“Sick”

I’m very interested in Jonathan Cohn’s new book Sick: The Untold Story of America’s Health Care Crisis – and the People Who Pay the Price. This is from the NYT review:

In “Sick,” Jonathan Cohn, a senior editor at The New Republic, lucidly shows how America’s system for financing medical care helps determine who gets proper medical attention – and who doesn’t. He tells this story through the experiences of ordinary people, like Cynthia Kline, a 55-year-old teacher in Cambridge, Mass., who suffered chest pain one afternoon and knew from prior experience that she was having a heart attack. She phoned 911, and when the paramedics arrived, Kline told them to take her to Mount Auburn Hospital, a nearby facility known for its intensive cardiac care unit. But since the emergency room there was full, the paramedics sped her to another facility, even closer than the first, only to discover, as Kline herself evidently suspected, that she needed an emergency catheterization – a procedure the staff at the second hospital was not able to perform. Two and a half hours after dialing 911, Cynthia Kline was dead.

I’ll bet at least one of our readers knew Ms. Kline. This hits home everywhere.

The author has posted today on TPM Cafe, with this sadder but wiser reflection:

One of the most fascinating products of researching my new book, Sick, was also one of the most depressing: the realization that we’ve been here before.

If you go back to the late 1920s and early 1930s, you’ll find a situation that looks more than vaguely familiar. As medical care was becoming more expensive, large numbers of people were finding they literally could not afford to get sick. Many of these people weren’t indigent in the narrow sense of the word. They had homes. They had jobs. And yet when they got sick, their lives unraveled. Some went into debt to pay for it. Some rationed their own care. The result was financial misery, medical hardship, or both.

Yup. I’ve not finished it, but Paul Starr’s 1984 tome “The Social Transformation of American Medicine” demonstrates how little the problems and rhetoric of health reform have changed since the first half of the last century.

Reason for optimism from Cohn, however:

I realize that much of the media elite – and, more broadly, the entire political class – already thinks single-payer is not feasible. But we’re not yet at the point of the debate where those boundaries are fixed. This is the time when educating and organizing – both the public and the political class – can actually broaden the political playing field. By preemptively rejecting single-payer, we narrow that field.

I think the debate in the national sphere is early enough that we should think big and push single-payer as loudly and forcefully as possible. It should be said that single-payer is not the only effective way to get to universal health care; Germany, for example, has a decent multiple-payer system, with those making modest incomes heavily subsidized. But pushing for single-payer legitimizes the central role of government, which needs to be significant even in a hybrid/multiple-payer plan (such as MA’s health care law). It would also be helpful for the health plans to be forced to justify their existence. Cohn correctly encourages us to think dialectically and ask for what we actually want.

Please share widely!

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