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112 of 123 people found the following review helpful:
3.0 out of 5 stars
Physician Response, December 11, 2008
Why is Tom Daschle (who interestingly is not a physician, but a lawyer, politician, and lobbyist) in charge of the health care arena in the first place? It's insulting to us physicians that the president elect couldn't find one of the many talented physician leaders to head up this project.
With that said, Daschle's main ideas gleamed from reading the book are:
1) Set up a Federal Health Board to regulate policy and provide evidence-based practices - The idea of a Federal Health Reserve is a good one. It would allow a nonjudgmental board to improve medical care at the federal policy level without political biases.
2) Expand Medicaid - This, although reasonable, is scary. Medicaid is amongst the lowest of all reimbursers. Many treatments and procedures simply cannot be done at the Medicaid reimbursement level, such that major academic centers with Federal support eat the costs of doing business with these patients. Any expansion will have to see reimbursement rates dramatically increased or physicians protesting.
3) Mandate by law (like in Massachusetts) that individuals have insurance - This seems like a good way to increase "insured individuals." What it does for quality of care remains to be proven.
4) Pay physicians based on their success - This is a slippery slope as it will reward physicians who are less apt to take risk. Also, deciding upon which outcome measures and variables to reward will be no easy task - the scientific community has only defined the variables for a very small subset of patient care items to date.
5) Open up the federal health insurance "group policy' to all employers and individuals to obtain an economy of scale - I don't know anyone with this insurance, but it seems like a fine idea.
6) Implement an electronic medical record - this is already being implemented around the nation. The best idea would be to implement one or a few that all interact, but that would take serious organization, time, and money.
7) Criticize the US health care system as mediocre at best - There is no one best way to measure health care systems. Proxy measures such as life expectancy and infant mortality do exist, but they are confounded by different demographics in different countries, different genetic susceptibilities, different risk taking activities by health care systems, etc. The US health care system has driven most of the critical advances in health and for sure health care education in the last century and it is where many international diplomats, athletes, etc. receive their care. The real issue at hand is the massive amount of money being wasted in the system.
Interestingly, Daschle does not comment upon:
1) Malpractice claims and the cost of malpractice insurance
2) Insurance agencies and their lack of regulation and the fact that they do nothing for the system but put money in their own pockets
Any future system in the US should satisfy 3 basic groups:
1) The patients
2) The caregivers (Physicians, etc.)
3) The facilities (Hospitals, etc.)
There is no reason why lawyers, insurers, politicians, lobbyists, etc. should benefit from the system more than those crucial to it's existence.
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141 of 170 people found the following review helpful:
5.0 out of 5 stars
Illuminating, February 19, 2008
A big part of me resisted the idea of buying a book on health care written by a former Senator. It just seemed way too wonkish for me. But I am into politics and a minute does not go by without a candidate screaming about "Health Care" and "Universal Health Care" so I figured I should get up to speed on what the debate is all about.
I'm really glad I did. In truth, Critical is a well written book and is quite interesting. Daschle cogently explains why our current health care system is broken and why there is, in fact, a desperate need to fix it. I'd heard that said many times before but did not understand why. Now I do, thanks to this book.
I am a strong believer in the free market as the best means for providing most of the goods that people want at the best price. But I now have to admit that the free market is not working when it comes to health care. It really isn't. And I am not saying this as a Democrat. I am a registered Republican.
For those who might think that this book is nothing but a left-wing, socialist rant, they would be wrong. In fact, many of Daschle's recommendations for "fixing" the system are to make our system work the way it would in a true free market environment. That is, to provide the highest quality care at the least cost to the consumer. It was really eye-opening to learn how very far away from this ideal our current system is.
Daschle's book covers most of the bases. It describes our current system and why it is so flawed (the number one cause for bankruptcy in our country cannot be called a good system of health care!) He then describes the history of trying to create a better health care system in our country, starting with Truman, up to Clinton, and on up to the current day. He outlines the players who consistently get in the way of needed reform. And, finally, he puts forward his own idea of how we might create a viable health care system that affordably takes care of people when they fall into disease.
I got a great deal out of this book. For one, I've learned that right wing talk radio is REALLY clouding the issue when they talk about health care, and is doing the country a great disservice. Daschle persuaded me on a lot of important points and made me aware of the nature of the problem. I thank him for the time he put into writing such an informative, readable book on such an important issue. If you want to educate yourself on the state of our health care system, this is the place to start.
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44 of 52 people found the following review helpful:
4.0 out of 5 stars
A slim volume on fat topic, May 22, 2008
I avoided learning about the politics of the mid-East for a long, long time. Too complex and insoluble. Then 9/11 and, well... I picked up "The Mid-East for Dummies" at Barnes and Noble. "It's a start," I told myself, and not a bad one as it turns out.
As a supposedly responsible political actor, I've found myself similarly ignorant when it comes to the droning debate on health care. And, God knows, listening to the candidates for President is not terribly edifying in this regard. "Tastes great, less filling" would pass nicely for substance on this (or almost any other) topic in this election season.
To my rescue rides Tom Daschle and his co-authors whose "Critical: What Can We Do About the Health Care Crisis" could have just as well been sub-titled "U.S. Health Care Policy for Dummies."
Unlike the "Dummies" books, this one is prescriptive. Senator Daschle et al bascically argue that the U.S. Congress is in over its head on health care and--like it did on monetary policy with the creation of the Federal Reserve in 1913--should outsource its decision making on the immensely complex topic to a Presidentially appointed panel of experts. This is a an interesting proposition, coming as it does from the former Senate Majority leader who hails from a state with deep populist roots. But the case he makes is not uncompelling.
Daschle calmly traces how health care reform has crashed repeatedly upon the same special interest shoals, at least since the Depression. The shape of the barely submerged obstacle may change (doctors, unions, insurance companies), but its sheer, hulking mass only increaseth. Congress, he argues, has neither knowledge nor institutional will to make good and far-sighted decisions on behalf of its constituents.
The book is worthwhile if for nothing other than its mid-section, wich recounts the history of attempted reform, especially since Truman. The Clinton/Magaziner effort of the early 90s gets special attention, as it should. Daschle--ever the statesman--manages to scoff at how on-its-face silly was the C-M approach to health care reform, while not laying a glove on the former first lady. In fact, his account is practically tantamount to hagiography compared to the version delivered by Carl Bernstein in his biography of Mrs. Clinton.
Again, this is a very helpful book for the lay reader. But its brevity and accessibiltiy require that many good questions are left open. Is the obsession over absolutely universal coverage necessary? If the fault of the Clinton plan was primarily that it was too detailed, what details could have been eliminated with eviscerating its substance? If Congress can't handle health care, what else should devolve from its purview? Energy policy? The more delicate pieces of foreign policy oversight?
And finally, the elephant which has taken up tenancy in Daschle's rather modestly sized room: "gee, this all seems pretty expensive, doesn't it?" By book's end, I found myself with the mental image of one dial spinning clockwise, tallying the cost of the incremental (and undoubtedly worthwhile) programs Daschle proposes. Another opposing dial spun the opposite direction, counting the result of the cost savings the book proposes. You can guess which one spins faster.
Three things become quite evident in reading "Critical." The first is that tackling the challenge of universal health care coverage will requre monuumental Presidential leadership, and an almost reckless risk of political capital which no event other than a fresh election will generate. Clinton promised a proposal in the first 100 days of his presidency. And while that turned out to be a hyperbolic mistake of ambition, it nonetheless reminds us that in order for health care reform to succeed, it likely must be a new President's top priority.
Second, although Daschle's proposal of a National Health Board is not new, its timing may be apt. Health care has bubbled to the top of the list of main street issues, and Congress has perhaps never in the modern era been less trusted to address cleave the Gordian knot.
And finally, you can bet that if the nation chooses Barack Obama as its 44th President, this is not the last we've heard from Tom Daschle on health care.
Probably not a bad thing.
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