Can We Say No?: The Challenge of Rationing Health Care [Hardcover]

Henry J. Aaron (Author), William B. Schwartz (Author), Melissa Cox (Author)

Book Description

Publication Date: October 2005 | ISBN-10: 0815701209 | ISBN-13: 978-0815701200

Over the past four decades, the share of income devoted to health care nearly tripled. If policy is unchanged, this trend is likely to continue. Should Americans decide to rein in the growth of health care spending, they will be forced to consider whether to ration care for the well-insured, a prospect that is odious and unthinkable to many. This book argues that sensible health care rationing can not only save money but improve general welfare and public health. It reviews the experience with health care rationing in Great Britain. The choices the British have made point up the nature of the options Americans will face if they wish to keep public health care budgets from driving taxes ever higher and private health care spending from crowding out increases in other forms of worker compensation and consumption. This book explains why serious consideration of health care rationing is inescapable. It also provides the information policymakers and concerned citizens need to think clearly about these difficult issues and engage in an informed debate.

Editorial Reviews

Review

"The authors are impartial, astute, and wise." --Alan Garber, M.D., Henry J. Kaiser Jr. Professor, Stanford University --This text refers to an out of print or unavailable edition of this title.

About the Author

Henry J. Aaron is a senior fellow in Economic Studies at the Brookings Institution, where he holds the Bruce and Virginia MacLaury Chair. William B. Schwartz is an expert on national health policy and is a professor of medicine at the University of Southern California. He was formerly chairman of the Department of Medicine and Vannevar Bush Professor at Tufts University and was also president of the American Society of Nephrology. Aaron and Schwartz are coauthors of The Painful Prescription: Rationing Hospital Care (Brookings, 1984) and coeditors of Coping with Methuselah: The Impact of Molecular Biology on Medicine and Society (Brookings, 2004). --This text refers to an out of print or unavailable edition of this title.

Product Details

• Hardcover: 199 pages
• Publisher: Brookings Inst Pr (October 2005)
• Language: English
• ISBN-10: 0815701209
• ISBN-13: 978-0815701200
• Product Dimensions: 9 x 6.2 x 0.9 inches
• Shipping Weight: 1 pounds (View shipping rates and policies)
• Average Customer Review: 4.3 out of 5 stars  See all reviews (3 customer reviews)
• Amazon Best Sellers Rank: #4,734,326 in Books (See Top 100 in Books)

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Customer Reviews

Most Helpful Customer Reviews

5 of 5 people found the following review helpful:

4.0 out of 5 stars Valuable Info, January 12, 2006

By 

ConsDemo - See all my reviews

This review is from: Can We Say No?: The Challenge of Rationing Health Care (Paperback)

This is a topic that should get more attention than it does. Increased rationing of health care is coming, no matter how much we want to wish it away. Aaron and Schwartz deserve credit adding to the, so far limited, discussion on the topic.

The book is largely a comparison of the provision of certain services in the United States and Britain. The British National Health Service was established after World War II and it generally holds down costs by establishing global budgets and requiring providers to operate within them. This method is likened to managed care by some. The British system has much lower use of services such as dialysis and fewer intensive care beds, even after adjusting for population differences. Given lower capacity in some areas, the British have to been much choosier about who receives care in these areas.

The British system of rationing was largely unregulated, in the sense there was not often a uniform criteria for choosing one patient over another. Rather providers were obliged to simply make do within their budgets and this helped create a "culture" of care provision that differs from the culture in the United States. Beginning in the 1980s, technological advancements and increased expenditures in some of the most heavily rationed areas, such as dialysis, greatly increased the capacity to provide care although rates of treatment are still far lower than in the U.S.

The authors suggest it might be wise for the U.S. to copy some aspects of the British system to help hold down costs. However, they acknowledge there are some significant differences, such as an American legal system that gives deference to demands for care.

5.0 out of 5 stars Health care rationing., March 12, 2006

By 

HES Research - See all my reviews

This review is from: Can We Say No?: The Challenge of Rationing Health Care (Paperback)

Excellent analysis of the health care mess. However, like almost all other such books, it stops short of a solution. For a thought provoking formulation of a solution that provides better health care at lower cost by clearly defining what the health care system is supposed to be accompishing, and squeezing the fat out of the system, see "You Bet Your Life: The Zero Sum Health Care Game", available at [e-mail].

4 of 11 people found the following review helpful:

4.0 out of 5 stars Flawed in the longer run, January 23, 2006

A Kid's Review

This review is from: Can We Say No?: The Challenge of Rationing Health Care (Paperback)

I just heard one of the authors interviewed on NPR. Henry Aaron states in the opening that if health care costs continue to rise, they will move from 16% of the GDP in 2005 to over 33% by around 2030. He includes the caveat "that is a big if" yet the entire discussion assumes this is really inevitable.

Yet when one consider that technology is accelerating as pointed out by engineers Bill Joy, Ray Kurzweil, and others, medical technology will significantly transform health care over the next 25 years. Rather than costs increasing as a percentage of GDP, it is perfectly realistic to assume costs will instead decrease over the longer run.

We saw this trend with computers where Americans spent more and more per GDP on computers as computers and more software became available to more people. Yet at some point this trend began to reverse as computers became much cheaper even as they became far more powerful.

We will see health care costs *decrease* over time and the driving force - accelerating technology - should not be dismissed. The book makes sense over the shorter run and should be read with that timeframe in mind.