T.R. Reid’s call for universal coverage in the United States has received considerable praise from Senator Kent Conrad. I wish Senator Conrad had read Shannon Brownlee’s review of Reid’s book in the Washington Monthly, a favorite magazine of liberal wonks. Having read the book this summer, I’m inclined to agree with Brownlee’s basic assessment.
A distinguished and highly accomplished foreign correspondent, Reid appears not to know what he doesn’t know about the scientific and economic complexity of health care. He also gets his medical facts wrong, stating there are “millions of deaths each year” in the developing world from smallpox (smallpox was eradicated from the planet more than thirty years ago), that polio is a “bone-twisting” disease (it destroys nerves and can lead to muscle wasting), and that the U.K.’s National Health Service won’t give him a prostate-specific antigen, or PSA, test, because it’s not cost-effective (the NHS, in fact, does pay for PSA testing, but doctors in the U.K. don’t encourage it, having figured out long before we did that the test hasn’t been shown to reduce mortality, while leading to unnecessary and potentially harmful surgery). Health care reform is going to take a lot more than cutting the insurance industry’s overhead and slashing the prices of medical services. It’s also going to require profound and sustained changes in the way care is delivered. But you wouldn’t know any of that from reading The Healing of America.
The need for delivery system reform is a lesson that health reform proponents haven’t fully taken in — they seem convinced that Massachusetts will now “solve” the problem due to rising political pressure in the wake of coverage expansion and spiraling costs, which is a bit like assuming a can opener.