Why read the book . . .

when you can read the review?

And why read the review, when you can come here? Crusading docs Steffi Woolhandler and David Himmelstein, in the new JAMA, review "Uninsured in America: Life and Death in the Land of Opportunity," by Susan Starr Sered and Rushika Fernandopulle (U. of Cal. Press).

As you already are sick of hearing, if you've visited here before, we keep seeing the number of uninsured Americans go up, year after year. Steffi and David review the retrograde politics of the problem: Harry Truman called for national health insurance; Richard M. Nixon, not known as a socialist, called for universal coverage through employer mandates; the Clintons tried to create a byzantine, incomprehensible monstrosity in order to achieve something close to universal health care without having to call it a government program. Today, the Democratic Party's champion John Kerry is way out there on the radical left by wanting to expand Medicaid to cover a few more poor kids.

Today in the culture of life, according to the Institute of Medicine, 18,000 adults die every year because they are uninsured. Yawn. To quote Steffi and David (they wont' mind):

Sered and Fernandopulle's book is an effort to reawaken outrage, to restore the tears that are too often wiped away as people are transformed into statistics. The authors, an anthropologist and a health policy expert, journeyed around the United States interviewing the uninsured and recording their stories.

The suffering is legion, washing over the reader in chapter after chapter of ruined bodies, financial disaster, and families pulled into an inexorable downward spiral—what the authors label a “death spiral.” Even temporary gaps in coverage often breed disability, eg, from untended fractures, untreated psychiatric disease, preventable cardiovascular events, or dental disease, compromising future employability. In some cases a brief spell of bad luck snowballs into a lifetime of disaster, as for a middle class woman whose divorce and consequent lapse in coverage coincided with the discovery of a breast cancer. The case studies are varied: 20-somethings recently dropped from their parents' policies; self-employed carpenters, acupuncturists, even dentists who find coverage hard to come by; factory workers forced off their jobs and out of their coverage by illness or the need to care for a sick family member.

As the docs point out, we squander $300 billion every year on adminstrative costs which are principally directed at denying care and extracting profits. Gosh, with that kind of money, we could even afford to invade and occupy Iraq, which would be a better deal because we could easily kill 5 times as many people. Oh wait, we're already doing that too.