February 21, 2007

Why Are We Sick?
Sound & Vision, Michael Corcoran, Emerson College, Feb. 21, 2007

A new book reports on healthcare from the frontlines.

By Michael Corcoran, Emerson College

The number of Americans who currently do not have health insurance, now more than 46 million, is so staggeringly high that there is a tendency to focus on what it means to society rather than the individual. With all the talk of cost controls and managed care, it is easy to forget how our broken health insurance affects the care that millions of Americans receive—or don’t—every day.

Jonathan Cohn, however, makes no such mistake. His new book, Sick: The Untold Story of America`s Health Care Crisis—and the People Who Pay the Price, is not merely about policy, but about people. This work of non-fiction is the byproduct of five years of first-hand reporting, and it brings moving stories to light.

In the introduction to Sick the reader learns the story of Cynthia Kline, a 55-year-old woman who had a heart attack in her home in Cambridge, Mass. Kline maintained enough awareness to ask to be taken to nearby Mount Auburn Hospital, which is well known for world-class cardiac care. But the hospital was over-crowded, a fairly typical problem in America, and the ambulance was redirected to Cambridge Hospital instead.

If a back-and-forth between policy wonks, or the (often empty) rhetoric from a legislator does not move the average American, the haunting cries of Ms. Kline, who yells “I’m going to die, I’m going to die,” as she rides in the ambulance, surely will.

Ms. Kline’s prediction, sadly, turned out to be true. She passed away soon after arriving at the hospital. That Mt. Auburn Hospital would have been able to perform “cardiac catherization” and perhaps save her life—something Cambridge Hospital was not able to do—is sure to enrage readers and rightfully so.

Kline’s story is not unique; it happens all over the country. Other first-hand accounts of Americans from Los Angeles to Gilbertsville, New York, show, in painful detail, the dysfunction of our system and the nearly impossible hurdles many face in trying to find adequate health care. And these problems, as Cohn illustrates, are not just the concern of those without insurance.

For example, another of the book’s subjects is Russ Doren who as a public school teacher for many years had health insurance for him and his family. But when his wife, Gina, a longtime sufferer of depression and personality disorders as a result of sexual abuse as a child, required long-term impatient care, his life started to unravel. Their coverage only paid for a portion of in-patient care for mental illness for only 45 days per year. Paying for the remained of the coverage put the family into massive debt.

In one of her many suicide attempts—one of which would eventually prove fatal—Gina, clearly feeling guilt for the financial strain placed on her family, included a note that said “No more debt.”

These stories are interspersed in Sick with a fairly nuanced history of health care in the United States, leaving the reader with not only a sense of anger at the plight of the book’s subjects, but also with a good understanding of the origins of our failed system.

One element that Cohn could have addressed more pointedly is some of the lingering questions on “hybrid solutions,” such as the plan passed last year in Massachusetts that decreased the numbers of uninsured by requiring more employers to pay for health insurance. Moreover, while Cohn is justly critical of President Bush’s health care record, he could have done a better job of pointing out how much money Democrats also receive from private insurers and the pharmaceutical industry. At one point he writes, “But the Democrats didn’t win in November. George W. Bush did.” Such a statement gives the oversimplified impression that health care can be dramatically improved simply by electing a new president. If only it were that simple.

Still, Cohn’s suggestions for implementing universal health care, which are laid out in the book’s conclusion, are unambiguously and impressively bold. He has high praise for Medicare calling it “remarkably efficient.” Moreover, he speaks glowingly about many foreign governments’ health care systems. He has high praise for France’s system (where all legal residents have insurance and the government subsidizes around 75 percent of all heath care costs), which he says may be “the best showcase for what universal health care can achieve.” He also defends Canada’s single-payer system and says stories of long lines in Canadian hospitals are “wildly exaggerated.”

Moreover he sharply criticized Health Saving Accounts, which were first established in 2003 as part of a Medicare bill. The idea behind these accounts, which conservatives often push to expand, is to have taxpayers donate money to a tax-free account, not unlike the Social Security Individual Retirement Accounts President Bush pushed for in 2005, which they can then use to purchase health care. Cohn calls the logic behind these plans “dangerously naïve” and argues that these types of accounts, championed by the right as “consumer driven health care,” will only work for people who are already healthy and will therefore not face enormous premiums. The people who most need healthcare—the sick—will benefit the least.

In short, while Cohn is open to varied solutions in reforming health care, he is unafraid to widen the parameters of the debate to include drastic overhauls of the current system—and Sick, above all, is a passionate and persuasive plea for just that.

The timing of the release of the book is fitting, as health care has become central in policy discussion. Seventy-eight Congressional representatives have cosponsored a bill that would expand Medicare to cover all Americans.

“Universal Health care is really about finding collective strengths for our individual vulnerabilities—about helping a family member, a neighbor, or a fellow citizen,” Cohn writes. “One day people will realize this and make universal health care a reality.” It is up to us to make sure that day comes soon.

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