Ezekiel J. Emanuel
Public Affairs
New York
2020
452 pages
According to the Art:
The book is a compendium of health care system features common among eleven, high-income countries, which become the basis for comparing and judging them. While the analyses produced serve public health policy officials and educators best, they also provide insights into how health care policies, practices, cultures, and histories of countries can affect illness experiences.
Synopsis:
The author, Ezekiel J. Emanuel, says his book title “is a terrible question,” (p. 1) because “it is not possible to select the best health care system overall.” However, he continues, “it is possible and reasonable to make judgments about better and worse systems,” (p. 351) such as considering “which country has the best consumer choice,…the most innovative health care system,…or best addresses the needs of chronically ill patients.” (p. 7) And, that’s what he does.
Emanuel and his research partners compare eleven, high-income countries: United States, Canada, United Kingdom, Netherlands, Norway, France, Switzerland, Canada, Australia, Taiwan, and China. They examine eight content areas: history; coverage; financing; payment; the delivery of care; prescription drug regulation; human resources; and future challenges. These content areas serve as the subject headings for the chapters covering each country. In the penultimate chapter, “Who’s the Best?,” Emanuel assesses and judges each content area across countries. (Spoiler alert: the United States does not fare well.) The concluding chapter is built around “six lessons for improving the US health care system,” (p. 385) followed by a coda where Emanuel considers how his findings relate to the coronavirus pandemic.
Analysis:
The chapters describing the eleven countries’ health care systems comprise the bulk of the book. Each of these chapters focuses on the eight pre-selected content areas, giving the book a compendial feel and serving health care policy wonks and students well. The chapter summarizing overall findings and the concluding chapter serve readers less interested in details, especially with the tables provided.
Emanuel, a leading advocate for improving health care in the United States, and a leading figure in the largest expansion of health care access in decades with passage of the Affordable Care Act in 2010, is accustomed to the form arguments about health care systems take. He once disdained making country comparisons because the history and institutions within an individual country “shape how the system operates and constrains what reforms can be instituted,” (p. 2) giving comparisons little value (a problem Emanuel references as “path dependence”). But he eventually came upon the realization that “thinking about other health care systems can be extremely valuable.” (p. 5) As has been his practice with previous investigations, Emanuel and his researchers were on the ground in each of the countries studied. They reviewed research reports to supplement their empiric findings.
Any critique of the book would seem better placed in a medium covering health policy rather than one covering the Humanities as they capture what happens to people while ill. The pathophysiological aspects of health problems are not the only contributing factors determining how illness affects people; health systems contribute independent factors as well. Some of these factors include health care access, technology, competency, efficiency, and costs. As the Humanities contemplate what humans go through when ill, health care configurations can contribute to accounts of illness. This book informs how those configurations can be considered generally, and as they concern the countries studied specifically.
Also:
A version of this review is posted at the NYU Literature, Arts and Medicine Database.
