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82 of 88 people found the following review helpful
on October 16, 2004
It's funny that in this political season there is not much attention being paid to this book. Because this is exactly what the candidates should be paying attention to. As a life long conservative I could never have imagined rating this book highly, but it speaks the truth. The authors discuss the present day health care system, and where the present "market driven" emphasis has brought us as a nation. And truthfully, as we all know, it's not good. The authors lay out simple facts that we all know, but for some reason, strike us as incredible. For example, why is it that in the richest and most powerful nation that the world has ever known, is it necessary for parents to have to hold fundraisers and garage sales to finance the medical treatments that their children need to survive. We have all seen it, but have we ever actually thought about it? That's what this book does. It makes us look at what has become ordinary in this country, and ask why? What good is it to be the richest and most powerful country on Earth, if we can't take care of our children or our parents without having to go into bankruptcy, or holding a bake sale to finance necessary medical care. This is an eyeopening book about the sad state of our health care system. Plaese read this book and think about it. What makes a country great? Is it the flag, or the military? Or is it the way a country takes care of its people? Or the way the people take care of each other. It's funny, but I always would spout out the rethoric that we had the best health care on earth, but this book made me think. Do we? And I think we all know the answer; no. And why don't we? We should, shouldn't we?
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42 of 44 people found the following review helpful
VINE VOICEon November 11, 2004
For those people who vaguely remember when healthcare & insurance was generally a manageable aspect of our lives (as opposed to being a source of stress & potential financial ruin), this book will explain very well how healthcare in US arrived at the point where it is today. For younger readers, this book will remind them that once upon a time, there was a country where insurance was fairly comprehensive & affordable, hospitals were oriented towards community rather than being part of a bottom-line-obsessed corporation, and pharmaceutical commercials were not littering the airwaves.

The authors do an excellent job of showing that the shift, on every level of healthcare, to a market-based economic model has achieved exactly the opposite of what the proponents of the free market claimed would happen. Instead of streamlining healthcare & making it as a whole more efficient and affordable, the shift to the free market has actually created a massive bureaucracy (which conservatives claim to loath) and a far less efficient healthcare system. Certainly it is not any more affordable. Anyone who is familiar with medical collections & with the stunning increase in bankruptcies over the last few years can attest to this. The authors underscore their arguments with a litany of horror stories of patients dying or suffering hugely at the hands of a hopelessly tangled system which emphasizes the bottom line over the welfare of the patient.

All of this is well and good, and mighty depressing. However, only a minimal amount of time is devoted to what might be done about it. The authors' suggestion --- the adoption of a single-payor system --- is fine as far as it goes, but they offer only a cursory examination of the benefits of such a system and do not delve into any of the criticisms of the same. Neither do they discuss other proposals such as tort reform, which is the Bush administration's answer seemingly to every healthcare crisis. In interviews, the authors have observed that capping jury awards would only make a tiny dent in the overall costs of insurance, and certainly tort reform has had mixed results at best, depending on which of the states that have passed tort reform legislation one examines. Yet the authors barely touch on it their text. At the very end of their book, the authors mention the fact that Big Business (aside from the healthcare industry) certainly has good reason to want a single-payor system, since healthcare costs cut deeply into THEIR profits, thus setting up a contest of sorts between two powerful for-profit entities. It is probably the fact that the combined power of multiple US industries outweighs the power of the insurance & healthcare industries that will ultimately force genuine changes in how this country manages healthcare, but the authors for whatever reason prefer not to explore this particular topic. This is unfortunate.

Overall, this book provides some good detail on issues we all need to know more about, but if you are looking for detailed solutions, you will need to look elsewhere.
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19 of 20 people found the following review helpful
on December 11, 2004
I agree with the authors on the big picture: the state of health care in the U.S. is a scandal that should lead the news most nights. But the authors are able to describe only the tip of this iceberg, the part most exposed to the public. By this I mean that most of the book is a series of incidents along the lines of "Mr. X tried to get procedure Y but was denied for crappy reason Z." Or "HealthShysters, Inc. went under and left a million people without medical care."

I was hoping for an analysis which would examine more closely the economic and politcal roots of the current predicament. The subtitle of the book, after all, is "How Health Car in America Became Big Business and Bad Medicine"-- but I felt that precisely "how" is too often elided.

On the other hand, the current one is an easy read and a reasonable introduction to an important issue.
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20 of 23 people found the following review helpful
It's no secret that American healthcare has some problems. I wanted to get more background on this issue, and I discovered "Critical Condition." I found it to be readable, and it illuminated a number of healthcare crisis points. If you've ever read "The Rainmaker" by John Grisham, you'll have some idea of the stories this book contains. Free market healthcare was touted as the best possible way to ensure low prices and good treatment via competition (oddly enough, by the same guy who came up with the "body count" progress-measurement system in Vietnam.). But the authors contend it has led to higher costs, inferior care, and an uninsured class where millions are only an illness or accident away from financial ruin. And to top it off, the insurance companies have taken away patient care decision-making away from the doctors. I've seen and experienced some of the issues highlighted in "Critical Condition," and I'm appalled that a so-called "hyperpower" has a health care system where families must conduct bake sales to cover medical bills. I commend the authors for illustrating this problem in layman's terms.

However, they aren't so clear when it comes to a solution, and a couple of points stand out. First, the authors criticize efforts to speed up the introduction of new medicines. They argue that some drug companies do this to make a quick buck at the expense of patients. Perhaps they have a point, but on the other hand those with terminal cancer or AIDS have pushed for quicker drug introduction because their lives are on the line. Don't people in this category deserve to take a chance that may save them, especially if they have nothing to lose and everything to gain? Second, they argue for a standard IT system to ease the exchange of medical information. As a healthcare IT tech, I'd love that (although I'd probably end up outsourced as a result). But how? Ideally, you'd have to standardize applications (healthcare and otherwise), hardware platforms, operating systems, etc. Healthcare is a huge information technology market. Can you imagine the joy in Redmond if all US hospital computers had to use Windows XP and Microsoft Office? The Linux folks would blow a gasket, and we'd probably see another Microsoft antitrust suit. And what of the other complex legalities involved? Where I work, conflict of interest barriers have prevented us from linking our computer network with other health systems. "Critical Condition" doesn't address this type of hurdle, or even how HIPAA figures into their ideal information sharing process. Finally, there wasn't much detail on how a single-payer gov't system would be funded, especially with the costs generated by an aging population and illegal immigration. For two guys who go on about how drug companies skip over negative side effects, they should've spent more time on the T-A-X issue and its repercussions. A bullet point or two just doesn't cut it.

Ultimately, Mr. Barlett and Mr. Steele argue that only the federal gov't has the power to dismantle the current massive for-profit healthcare bureaucracy and create a single point of accessible healthcare (although they don't touch on the resulting fallout of job losses this paradigm shift would create). Even so, I would have appreciated some insight into an existing foreign gov't-run healthcare system they favor. They allude to the French and Canadian programs, but offer no breakdown of why or how their systems are superior (or possibly inferior) to ours. But despite their assertions, the authors reject a single-payer U.S. gov't run health plan as politically impossible. Instead, they call for a Federal Reserve-type quasi-gov't system to create a single health care entity (a bit ironic, given the book's anti-market theme. And how can it be "quasigovernmental?" I confess I don't quite grasp the nuances involved here.). I can buy into that avenue of approach, as long as this agency has the power to provide good, affordable care to everyone, create a manageable bureaucracy, and enforce patient and doctor-centric healthcare laws. Easier said than done, however. If the Clintons couldn't reform our health care system during their eight years in office, and the Republicans don't seem to see reformation as a big priority, then how will positive change occur?

There are countless historical examples of the Biblical admonition that "the love of money is the root of all kinds of evil." Free market healthcare has created an environment where it's too easy for this weakness in human nature to overwhelm the altruistic focus of medicine. "Critical Condition" admirably illustrates this problem, but a more comprehensive analysis and realistic solution will have to be found elsewhere.
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11 of 12 people found the following review helpful
The book could have been shorter, without a lot of the individual "sob stories", which I know help sensationalize a news article, but made the book drag on for me.

The authors hit the nail on the head when they bring up all the bankruptcies and foreclosures in our country due to health care costs, and also the horrible cost-shifting that gets placed onto the uninsured among us to support the deep discounts that Medicare, Medicaid and now a plethora of insurers have negotiated with providers.

I'm a dentist, and do not participate in plans which would insist on my discounting services to certain groups. If I am going to discount them (and I do) they are to those less fortunate in life financially, and are not determined by someone's age, race, or employer.

The fact that we have a bizarre system where your health care is tied to who you work for is perverse. The fact that this very system drives up costs for uninsured people, while taking more money out of direct health care and more into insurance company administration and profit is sickening.

I don't have the answers to our problem, but I think that this book is the foundation for much dialogue and debate.
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7 of 7 people found the following review helpful
on January 31, 2005
It's good that someone can protest the current health care hell, since the forty-five million with no voice or medical insurance are never heard. This depiction of the deteriorating scenario of free-market capitalism applied to the distribution of medical services is pretty shocking, something we already know or sense but put from our minds--the plight of those suffering maximu neglect as they finally reach the emergency, and many other horrors in the lottery of this immense swindle worthy of a banana republic. Almost pitiful is the picture of the way those with the least resources are often stuck with massive hospital bills, far greater than the norm for providers. That's unbelievable, as if the way the regime has made it seem normal. Now what do we do about it?
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6 of 6 people found the following review helpful
on June 20, 2007
I watched Sicko and loved it. I hated the reality it showed. The problem is I didn't want to jump on his bandwagon until I did some more reading on my own.

On some website, someone wrote that they highly recommend this book. I borrowed it from the library.

This takes Sicko and multiplies its intensity by 10. It's too bad the authors couldn't get the power of visuals and sound that movies, like Moore's enjoys. Otherwise this book would HAMMER this country so hard, it would tremble.

If you liked Sicko, but want more, READ THIS BOOK! If you hated Sicko, READ THIS BOOK, to get a dose of reality. Anti-moore fans can't say much after reading this book because Moore has nothing to do with this.

While I would have liked some graphs/charts or some another illustrative, visual way to reinforce the facts, this book is GREAT! Please read it!
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7 of 8 people found the following review helpful
on February 6, 2005
Over 40,000,000 Americans have no health insurance and many more millions are underinsured. Health Care in America has become big business with a primary focus of making a big profit. The free market is great for America, but is does not work for health care. The reason the free market does not work for health care is that the health care consumer in many cases is not making a real choice. The consumer that is rushed to the hospital has little or no free market choice. In any critical situation the person needing health care does not have free choice when facing life or death or any other critical situation.

There is a big difference between health care and other goods and services where a consumer has a real choice. The market system does not work for health care. Our system is not about health care, but it is about the insurance reimbursement system. The USA health care system is a huge bureaucracy where billions of dollars are spent on the huge bureaucracy that has nothing to do with basic preventative and life-savings care.

The leading cause of death in the USA is heart disease and has been so for decades. The second leading cause is cancer and has been so for decades. The third leading cause of death in the USA is new. It is shocking to now learn from this book that the third leading cause of death is now medical mistakes including drug interactions and bad drugs.

For those that are interested there is an author event for this book available on C-Span2 Book TV.
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5 of 6 people found the following review helpful
This seems to be a well-researched book and I think they do an excellent job of exploring the problem of health care in the USA today. In my opinion, however, they don't go far enough in their exploration.

The authors talk about the high cost of medical treatment. There's no denying the expense. I'm aware of more than one time when a patient has received needed care only because family and friends raised the money to pay for it. However, the way that government interference contributes to the jacked up prices is barely mentioned. (An example from a few years ago in the news, in a western state, all insurers were required by law to cover everyone who came to them, even those dying of incurable diseases. As a direct consequence of the new law, the prices of both medical treatment and insurance rates rose dramatically.)

The authors talk about how many pills are marketed and overprescribed (and I agree with them on this), but again, they don't consider in any depth the government's contribution to the problem. The DEA is waging major war on painkillers. Physicians are intimidated into not prescribing needed painkillers. This artificial market control is raising prices, as well as lowering the quality of health care and hurting people who desperately need those drugs. The authors also ignore how very affordable drugs are kept illegal by federal regulation, despite state voters voting to make them legal.

Where they really flounder, however, is when they propose their solution. They give an unconvincing plan of getting the government involved to wisely and charitably make sure everyone gets the competent medical services they need. This seems to me to be more about what government *should* do rather than what it likely would do. The government is a major part of the problem now. How is it going to change and become the solution if it takes direct control?

It seems to me that they haven't thought through their position. For instance, they write:

"Resistance [to our suggested health care reform] would come from health care providers themselves; from insurers, some of whom would go out of business; from some in the U.S. government bureaucracy who would lose control; from the antitax community; from some physicians and individuals who are content with their personal situations, and most of all, from members of Congress who benefit so handsomely from free-market health care."

I was confused by this because of how often they said most of these people were desperate for change. For example, this statement:

"We have a system in such constant turmoil that almost everyone is unhappy--patients, doctors, nurses, aides, technicians. Almost everyone. But for a lucky few, the turmoil is worth a lot of money."

If all but a "lucky few" are unhappy, then why would they resist change? This goes against what they said repeatedly before the chapter on their propopsed remedy, including some compelling anecdotes of these people who'd resist having been disillusioned and alienated from the system as it is. And why would this government that already has control dread losing control by getting even more control? For that matter, if the government is dysfunctional now, why wouldn't it continue to be dysfunctional later? And if their remedy wouldn't add any costs to society but replace existing taxes, then why would antitax people resist it so bitterly? While the antitax folk might resist any taxes, I'm pretty sure they'd rather taxes go for health care than for the wars at home and abroad and the other things that make people ashamed or angry to be forced to pay for.

I also wish they had spent more time considering how health care works in other countries. I'm not sure that the Scandinavean model could work for the USA because of how different the two places are in population and character, but I would've liked more discussion of the possibilities. I was intrigued by what they said about the system in France, but again, they didn't go into details. I'm also interested in hearing more about Thai health care, which I understand is affordable and excellent despite no national coverage (and popular with some Americans who can afford to go there to get it).

In general, I wish that they'd have explored other, already functioning systems more, and looked at why our FDA is so inferior in ethics and practice to its counterparts in other countries, as well as considering in more depth why (or why not) another country's system could work for us.

Also, from their description, it sounds as if health care was good in the USA until Wall Street, supported by their cronies in Congress, took the medical business over. If that is true, why not focus on getting Wall Street out, instead of the government in? Especially given how badly the government has done so far?

Overall, I think this book is important in understanding the problem of health care in the USA today, though not sufficient all by itself. I'm sorry the authors didn't put more thought into proposing solutions for us to get out of this mess.
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1 of 1 people found the following review helpful
on November 4, 2007
I won't give an exhaustive review as others have done so well. I just wanted to add my voice to those that note this book contains many well-researched examples of just how bad things have become. What the book does not do, however, is give a thorough and balanced look at possible solutions. One must wait until the last chapter, which is quite short, to read about one possible solution - and even this one possibility is not covered in great detail. So, I would recommend you read the book just so you see that, even if your experience has not been bad, it definitely has been very much so for others. But you really will not find "what we should do about it."
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