret this spending, as he goes on to make a pitch for the Wyden-Bennett health care bill. I, too, think that Wyden-Bennett is a pretty good idea. Wyden-Bennett is not Serious Medicine, but if it helps Americans build themselves a safe and secure platform of Routine Medicine--which I think Americans should expect--then that Routine Medicine platform could become the launch pad for Serious Medicine.

Thus the one point I would add to Weisberg's review of Reid's book. America, in all its high-tech--or, if you prefer, "gold-plated"--glory, does spend a lot of money on health care. And for that money, we get the best Serious Medicine in the world. That's why the fatcats of the world tend to come here.

The Serious Medicine Strategy argument is that the influx of fatcats could be augmented by inviting in less fat cats, followed by skinnier and skinnier cats. Not to come and live here, unless we want them to, but as patients at our great hospitals and clinics. And then, furthermore, let's figure out how to export our Serious Medicine overseas--and not just the pills and machines, but the holistic services themselves.

In the SMS reckoning, all those expenditures we make--totaling 17 percent of GDP--should be thought of as an asset to be leveraged, not as a liability to be squelched. If we saw the trillions we spend on health care as an asset, we would see that the rest of the world, over all, pretty much aspires to the same "gold plating" that we enjoy. To be sure, the health care elites in those countries might be horrified at this American-ization of their health care systems, but the masses of folks in China and India and everywhere else seem to show a great interest in enjoying the benefits of a consumer society. If they like our Kentucky Fried Chicken, they will like our treatments for obesity. And health care, of course, is a great consumer good--the ultimate consumer good.

So if we wanted to, we could do a lot more to sell Serious Medicine to the world, and we could invite the non-terrorist populations of the world to come here, if they could afford it, to consume Serious Medicine. (And if, as a matter of charity and/or national strategy, we wished to donate Serious Medicine, that would be fine, too.)

If America could be the hospital to the world, in the way that, say, New York City, LA, Philadelphia and Houston (as well as more out-of-the-way places, such as Rochester, MN, home to the Mayo Clinic) are hospital-cities to America and the world, then nobody in the U.S. could legitimately complain about how much we spend on health care as percentage of GDP. It would all be to the good. Indeed, it would be a great industry for us. Better health and a stronger economy: a win-win.

That's the American Way. That's being more like us.

1 comment:

  1. Fascinating article. Am still thinking about it & its practicality vis-a-vis the "Hill People" and their corruption. One might say 'I'm 'Rangeling' on it ;)
    If there is a way to make a buck or buy a vote the "Hill People" will be interested in the idea. But don't hold your breath. And yes, they are playing with fire when they play with our cultural soul.