Customer Reviews

Fixing American Healthcare: Wonkonians, Gekkonians, and the Grand Unification Theory of Healthcare

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When exposed to models, I learned to appreciate simple first and complex next. This book introduces the reader to health care challenges in the right sequence: Simple first.
As a systems architect for more than 35 years, this book has gained my utmost respect. What the health care system lacks is correct feedback. Patient entitlement, social carrying capacity, doctor decisional independence or lack of, accountability at various levels and so on are all lacking basic systemic sanity. As Lord Kelvin said in the late 18XX "you can not control what you can not measure". If professional competence is removed from decision of service, services are removed from payment ability, outcomes are removed from services and quality of life is defined by somebody else, nothing can be really stabilized, except in political fairy-tales. Another prediction from the world of systems theory; as per the second law of Thermodynamics and the Nyquist principle, all systems without control end in chaos. QED now we know.

Dr. Fogoros goes where few other authors on health care reform/transformation can go. He does an extraordinary job taking us inside the health care system and exposes many frightening truths:

*We ration care, we just don't call it that
*Doctors have been strong armed into putting the interests of employers, insurance companies and the government ahead of patient interests
*Money talks and when your insurer is a for-profit company they are obligated to make the highest profits possible and they put their profits ahead of your health
*Private insurers intimidate doctors to ration care and increase corporate profits
*Money talks and when your government is trying to save money they put their budget ahead of your health
*The government intimidates doctors to ration care and decrease spending
*Scientific studies are manipulated to support rationing of care
*Doctors have been complicit, through action and inaction, in destroying the patient-doctor relationship and consequently supported covert rationing of care

Almost no one is blameless when it comes to being responsible for the mess we are in.

Dr. Fogoros shows us how who pays for your care and who decides what care you can and can't have determines the quality of the system we have and the care we receive. He shows us how insurers and our government programs, Medicare and Medicaid, ration care without our knowledge and consent, sometimes hiding behind suspect science.

And he shows us how we will have to ration care because we just can't pay for everything for everybody. Americans have a "no limits" mentality when it comes to the care we want. Unfortunately we do have a limited budget and will need to learn to ration care openly and with compassion.

Besides the powerful insight he gives us into the real workings of medicine he gives us a blueprint for getting out of the mess and his solution starts where it should, with the patient and the patient-doctor relationship. Patients and doctors need to get back to the root of excellent care in our country and that is the relationship that they share.

This book should be on your reading list if you are a health care consumer, doctor, patient or health care reformer.

We all know we're facing many challenges in our health care system. Certainly at a national level, we need solutions to deal with the fact that there are 50 million uninsured people in America.

But individually, many of us access our health care through a less-than-perfect system of health insurance and HMOs. And we are up against a challenge that is coming to be known as "covert rationing" -- a term coined Fixing American Healthcare's author Dr. Richard Fogoros, MD -- known as "DrRich." With covert rationing, not only do insurance companies do such obvious things as try to cancel policies when we're sick, but behind the scenes, they are doing whatever they can to systematically deny patients access to specific information, experts, specialists, procedures, treatments, and medications we may need.

But how do we learn about these covert tactics? How do we find out exactly what is going on behind the scenes in doctor's offices, hospitals, as well as the offices of drug companies, insurance companies and HMOs around the country? How can we know what the doctors and insurers and HMOs don't tell us -- and don't want us to know?

The answer: Fixing American Healthcare: Wonkonians, Gekkonians, and the Grand Unification Theory of Healthcare. Full disclosure here: I wrote the foreward for DrRich's book. More disclosure: I happily volunteered to do it, because as a thyroid patient advocate, part of my role for the last decade has been to help expose the many ways our medical system is failing us, as relates to our thyroid disease. I was seeing covert rationing in action -- I just didn't know what it was called until DrRich came along!

There's a bigger picture. Even when we're aware of covert rationing, how it works and the dangers it poses, we need to know what's next. What can we do to protect ourselves and our loved ones from falling victim to it?

That's where DrRich's book shines. Fixing American Healthcare presents what DrRich has called the Grand Unification Theory of Healthcare, GUTH for short. Grand it is, as it explains how doctors, patients, and health care companies all fit together and interact with each other, and how you can navigate that complicated system to make it work better for you, personally. And perhaps most importantly, how you can improve your own odds of getting well, staying well -- even surviving -- in the face of disease or illness. The book also looks forward and lays out a plan to explain how the system could be better if particularly improvements were made.

I know that those of us with chronic diseases can get into our own little worlds of doctors, medications, and treatments specific to our own condition. That makes it harder to step back and take a look at the bigger picture. But I truly recommend that you do, and Fixing American Healthcare is a good place to start.

I'm always urging readers and fellow patients to ask questions, insist on knowing your options, challenge the conventional dogma, and don't believe everything you hear -- whether it's from a doctor, a nurse, a pharmacist, a drug company ad, or a medical journal article. I'm always encouraging people to read, study, learn, and be educated, empowered patients. In Fixing American Healthcare, DrRich refers to people like me as "patients behaving badly." He doesn't intend it as an insult -- actually, it's a compliment. He's talking about patients who ask questions, who do their homework -- those of us who aren't walking around with their heads in the sand.

According to DrRich, if enough of us patients behave badly at the micro level, our grassroots effort will force the system to change at the macro level. So in this way, apart from writing to Congress, or voting for whichever Presidential candidate you think can save America's health care system, we may be able to have an impact on American's health care system.

So the best part is that each and every one of us is part of the solution -- in fact, the solution relies on us.

Whether you are concerned about the care about the quality of your own health care, or the status of health care in America -- or both -- a wonderful first step in your education is reading Dr. Rich Fogoros' Fixing American Healthcare.

Dr. Fogoros foregoes the usual cliches seen in proposing health care fixes. His analysis of our current system, including how we got here, is very insightful, and rings true to someone working in healthcare. American healthcare is very complex and won't be fixed in a sweeping reform, especially by the government, so it is difficult to propose changes in a scientific way, but he backs up his proposals with sufficient anecdotes and facts to make them plausible. A must read for someone interested in the future of our healthcare.

Reviewed by Richard R. Blake for Reader Views (11/07)


In "Fixing American Healthcare" Dr. Richard N. Fogoros provides important insight into the truth about American healthcare. Part I of the book provides a quick overview of grand unification theory of health care (GUTH), a conceptual model that describes the universe of possible healthcare systems. Part II applies the GUTH in an analysis of the current American healthcare system. Part III uses GUTH to develop a solution to the American healthcare crisis.

I found the graphics and the highlighted sidebars, consistent throughout the book, to be extremely helpful to my understanding of the quadrants of the decision-making process in healthcare today.

I was shocked and concerned when I read rationing in healthcare, the fairness argument, the cost of healthcare, fraud, and the demographics of an aging population. The chapter on "Covert Rationing and Managed Care" is alarming and should be a wakeup call to every American to the state of our healthcare system. Dr. Fogoros reveals how some health care plans have corrupted the ethical standards of the medical profession, and the introduction of antifraud measures have been instituted through government intervention. Dr. Rich, often thought to be a radical, speaks out about the impact covert rationing has had on medical science through the use of randomized trials, and end of life medicine.

On a positive note Dr. Fogoros offers a plan that moves toward the upper quadrant of healthcare system. His plan incorporates: individual autonomy and empowerment, open competition, and universal coverage. He maintains rationing must be decided in an open forum, and healthcare services must be prioritized according to clear ethical standards.

I personally found the chapter summaries helpful in reviewing and assimilating the wealth of information presented. The magnitude of information is daunting, however Dr. Rich has a unique communication approach that reaches down to the layman, while addressing the professionals directly involved in the process evolving in American healthcare today.

"Fixing American Healthcare" is a book that should be read by everyone enrolled in an HMO, or other healthcare plan, as well as every plan provider or professional involved in healthcare. Dr. Fogoros, M.D., has come up with priorities that every citizen needs to take to heart, to protect themselves and their loved ones in a time when they will need healthcare.

Received book free of charge.

Dr. Fogoros overarching message, that rationing exists already and must be openly addressed by any reform proposal is dead-on. When demand exceeds supply, as any high-school economics student will tell you, rationing occurs.

Beyond that, however, I found little else compelling in his treatise for reform. Much of what was presented was presented without reference or support. More could have been done to develop his position had he provided historical perspective, point and counterpoint arguments, or even more germane anecdotal stories concerning the current state of healthcare.

Instead, I found his positions to be shallow and poorly developed. "Redefining Healthcare" by Porter and Teisberg is a much richer (and more academic) book, while Halvorson's "Healthcare Reform Now!" and Gratzer's "The Cure" provide much more detailed insight's into healthcare woes without reading like a new car owner's manual.