Not surprisingly, given everything we've been hearing lately, the American health system came out poorly compared to those of much of the rest of the industrialized world. In 2006, the average life expectancy of a child born in the US was 77.85 years, which, according to data collected by the Central Intelligence Agency, was 47th in the world, lower even than that of much poorer countries such as Bosnia and Jordan. By comparison, a child born in Japan, which was ranked at 1st place, could expect to live 3 years and five months longer than his American counterpart, to the age of 81.25 years. The United States ranked 22nd in infant mortality in 2005, with 6.8 deaths in the first year of life for every 1000 live births, which is more than double that of Japan (2.8/1000). These discrepancies do not stem from a lack of spending. According to the OECD, health expenditures in the US in 2005 accounted for 15.3% of GDP, compared with 11.1% in France, 10.7% in Germany, 9.8% in Canada, 8.3% in the UK, and 8% in Japan, all of whom, incidentally, provide universal health coverage to their citizens.
How, then, do other societies manage to provide health care to all their citizens while spending less and achieving better outcomes? They do this in many different ways. One way of limiting costs is to restrict access to specialists and make people wait months to see a specialist. Reid cites a study by two American researchers, Bodenheimer and Grumbach, who found that 38% of Britons in need of elective surgery had to wait more than 4 months for their procedure. Another way of reducing costs is simply by limiting which procedures and treatments can be performed and given. The former British health minister, John Reid, is quoted as saying that "we cover everybody, but not everything". The author himself came up against this when he was bluntly told by his British GP that the National Health Service (NHS) would not pay for the total shoulder arthroplasty which he had been advised to undergo by his American orthopedist (and which would have cost approximately $40000 in the US). After consulting with an orthopedist in Japan, he was told that he could have the same operation in Japan for about $10000, or a quarter of the cost in the US. This brings us to another way in which expenses are kept down in other countries: by tightly regulating and controlling what physicians get paid, their income winds up being significantly less than that of their American counterparts. While some of this is offset by significantly lower malpractice insurance premiums and education debt (the latter often entirely absent), many of the non-American physicians he interviewed indicated they felt they were struggling financially. One German physician told Reid that she had to supplement her income as a family physician by installing a treadmill in her office and charging patients $15 for each half hour of use. When Reid asked one of the two physician owners of a small 19 bed hospital in a suburb of Tokyo why they charge their patients $4/hour to park in the 10 space parking lot when they could just as easily park a block away for free, the response was "That's no laughing matter. We sometimes make $100 in a day from that parking lot. And doctors in Japan don't make much money, so we have to figure out how to take in every yen we can get". Incidentally, Japan's total spending on health was 3.16% less in 2006 than in 2005.

Preventative care is a core tenet of most of the other systems, and it turns out to be a win-win proposition for everyone involved. Diseases such as diabetes are diagnosed earlier, making it easier to treat and to help patients and the system avoid some of the debilitating and expensive complications that develop when not properly managed. Reid's GP tells him "You know, the NHS pays me for the people on my list whether they come into the surgery or not. So why do I want them in here? My message is: ‘Look mate: don't get sick'".
Medical record portability, simplifying billing and payment, and reducing administrative costs are all important components of these systems. In France all adult citizens carry the "carte vitale" which contains their entire medical record back to 1998, and also facilitates billing. This instant availability of the patient's chart reduces costs both directly and indirectly, by eliminating the need to maintain and store paper charts, and to repeat labs and/or tests because the results are inaccessible.

And, most importantly, everyone is covered. This stems from a philosophical and moral decision to treat access to healthcare as a fundamental human right, which has been made by most advanced societies, with the notable exception of the United States. In 2009, it is estimated that there are at least 45 million Americans without health insurance for at least part of the year, which results in the unnecessary deaths of over 22 thousand Americans yearly, according to calculations by the Urban Institute and the Institute of Medicine. This number, which almost defies belief, belies the claim made by President Bush in 2007 that "People have access to health care in America. After all, you just go to the emergency room".

Clearly, there are many facets of other countries' health care systems which we could embrace. While many opponents of health care reform have a tendency to decry "socialized medicine" anytime it is suggested that we learn from other countries, Reid points out that in many of those countries the physicians are self employed, and the hospitals and insurance plans are privately run. He also reminds us that both Medicare and the Veterans Administration consistently get high patient satisfaction, even though both are managed by the US government. Reid ends his book by saying that "Given our country's remarkable medical assets... the United States could be, and should be, providing its citizens the finest health care in the world". It is, ultimately, a matter of choice.