Billing/Book Report

Jonathan Cohn’s “Sick presents case studies that demonstrate how America's current system causes even many middle class Americans serious financial or medical hardship. It lays out a history of health insurance in America and points to the record of systems abroad, particularly in France, as proof that universal coverage works.

Cohn quickly dispenses with the common belief that it is the forty-plus million uninsured Americans who are the problem with our present system. It is our insurance itself that forms the biggest problem, an erratic problem that fails to provide needed health.

Cohn methodically discusses each piece of the book one by one, using case histories to illustrate his points. He meet a few people with no insurance at all, a few with Medicare or Medicaid, and a few with good private policies. All are hard-working, well-intentioned, and startled that they have been punished, financially, emotionally, medically, or all three, for getting sick.

What sets Cohn’s book apart from other compilations of sad stories is the comprehensive, dispassionate analysis he offers of the policy behind the tragedies. He provides a history of U.S. health insurance from the beginning up through the politicking behind Medicare and Medicaid in the 1960s, the rise and fall of health maintenance organizations (HMOs) in the 1990s, and the confused debut of last year’s Medicare Part D (for prescription drugs). I suspect that committed policy wonks might find his analysis fairly basic, but for those of us without formal background in the area, it is a pleasure to have the whole drama laid out, act by act.

Cohn seeks to tie together all of these troubling stories and histories in order to make a case for publicly funded, universal health care. His proposed solution resembles the French system, which (unlike, for instance, Britain’s entirely state-run apparatus) maintains key elements of private insurance under an umbrella of government regulations and subsidies. Though far from perfect, Cohn argues that the system would be “fairer, more equitable, and simply less painful” than what American health care has become, especially for the poor and the chronically ill.

Cohn does not take such modest, piecemeal reform seriously. He considers it little more than a political diversion, promoted by conservatives who consider universal health care “an imposition on liberty that weakens individual initiative.” Here his ideology gets the better of him. The chief objection to universal health care for the U.S. is not that it would defy some abstract principle of liberty, but that it would be both economically ruined and culturally unsustainable. There are more practical ways to improve American health care.