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What VM Staffers are Reading This Week

From time to time on the blog we plan to highlight a new feature: short summaries of the books VM staff writers are reading and thinking about. This week Peter Blair (@PeterBlairAI), who covers health care and religion, talks about Affordable Excellence and Mother Country. 

Affordable Excellence: The Singapore Health Care Story, published in April of this year by Brookings Press, is the first book-length study of the Singaporean health care system, which has long been notable for its low costs and quality health outcomes. Even though the country’s system contains many elements mainstream American conservatives would definitely reject, parts of Singaporean health care have become increasingly popular on the right as a model of what health reform could look like. As we noted on the blog yesterday, decontextualized statistics can’t always give you a full picture of any given health system, so it was helpful to get a more in-depth treatment here. The author, William Haseltine, covers the payment mechanisms, the service delivery structure, and the way doctors are trained, among other things. There are many reasons why policies that seemed to be working well in Singapore—for the book indeed confirms they are working reasonably well—couldn’t be directly transferred to other countries, America definitely included. But Affordable Excellence is worth reading to get a sense of what a coherent, worked-out, consumer-oriented health care system can achieve.

Mother Country: Britain, The Welfare State, and Nuclear Pollution was the first non-fiction book published by Marilynne Robinson, a novelist, critic, and public intellectual. Robinson won the Pulitzer Prize for her (highly recommended) novel Gilead, which President Obama cites as one of his favorite books. I became interested in her for her serious and attractive approach to Christian faith, which has often won over skeptics to a fresh understanding of what Christianity is. She has made her name by beautifully arguing against the received wisdom on everything from Calvinism to the philosophy of mind, and Mother Country is no exception.

It examines British and American political thought, and the relationship between them, through the lens of Sellafield, a large nuclear waste disposal plant in England. Her book is divided into two parts. The first is a highly critical discussion of the history and roots of British social thought from the 14th century up through the Poor Laws to the time at which she wrote the book (1989). The second is a denunciation of the policies surrounding Sellafield—she argues the plant is poisoning the planet and elevating the cancer rates in the area— and she traces the British tolerance for Sellafield to the poor quality of the social thought articulated in the first half. Her study quickly takes her out into deeper waters, including a truly fascinating re-interpretation of Karl Marx and Adam Smith. There’s a lot to disagree with in this book— her attacks on England, for example, may seem intemperate at times, and some of the scientific data she was working with on the nuclear plant has been called into question— but it nevertheless amply repays reading.

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  • Andrew Allison

    “There are many reasons why policies that seemed to be working well in Singapore — for the book indeed confirms they are working reasonably well — couldn’t be directly transferred to other countries, America definitely included.” Such as?

    • ljgude

      Well I can’t answer that in terms of Singapore, but I can talk about how things work in Australia which is a Texas mile closer culturally to the US than Singapore. Everyone pays a Medicare levy and everybody is covered. Get run over and you will get the best Australia can do for you. It happened to a teenage girl on my doorstep. Those of who were there literally threw the car off her. It flew. She was having convulsions. The Ambulance came and went. Never heard what happened to her. But I know this: her treatment was not dependent on her parents insurance plan. No one spent one moment worrying about the bill. The downside is that that same public system has waiting lists for getting things like a pacemaker or a kidney stone removed. But there is a private insurance system and private hospitals. I’m 71. I pay a lot – $2000 a year. (Horrifying no?) I’m getting a pacemaker for my AF after two ablations that didn’t stop the irregular heartbeat – the day after tomorrow. Waiting time 8 days. There is a crushing co-pay of course. $25. That’s twenty five dollars and no cents exactly like when I write my check to the IRS. The private system takes the pressure off the public system. In the US that girl would get the car thrown off her by Americans too, and the treatment she would get might vary a bit more, but it would be the best too. The difference is who would pay and how it would be paid for. If the girl was indigent then she and her family would not be paying but the public hospital would be recovering it costs in a system that is much more complex and inefficient than in Australia. Again see the Time article Bitter Pill. The difference is that in Australia the public and private system complement each other. If the private system gets too expensive people drop their private insurance and rely on the public system. If the public system gets overloaded, people take out private insurance. Our insurance companies work hard to keep the private system within reach. The public system works hard to give its patients what they need. It ain’t perfect by a long shot, but it works. Australia spends $3800 per capita on healthcare, Switzerland, $5643 and the US $8508. Us Roos are doin’ just fine down here.

      • Andrew Allison

        This can’t be right. Everybody knows that single-payer systems provide lousy service and are going broke [grin]. Thanks for the detailed description of one such, which nicely illustrates what’s wrong here, namely that despite almost two-and-half times the per capita expenditure, decent healthcare is, in effect, accessible only to those with private insurance or Medicare/Medicaid.

        • ljgude

          I’ve spent two long nights in australian big hospital emergency rooms and there was plenty dramatic things going on. There was a mix of young staff and older staff that coped marvelously. My first emergency visit was as good as I could ask for and they got my AF under control very effectively and I saw really competent doctors who settled things down quickly. I had top doctors continuously since I took out insurance and the treatment has been excellent. It has been easy to negotiate treatment questions and the whole process has been very professional. Much like what I saw a cousin receive at the Mayo Clinic in Phoenix.

  • lukelea

    What, no serious literature? Me, I just reread the Jill and Skeeter chapters in Rabbit Redux. Those have got to be two of the most powerfully realized characters since Shakespeare.

  • wigwag

    With all due respect, if that’s the reading list the Via Meadia staffers need to get out more.

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