Customer Reviews

The Buck Stops Nowhere

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I finished this book in an evening; I couldn't put it down. The author has succinctly outlined our present healthcare system and how we got here. More importantly, she explains why it doesn't work and some ideas on how to design a system which will work. The book is written for the layperson, but as a healthcare professional, I found this book to be a real eye-opener.

"Kathleen O'Connor's book "The Buck Stops Nowhere" is a pithy, down to earth primer for anyone who cares about reforming our healthcare "system" and has trouble seeing the various parts of the elephant, like the proverbial blind wise men. She cuts through mountains of material to make some large generalizations that ring true to this family practitioner of over twenty years. She ends with a plea for public engagement in a democratic process that is the only new idea going for basic reform of the world's 37th best performing and most expensive healthcare system: ours!"

Harry Truman famously said, "The buck stops here" to punctuate the fact that as President of the USA, he is in charge. The title of this book then refers to the fact that in the American health care system, the buck stops nowhere because no one is really in charge. The book itself is a condensed primer on the shortfalls, inefficiencies, and immoralities of the US health care system as it exists in the beginning of the 21st century. The book examines health care plans, insurance coverage, and the medicare / medicaid problems. From such a large set of problems, the author draws out several major trends seen by all involved in the health care system, and proposes several things that we, the voters can do to help the system.

There are several drawbacks to this book. First, the book focuses on the health care system in general, and mostly neglects the social and cultural environment that has come to exist in America from 1945 to the present. Specifically, America has become a car society, such that the primary form of exercise practised in other countries - walking between work, school, store, and home - is rarely practiced in American any more. As America becomes more and more suburbanized, people will drive more and walk less. This can only lead to more obesity, and all the other problems related to it.

Second, the author should have devoted a whole chapter to the food, alcohol and tobacco industry. Major parts of the US economy gain their profit by Americans doing unhealthy things such as eating junk food, smoking, drinking alcohol, etc... As long as these industries have lobbyists working for them in D.C. and state capitols, there is only so much preventive health care that can occur in this country.

Third, and most importantly, the author should have examined the way health care professionals (doctors, dentists, nurses, pharmacists, opticians, etc...) are trained and certified / licensed in America, and compare / contrast this with what happens in other countries. Specifically, health care professionals in the US form the highest-paid union, and entry into this union is quite expensive. On the other hand, health care professionals in most other societies are not compensated so handsomely as those in the US, and getting an education in health care is quite different in other countries as compared to here. For example, one can get a B.S. degree in Medicine in China, and go on to practice medicine. This is not possible in the USA.

Overall a good book, and one that packs quite a punch for its short length. But there are topics it misses entirely.

I have been in healthcare for over twenty years. I have always been perplexed by the lack of vision with our healthcare system. Ms. O'Connor has clearly identified the critical issues that influence our misaligned health system.
On page 39 Ms O'Connor points out that we are #1 per capita healthcare expense however our country is #37 internationally in overall health outcomes. This alone should alarm the average American to call their U.S. Representative today and ask the question why?
I applaud Ms. O'Connor for articulating the difficult issues.
Ms. O'Connor uses a pithy style to explain the real issues that shape the U.S. health system. This book is a must read for all who want to gain insight into the problems that effect the health of the citizens of this great country.