Today, the US healthcare system occupies a place very like US beer did in the 1990s.
See back then, US beer was a joke to liberals, or anyone that took beer seriously, and a point of patriotic pride to conservatives.
These days, after decades of shifting regulations that allowed the market for craft beer to first find a foothold, then blossom, US craft beer is world-renowned. Numerous pubs in other countries proclaim they serve "American-style craft beer." People across the political spectrum can take pride in their local brewers, no snobbery or jingoism required.
Our healthcare system has not experienced anything close to that kind of renaissance. Conservatives refuse to countenance any critique of the system, while liberals use it as a tired punching bag. We're warned of the dangers of "socialist medicine," all the while my mother-in-law is constantly harassed about a $4,000 bill she doesn't owe (the hospital filed it wrong with her insurance), doctors and nurses are overworked, and millions go without any sort of insurance.
And, frankly, Medicare for All sounds great, but it scares the bejeezus out of anyone to the right of Bernie Sanders. Not to mention it's sort of vague on details, and seems to require a rather large leap to get from here to there.
So I was primed for a retread of the old arguments in Which Country Has the World's Best Healthcare?. US healthcare is terrible, Canada's is great, etc etc.
Thankfully, that's not what I got at all. Instead, I found the missing manual, a way to evaluate different healthcare systems around the globe. Along with a proper sense of the history and workings of eleven of them.
Emanuel describes a set of axes along which to measure a healthcare system. Things like patient wait times, or costs at the point of service, or choice of doctors. Then he proceeds to examine each country's system in turn, looking at the things it does well, the challenges it faces, and -- most importantly -- how and why it does those things well or badly.
True, the US performs terribly on basically every axis. That's not news. What is news is that multiple countries manage to provide better coverage, better care, and cheaper care, without giving up private practices, or even -- in some cases -- letting go of private insurance!
Reading this, I felt both relieved and angry.
Relieved, because with so many different systems out there, no one's got a monopoly on the "right" way to do things.
Angry, because for so long the debate in the US has been framed as single payer or status quo. When the truth is that we can do a lot to improve our system without letting go of the basic free market nature of it.
How much further would we liberals have gotten, if we'd argued for a regulation of drug prices, instead of single-payer? Or insisted that insurance coverage for children be provided for free, as part of any policy, like it is in other countries with well-regulated markets?
We don't have to have the government take over as the single payer for everyone. We don't need to radically overhaul the system. We need to properly regulate it, to get the outcomes we want: patients being able to choose their doctor, use their insurance to help pay for their care, and not go broke obtaining the prescriptions they need.
Framed as the proper regulation of a free market, what could the conservative response have been? I suppose they could argue that Greed is Good, and everyone that has to choose between paying the rent and buying their blood pressure meds deserves it, so the CEO of some corp can enjoy a multi-million dollar bonus.
But that doesn't have quite the same ring as "death panels," does it?
So ultimately, I'm grateful that Emanuel and his team chose to write this book, and publish it now. It's high time we brought a more nuanced, useful debate, to the argument over healthcare.