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Can We Say No?: The Challenge of Rationing Health Care 1st Edition
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"informative and insightful...'Can We Say No?' is a useful book to stimulate needed discussion and debate. It would be a valuable textbook for a public health or public policy class in comparative health care systems." Ross Mullner, University of Illinois at Chicago, Inquiry - Excellus Health Plan
"CAN WE SAY NO? provides important evidence about how capital limitations might affect the American health care system. Aaron's account of how limits on spending have worked in the NHS is particularly credible" Joseph White, Case Western University, Public Administration Review, 1/31/2007
"The authors are impartial, astute, and wise. For anyone interested in drawing lessons about health care reform from the experience of other advanced nations, there is no better place to start than this brief and timely volume." Alan Garber, M.D., Stanford University
"This book is a well-written and insightful analysis of the challenges facing decisionmakers in both countries. The authors' focus on the inevitability of rationing, on funding what is a proven benefit to patients, and on the better incentivization of efficiency is welcome." Alan Maynard, University of York, England, Health Affairs, 11/1/2005
"Everything Henry Aaron writes about health care is worth reading, including this busman's holiday of a book on what we should learn from the British health system....Aaron and colleagues believe that skyrocketing spending in the United States will force rationing of health car. He is absolutely correct that projected increases in Medicare, Medicaid, and private insurance spending are unsustainable." Jim Cooper, U.S. House of Representatives, a member of the House Armed Services and Budget Committees, Health Affairs, 11/1/2005
"It's a valuable survey of the real medical issues involved in British rationing, and gives a taste of the dilemmas the U.S. system will eventually face." Paul Krugman, Robin Wells, The New York Review of Books, 3/23/2006
"the book offers a highly engaging, accessible, and provocative look at the most significant issue facing American health care." Michelle Mello, Harvard University, Journal of Economic Literature, 12/1/2006
"This book will be of interest to anyone involved in the implementation of government targets or trying to achieve financial balance." Sheila Bullas, Health Strategies, British Journal of Healthcare Computing & Information Management
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. Among his many books are Can We Say No? The Challenge of Rationing Health Care, with William B. Schwartz and Melissa Cox (Brookings, 2006), and Reforming Medicare: Options,Tradeoffs, and Opportunities, written with Jeanne Lambrew (Brookings, 2008). 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. Melisssa Cox is a student at Yale Law School.
Top Customer Reviews
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.
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.