I just finished reading Sick: The Untold Story of America’s Health Care Crisis—and the People Who Pay the Price,  Jonathan Cohn’s surprisingly balanced book about America’s health care system.  Unfortunately for Cohn I think a lot of people will confuse his book with Michael Moore’s unbalanced film Sicko, so they probably won’t bother to read it despite the painfully long sub-title that seems to be symptomatic of all non-fiction books published these days.

When I say that the book is surprisingly balanced it’s because I kind of expected it to be a screed against the evil insurance companies, pharmaceutical companies and hospitals, but in reality it provides a nice historical perspective on the development of the modern US health care industry and uses half a dozen anecdotal cases to signify how real people are affected by the system.  Where I think Cohn earns his stripes is in not laying the blame for the current health care situation at any one group’s feet, but rather pointing out how the actions of the various players (insurance companies, HMOs, government, hospitals, pharmaceutical companies) are logical given the climate in which they exist. 

Not that Cohn doesn’t have an opinion.  He thinks that the fundamental flaw with the US health care system is that it doesn’t treat health as a function of the common good.  He’s very much in favor of some form of universal health care, and he seems to favor France’s model over Canada’s, the UK’s or other industrialized nations, but he doesn’t prescribe specific plans.  Rather he points out that even though we spend 16% of our resources on health care we put too much of a burden on the poor and middle class.  He says other industrialized nations spend less and provide more coverage for all of their citizens.

Throughout the book Cohn explores both sides of the health care debate as described as universal vs. non-universal health coverage.  He acknowledges some of the free market arguments, but de-bunks many of the sound-bite arguments you hear from the non-universal crowd: long lines in Canada, lack of resources in the UK, sub-standard care.  Just as an example he points out that the UK’s problem isn’t universal care but the fact that they are trying to have universal care on the cheap.  Ends up they spend just 7% of their resources on health care.

Cohn also spends some time explaining why efforts by health care reformists have failed to get universal health care passed in the US.  Of course he focuses on Hillary Clinton’s failed efforts in the early 90s, but he also looks at earlier developments under FDR, JFK and LBJ.  In fact the story of how Medicare and Medicaid came into being is absolutely fascinating if for no other reason than to show that our current crop of politicians aren’t much different from 40 years ago. 

By the way, Cohn thinks that if things keep going the way they have been lately then health care reformers have a better shot in the near future than they’ve had in at least a generation.  Without getting too much into the details lets just say that in ’92 the average person still had adequate health coverage through their employers, but now that many middle class Americans are paying a very hefty price for their coverage AND can easily imagine themselves being devastated by a serious illness they are much more likely to support politicians who promise to take that very fundamental worry away.

There’s a lot for people to argue about in the book, but that’s what makes it a worthwhile read.  Heck, the guy provides literally dozens of pages of citations and notes at the end so you can’t say he hasn’t done his homework.   And for those who might wonder what I think it’s that I agree that we need some form of universal health care.  It fascinates me that as a society we seem to have no problem with the concept of paying taxes to fund our armed forces, our police and firefighters and our roads, but somehow it’s a problem to pay taxes to secure a basic level of health care for every citizen.  I also don’t think the system has to be 100% government administered, it can be some sort of public-private hybrid, but I do think that if we are going to continue to be the most prosperous nation in the world then we’ll need to make this change.

And here’s my own anecdotal evidence that there’s serious need for change: I have a relative who shall remain unnamed that is anything but poor or needy yet after retiring from her "career job" faced health care expenses so high that she took a retail job that paid minimum wage in order to secure health care benefits until she turned 65 and when she turned 65 she had a Medicare party. I’m told that Medicare parties are very common in her circle of friends.  So if government-provided health care is such a nightmare why are these middle and upper-middle class folks so happy to get it?