Pale Wire (Popscene)

Tuesday, November 01, 2005


I spent most of my Monday furrowing through Donald Barlett and James Steele's 2004 book Critical Condition.

Like most of their other work (including last week's Time magazine cover story) it's as much polemic as journalism. And, like most of their other work, it lands like a kick in the pants.

The nut: America's health care system is broken. Why? Because competition doesn't work in medicine. We banked on the free market, and the free market let us down.

After opening with a stark series of statistics that lay out America's huge investments (world no. 1 in per-person expense) and mediocre results (middle-of-the-pack life expectancy and infant mortality rates, more than 40 million with absolutely no insurance while millions more go "underinsured" compared to full coverage in other countries), B&S document a raft of personal tragedies and a mountain of examples of corporate corruption they then place at the feet of a system they argue is driven by a misguided, manic belief that the logic of Wall Street can solve any problem.

This stuff should sound familiar. We hear about it a lot in the media. But there's a lot to learn here about the intricacies of the system, how it measures up against the performance of other systems, and how it came to be in the first place. You get a hard-edged analysis of the political rhetoric out there and a lot more than the usual talking points.

I found the intellectual history of privatized medicine to be especially fascinating. B&S trace the idea back to an associate of Defense Secretary Robert McNamara and make an interesting ideological connection between the cold, number-crunching actuarial approach to war embodied by McNamara and Vietnam-era realpolitik and the ethos of privatized health policy.

In the end, B&S advocate the creation of a Federal Reserve-like board charged with leading a single-payer health care system for all citizens. And they make a compelling case. Even if you disagree with their recommendations, or decline to share their optimistic attitude toward government solutions, they make it hard to argue that things should stay the way they are. As they paint it, it's difficult to imagine a government system more bloated, confusing, and unfair than the one we've already got.

It's a great book, but it suffers mightily from repetition. After you've established that the system is fundamentally flawed, it's unnecessary to use the words "shocked" and "stunned" as often as they do. If the thing is busted, you shouldn't be surprised when it acts dysfunctional. And, as effective as the tactic is, it doesn't take long before you can see the horrific anecdotes coming a block away. As soon as the latest middle-class mom, blue-collar stiff, or quiet widow takes their first step out on the page, you're already waiting for the anvil to drop.