Jonathan Cohn, senior editor at The New Republic, has released a book entitled Sick: The Untold Story of America’s Health Care Crisis — and the People Who Pay the Price (Newsweek article, reviews: NYT). I plan to read the book when it's out, but I thought it worthy of a brief mention partly due to its content and partly due to the characterization of its content in the media. From the NYT review:
The timing of this book is perfect. An epidemic of anxiety over the cost of health care has catapulted reform back onto the national agenda, and states from California to Massachusetts are now experimenting with universal coverage. It also promises to be a key issue in the 2008 election.
The reviewer, Sally Satel, is the author of several books that should make her own personal beliefs rather clear. Cohn, on the other hand, is a somewhat less-than-outspoken proponent of universal health care. I found the following passage in Satel's review somewhat surprising:
“Sick” does not offer a prescription for our ailing health care system, but it does include a closing chapter on what to do. Here the argument turns tendentious....[Cohn] sweepingly denounces “the principles of modern conservatism” for being “conspicuously short on ... comfort or hope.” In truth, there is nothing inherently pessimistic in choice, self-reliance or limited bureaucracy — the values that underlie a market-based proposal like the one introduced by Senator Ron Wyden, an Oregon Democrat. (Wyden’s proposal also offers subsidies for the unemployed.)
Tendentious? Really? Tendentious arguments are generally characterized by an unreasonable refusal to acknowledge that the bulk of evidence is not one's favor or that evidence that would tend to mitigate against one's conclusions exists, but in his April 1 NYT Magazine article, he acknowledges that "the data on medical outcomes are notoriously uneven and hard to interpret." He also describes, without rancor, Senator Wyden's proposal in reasonable detail given the venue. Given the date of his article, perhaps he was just playing an April Fools prank.
Satel also goes out of her way to characterize the content of his book in a manner with which I doubt Cohn would agree. For example, she minimizes the indictment of the health insurance industry:
By the end of Cohn’s narrative we’ve run the gamut of woes: the hopeless fragmentation of the mental heath system; staggering medical debt; the dependence on job-based insurance; frayed social safety nets; lousy (or no) guarantees of preventive care; selective access to medications. Lack of insurance is a meaningful problem, too, especially for the mentally ill. But since 80 percent of all emergency room visits in 2004 were made by people who had at least some form of coverage, the problem can’t be pinned solely on insurance.
The hand-picked subjects in “Sick” don’t reflect the full range of causes for so much poor health in this country, many of them rooted in inertia: not watching one’s diet or exercising, drinking to excess, smoking. Cohn’s victims are in almost every instance hardworking, conscientious people blocked at every turn by a dysfunctional system.
Note the approach. First, despite the fact that at least two of the "woes" mentioned in the first paragraph (i.e. "lousy...guarantees of preventive care" and "selective access to medications") can be directly attributed to health insurance, the fact that "80 percent of all emergency room visits in 2004 were made by people who had at least some form of coverage" somehow exonerates the insurance industry to a degree. Next, Satel characterizes the subjects of "Sick" as "hand-picked" and not representative of the "full range of causes for so much poor health." The implication is that people failing to take responsibility for their health is by far the larger problem.
"Self-reliance" is a hot topic for Satel. She wrote One Nation Under Therapy: How the Helping Culture is Eroding Self-Reliance (summary, reviews: Jack Trotter, Psychiatry Online) in 2005. Given her dim view of Cohn's stance on universal health care as expressed in the final chapter of his book, why does she praise the remaining content? At this point, those in favor of market-based reforms and those in favor of single-payer proposals would agree that there's something wrong with the American health care system; for them, the only remaining issue is how things should change. Books like "Sick" effectively raise all ships equally; they make the case for change, no matter the content of that case, readily accessible to everyone on the fence.
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