In his new book The Healing of America, the journalist T.R. Reid employs a clever device for surveying the world's health systems: He takes an old shoulder injury to doctors in various countries. In the United States, a top orthopedist recommends a major joint-replacement operation, costing tens of thousands of dollars. In France and Germany, general practitioners offer him the same surgical option, at little or no cost, but steer him instead toward a regimen of physical therapy. In Britain, the doctor is unimpressed with his injury and tells him to go home. In Canada, he is offered a place in line, where he will wait a year just to consult a specialist. In India, he is sent to an ayurvedic clinic, where he is treated, quite effectively, with herbs, massage, and meditation.
America's system has become wildly unfair and expensive. In fixing it, Reid says, we should follow other countries where health care is fairer, cheaper, and produces better results. He's right that we can learn much from practices elsewhere—why, for instance, can't we have those nifty smart cards the French use instead of paper records? But the lesson I took away from Reid's book was somewhat different: Health care systems are not just policy choices but expressions of national character and values. The alternatives he describes work better than ours not just because they're well-designed and competently managed but because they reflect the expectations and traditions of their societies.
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