Customer Reviews

Health Care Meltdown: Confronting The Myths and Fixing Our Failing System

5 star:		(15)
4 star:		(2)
3 star:		(2)
2 star:		(0)
1 star:		(0)

 

 

This book is is very timely and amazingly lucid on a topic seen by many as beyond comprehension. LeBow has sifted through the complexity and pinpointed the key players and the major causes of a system that has "melted down" - i.e. become dysfunctional for millions of Americans. The book documents how vested interests - people who make a great deal of money by maintaining the status quo - have systematically worked to keep Americans clueless about the extent of the health care meltdown, the causes of the meltdown, and the real story about feasible alternatives. One of the greatest values of the book is found in the opening chapter that identifies and examines thirteen myths that have been perpetuated about the American health care system. LeBow's contention is, quite correctly, that unless these myths get debunked, Americans are not likely to have the necessary will to fix the system. In fact, one of the myths is that old adage "We don't need to fix what isn't broken" applies to our health care system. LeBow's personal accounts of patients' experiences with our system illustrate poignantly just how broken it is. Fortunately, LeBow goes beyond the compelling critique to offer a solution, in the form of a single-payer, single risk-pool model. Recognizing the extent to which interest groups have propagandized the American public against such a model, he argues effectively that this is the ONLY model that will allow this country to resolve its access problems without spending even more on health care than we do already. His arguments are strong, his personal illustrations reinforce his points in well-chosen fashion, and he offers hope for something better. His book is somewhat of a primer for those who are motivated to work for change at a grass roots level, as well as at a macro level. And the reading is easy, on a complicated subject, including nice tight summaries of key points at the end of each chapter. Very worthwhile reading.

As an Adjunct instructor in the Concordia University system, I have had the opportunity to encourage my MBA students to read this book for my Special Topics in Health care class. After reviewing other possible textbooks during the last 6 months, I have decided to now use this text as the basis for my 8-week adult education class. Offering ample examples and 'myths' that portray our fractured health care system of today, this author has summarily provided a springboard for ongoing conversations and possible answers for this country. Granted all, the HC system will not be corrected for some time, but an accounting will be made when the public becomes a focused participant at the table.
As health care professionals, it is our responsibility to study, learn, participate and educate others, as well as ourselves.
This will begin that process and it will be well worth your effort and consideration.
Thank you
ESchwarz, RN, MBA, CCM

In more than 20 years teaching a course focusing on analysis of American health care history and policy, I have yet to discover a more persuasive diagnosis of our health care delivery system's ills or a more convincing case for how to cure them. Dr. Lebow brings to this examination direct experience as a practicing physician from which he draws numerous stirring personal accounts. To his clinical perspective, he adds an extraordinary command of the broader economic and political issues essential for understanding the context and causes of America's current health care crisis epitomized by the alarming number of our country's uninsured--now about 44 million and growing. The book is honest, engaging, and sure to stimulate discussion with its clear prescription for change. With lively prose and strategically placed humor, he makes complex matters understandable. His humanity and passion are the earmarks of a brilliant teacher. Regardless of how deeply you presently understand America's health care system, you can learn from this book. And regardless of your political inclinations in respect to his advocacy of a single-payer solution, you can't ignore his meticulous presentation of the facts or the relentless logic of his conclusions from them.

I'd like to give this book 4 stars, but there are just too many holes for me to do so. Dr. Lebow presents many important points, but the book simply is not the answer to our prayers regarding the current healthcare mess.

As Dr. Lebow points out, in the health insurance industry, competition among health insurers has led to less efficiency rather than more efficiency. 10 different credentialing applications, 12 different contract types, no standardization whatsoever and an administrative mess for any doctor who doesn't have the luxury of a seasoned healthcare administrator in his office. Add to that the eligibility trouble. Multiple phone calls for every patient to check eligibility for every appointment. Worst of all, the current health insurance system provides no incentive to managed care to pay for preventive care.

These are the issues that single-payer would fix for the insured population, saving billions of dollars. Dr. Lebow is right on, though I wish he spent as much time on eligibility and insurance company hassles as he did on preventive care. He also does great work in presenting the myths of healthcare today. Many of them can't be repeated enough (like the corporate welfare given to prescription drug companies).

But I have several issues as well.

My biggest complaint is that his solution only delays the inevitable a little longer. He deals only with the healthcare funding system and has little to say about the healthcare delivery system. "Market Driven Healthcare" by Regina Herzlinger and "From Chaos to Care" by David Lawrence offer real long-term solutions to the healthcare delivery problems we face in our current environment. Unless those market principles are imposed on healthcare, single payor will only delay the final implosion of medical care. Once the financial gains from single-payor healthcare are realized and exhausted, the costs will continue to spiral out of control.

Another issue is that he gives few details in the "how" of his solutions. Focusing on prevention and public health is a good and obvious point. Everybody agrees on it, but I don't think simply saying "it will happen once a grassroots movement demands it" is sufficiently descriptive of how he sees prevention and public health becoming the standard. Who will implement it? How?

Because of these problems, Dr. Lebow does not make a convincing case to those in power that change is good for them. He persuades the persuaded brilliantly, but I can't imagine why someone who opposes single-payer would change his mind after reading this book. And those in power are whose minds must be changed if change is to come.

The way I see it, healthcare as we know it is a very young industry. Only 16 years ago, managed care was almost an unkown in the healthcare world. Now, it dominates. Unfortunately, that insurance model grew so quickly there was no way anyone could have planned it properly. Imagine how the computer industry would have destroyed itself if it weren't entirely made up of systems thinkers known for their planning ability. ISO-9000 was brilliant, as is settling on the PC as the standard. Healthcare needs, and is getting, more of that now. HIPAA and state-mandated credentialing applications perfectly demonstrate the government's role in fixing healthcare. It should be a regulator, an agent for the lowly to make sure the big guys play fair, and a standard-setter to make commercial insurance more efficient. But it's entirely too early to declare the market dead and single payer as the only way out of this mess.

Most of us are aware that there are serious problems with our health care system, particularly that health care costs are out of control and that far too many of us are without any health care coverage. But because of our own relatively good health and complacency with the health insurance coverage that we have, we tend to ignore the crises in funding and access to health care as we concern ourselves with our other daily routines.

In "Health Care Meltdown," Robert LeBow explains precisely why our complacency potentially exposes us to financial disaster. Any one of us at any time can develop a serious acute or chronic medical disorder, and only then will it be discovered that current insurance plans are using devious methods to shift costs to their own beneficiaries. It is a great irony that a leading cause of personal bankruptcy is medical bills that mount up for individuals who believed that they had adequate coverage. Shortly after completing this book, Robert LeBow became a quadriplegic as the result of a freak bicycle accident. He has "excellent" health insurance, but is close to depleting his lifetime benefit. Then he'll have no insurance at all. Little did he realize that he would become a victim of the health care meltdown that he so aptly describes.

Robert LeBow explains how we have more than enough funds and health care capacity to provide comprehensive services for everyone. But because of our sick system of funding care, our resources are diverted to the superfluous middlemen in the system, depriving many of us access to essential health care services. Many myths about health care funding prevail, but Bob explodes those myths, revealing to us the real world behind our nefarious mechanisms of shifting our health care funds from patients to those who benefit from the administrative excesses of our system.

But there is hope. Robert LeBow explains precisely how we can reform our system to ensure access for everyone to comprehensive health care, without spending one more penny than we do today. It only requires that we understand what is going on, and what can be done to correct the problems. "Health Care Meltdown" is essential reading for each and every one of us who believe that we should all have life-long, affordable access to comprehensive health care services.

Health Care Meltdown: Confronting The Myths And Fixing Our Failing System by Robert H. LeBow (former Medical Director of an Idaho community health center for more than 25 years and who was paralyzed in a cycling accident shortly after completing this book) is a clarion wake up call focused upon the medical care system's rampant excesses, over billings, neglects, and quagmires that floods the American health care system to near incapacitation. Over 40,000,000 Americans have no health insurance. This places an unsupportable burden on Emergency Room Care (one the most expensive health care provider resources), and while money is in unnecessary and wasteful bureaucratic and law-suit avoidance oriented testing, far to many people simply go without the medical service they desperately need. A sharply worded criticism that also offers models for reform and improvement, Health Care Meltdown should be mandatory reading for health care providers, citizen health care activists, anyone charged with the responsibility of developing policies and guidelines for managing health care services.

Bob Lebow has lucidly highlighted the failure of our chaotic healthcare system. He offers in an excellent literary style the flaws in applying a market-driven approach to healthcare and provides practical and ethical solutions to the mess which confronts us. Publically financing healthcare while maintaining individual private practitioner control promotes freedom of choice for patients, and guaranteed care for all of us. Furthermore, this would eliminate the ethical dilemma presented by our system where financial status dictates quality of care, and insures that less fortunate individuals receive inferior care or none at all.

Dr. LeBow's book about the current state of the health care system is a 'must read' for anyone wanting to know the real story. His style is forthright, aggressive, and accessible, using patient vignettes to illustrate it's points. It is a quick read, and gives the reader a human perspective on the deficits in our health care system.

Anyone interested in health care in the United States needs to read this book. Dr. LeBow takes lessons learned from his years of practice in rural Idaho and looks at the human costs of not having universal healthcare for all of our people.

Dr. Lebow's passionate plea for health care reform, although written five years ago, still resonates today. He has seen it from the trenches in public clinics. To the critics of health care reform, he will be labeled as a socialist which is nonsense. He effectively points out that insurance and pharmaceutical companies lobby for protection of their obscene profits. Dr. Lebow astutely points out many of the myths of the current system. As the chapters progress he is sometimes repetitive and preachy, but this can be overlooked.