Constitutionally Infirm


The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care by T.R. Reid The Penguin Press, 2009, 288pp, $25.95

This book is a very good primer on the basic aspects of universal healthcare systems in a number of countries around the world: France, Japan, Germany, the UK, Switzerland, Canada, and Taiwan. Not surprisingly, Reid finds that all of these countries have vastly superior healthcare systems than ours in that they cover everybody while spending much less on healthcare as a percentage of Gross Domestic Product. He also conclusively demonstrates why any healthcare "reform" effort that perpetuates for-profit basic health insurance, fragmented payment systems, and a lack of universal coverage (such as the one that's about to be passed in Congress), is ultimately doomed to failure. Healthcare reform needs to be universal and non-profit, or it will not be at all.

Where Reid's book falters is in its somewhat naive assumption that as long as Americans learn the facts about healthcare in other countries and accept the concept of healthcare as a basic human right, we'd be on our way to the kind of healthcare reform we need. Unfortunately, this is probably not the case. Aside from the fact that so many Americans are loathe to acknowledge the fact that anyone outside our borders has ever had a good idea, most Americans already think that everyone should have health insurance coverage when they get sick. As Reid himself notes, according to opinion polls approximately 85% of Americans hold this position. So then why don't we still have a decent healthcare system in the United States?

There are many factors, but the most important is this: in addition to having an outmoded, fragmented, for-profit health insurance system, the United States has an outmoded, fragmented, for-profit political system that is explicitly designed to militate against the kind of large-scale social reform that universal healthcare represents. Just read the Federalist Papers if you don't believe me.

Aside from the fact that the system is awash in corporate money, the anti-democratic Senate stands in the way of even mildly progressive reform, and has done so ever since the country's founding. Until we scrap, or at least radically modify, a legislative body that allows a handful of senators representing a fraction of the national population to exercise vastly disproportionate influence over the legislative process, we will have a hell of a time solving healthcare or the many other serious problems facing our country. As Reid notes, universal healthcare was furiously opposed by powerful interests in every country in which it has been established. But because most of those countries have more responsive and democratic political systems than ours, majority opinion in favor of universal healthcare ultimately prevailed. It also didn't hurt that most of them have also had a powerful socialist left, something that we've never had here in the U.S. Admittedly, Reid's book doesn't purport to analyze the defects of our political system, but an assessment of the prospects of healthcare reform that does not take into account its structural anti-reform biases is necessarily incomplete.

So the next time Joe Lieberman, Ben Nelson, or some other wizened blowhard with droopy eyelids and bad hair stands in the way of badly needed reform, remind yourself that the Constitution we all hold so dear gives them every opportunity to do so. Don't hate the playa - hate the game.

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