What ails U.S. health care


The Untold Story of America's Health Care Crisis---and the People Who Pay the Price

IN MANY ways, Sick is more comprehensive than other recent and likewise excellent U.S. healthcare exposés.

Jonathan Cohn, a senior editor at The New Republic, focuses each chapter on a particular aspect of the system—the rise of Blue Cross/Blue Shield and its conversion to market principles, for example, or the shifting conditions in which retirees won—and are now fast losing—employer-based health care. Cohn also arranges the pieces into a total picture of U.S. health care that’s concise and comprehensible.

For anyone raising the questions, “Where did the current crisis come from? How can it be that the United States spends so much and people get so little?” Sick offers clear and historically grounded responses plus compelling narratives of individuals and families. Even if you’ve seen Michael Moore’s film Sicko five times and lived through multiple managed-care nightmares of your own, these are stories of struggle and suffering that will bring you to tears and to your feet.

Together, the historical and personal narratives reinforce Sick’s central argument: For-profit health care is appalling, but its actions are also “perfectly rational, entirely predictable reactions to the incentives of the marketplace,” which is why the U.S. health care crisis is “not one the private sector will, or even can, solve on its own.” More, by offering the full twentieth century history of U.S. health care, Sick shows where this crisis is headed—back to 1929, “a time when large portions of the American population were left to face the threats of illness on their own.”

What Cohn’s book doesn’t offer is a clear view of the forces behind this turning back of the clock. Downplaying the investment of Democratic politicians in free-market medicine with its powerfully organized lobby and Republican Party allies, Cohn charges ordinary people with “ambivalence” about government-administered health care, concluding that what stands between us and real reform is our own misguided individualism:

One day enough people will realize this to make universal health care a reality. The only question is how many more must learn it firsthand—and suffer the consequences—before that happens.

This construction of a recalcitrant public also prompts Cohn to water down expectations for what universal health care means, echoing the assertions of last spring’s Democratic presidential hopefuls that “private insurance has a place.” Yet Cohn rightly stresses in his final chapter that, despite the Reagan revolution’s sowing of public skepticism toward government, “times change and public moods shift”:

Politicians now get more mileage from bashing an HMO than they do from ranting about welfare queens as Ronald Reagan often did. Middle-class families with kids may not like seeing the government take taxes out of their paychecks, but if you sit at their dinner tables, you’re more likely to hear them complain about a pharmaceutical company charging their grandparents thousands of dollars for life-preserving medication. In fact, criticism of the drug industry—and big business more generally—was a key factor in the Democratic Party’s landslide win of 2006.

Although Sick doesn’t tell us what’s needed to mobilize this public mood into a movement that can impose its will on Wall Street and Washington, it can arm activists with more facts, arguments, and anger for our side.

Issue #90

july 2013

Will the revolution be tweeted?

Mass struggles in an age of social media
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