How Do We Cure a Sick Health Care System?

Every day, millions of hard-working people struggle to find affordable medical treatment for themselves and their families -- unable to pay for prescription drugs and regular check-ups, let alone for hospital visits. Some of these people end up losing money. Others end up losing their health or even their lives.

The United States is the only country in the developed world that does not guarantee access to medical care as a right of citizenship. As outrageous as that fact is, why is it so? What does it mean in the lives of individual Americans and their families? And what can we do about it?

Like Michael Moore's critically and commercially successful documentary, SiCKO, Jonathan Cohn's new book, SICK probes the larger problems by focusing on the stories of individuals -- most of them working members of the middle class -- who are cruelly let down by our failing system.

Jonathan Cohn is a senior editor at The New Republic, where he has been since 1997. Prior to that, Jonathan worked for six years at The American Prospect, where he remains a contributing editor. A senior fellow at Demos, Cohn has also written for many other publications, and is the author of SICK: The Untold Story Of America's Health Care Crisis -- And The People Who Pay The Price.

Terrence McNally: How did you grow to focus as much as you do on health care?

Jonathan Cohn: It happened a little bit by accident. In the 1990s, I was working at The New Republic both as an editor and a writer, and picked up some stories about health care here and there along the way. This was in the years not that long after the fight over the Clinton health care plan. People in Washington really didn't want to talk very much about health care, and the country wasn't in the mood for another big health care debate. As I started learning about the issue, it quickly became apparent that all the problems that had led to that earlier debate hadn't gone away. In fact, they were getting steadily worse. As I read more about the history of health care in this country, I learned that we keep coming back to this debate every 10 to 20 years.

In Washington we talk about numbers, and we have lots of jargon to refer to this policy and that policy -- "the crowd-out effect" and "reimbursement levels." That's all well and good, but for too long not enough people have cared enough about health care politics to actually make a change. I set out to write a book that could build a bridge between the world of policy and the world of everyday lives.

TM: You said there haven't been enough people caring enough to fix health care. To me, that's similar to the War on Drugs. I believe many people agree that drug prohibition doesn't work, but changing it isn't one of their top priorities. On the other side, however, there's a moneyed interest group -- the correctional unions and the corrections industry -- for whom the status quo is issue number one. In health care, you have a diffuse bunch of people who know something's wrong versus a single minded and well-financed group for whom preserving the status quo is their number one priority -- so far, in both cases, that's a losing battle.

JC: I'm hardly an expert on the drug war, so it would be wrong of me to really weigh in on that. But I think your description of the way the fight over health care has played out in this country is very true.

If you look over the history going back to the 1920s, which is really when our insurance system comes into existence, the roster of people opposed to change has evolved slightly. In general, some constellation of the insurance industry, drug industry, hospitals and doctors move in and out of the list, depending on what period you're talking about and what particular issue.

People who are making a lot of money off the way we provide health care now don't want to change the system, and the number of Americans who find this situation a personal threat to their livelihoods and to their lives has not been large enough to overcome that.