You'd have to be living under a rock to be unaware of the debate that's currently going on about health insurance in America. In fact, debate may be too generous a term for it, as the discussion has gotten downright vitriolic and full of scare tactics.

For those who are interested in health policy and in how other countries have handled these issues, I highly recommend T. R. Reid's new book, The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care. 

In a search for both a solution on a personal level and insights about other nations' health care systems, Mr. Reid takes his chronically aching shoulder to doctors around the world. He describes the varied recommendations he is given for his own healing and he talks with physicians and patients about what it is like to work and receive care in a variety of systems. He also discusses the history of the various systems and how they came to be. Contrary to what you might expect of a book about health care policy, it's a fascinating read. I couldn't put it down. 

There are two central themes in this book, both of which are crucially important as we look at reforming the US system, and neither of which is getting the attention that it deserves.

The first question that we must answer is this: Do we, as a nation, believe that some basic level of health care is a right to which everyone should have access? If the answer to that question is no, then we can stop right there. If it's okay with us that people die for lack of access to basic medical care, and if it's okay with us that people go bankrupt because of medical bills, then our system is fine just as it is. 

We must take our heads out of the sand: any of us may be one layoff away from being uninsured and uninsurable, and so any of us (except the very wealthy) are potentially at risk of medical bankruptcy under our present system.

The second theme in Mr. Reid's book, and the one which I've not seen discussed elsewhere, is the idea that our national cultural "personality" and values need to be a part of the conversation as we design our health care system. 

For example, equality is important to Canadians; economist Uwe Reinhardt is quoted in the book as saying, "Canadians don't mind the waiting list so much, so long as the rich Canadian and the poor Canadian have to wait about the same amount of time." 

The archetypal British "stiff upper lip" is reflected in the advice a British doctor gives to Mr. Reid about his aching shoulder: "You are living your normal life without much impairment. So [shoulder replacement surgery is] not indicated."

And contrary to the what the "socialized medicine" scare-mongers would have you believe, the capitalist ethic thrives within many of these systems. The difference, relative to the US system, is generally that the system which delivers a basic level of care to everyone is a non-profit enterprise.

These may or may not be some of the values that we think are most important for our system, but without conscious attention to these questions we will almost certainly not get what we want. It may very well be that none of these systems are exactly right for the personality and values of our American culture, but right now values are not even part of the conversation. We can't design a system that meets our needs until we've clearly expressed what those needs are.

What values do you think our health care system should reflect? You can share your comments here, and I'd also encourage you to share them with your friends and family and your Senators and Representatives.

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