Customer Reviews

Health Care Will Not Reform Itself: A User's Guide to Refocusing and Reforming American Health Care

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With all the current interest in health care reform, I found this an excellent book to provide hope and background for those of us who favor health care reform under President Obama. Written by the current CEO of Kaiser Permanente, the book systematically provides areas where cost-savings can be achieved in an easy-to-read-and-follow format.

His first and, perhaps, most important suggestion, is, to me, a blockbuster. Per Halvorson, if we get everyone in our country insured, this, by itself, should reduce the average annual cost of health care insurance to a family of four by about $1,200. (The average cost to a family, he tells us, is now about $12,000 per year.) This cost reduction, if it could be sold to more folks in the current health care reform debate, could, of course, be a very strong argument in favor of the "public option." But Halvorson does not really tell us exactly where this savings would come from. He infers that it would be in the insurance company premium, itself. But the book is embarrassingly short on much of any criticism of insurance companies, their CEO salaries, their profits and administrative costs, etc. It is one of the flaws of the book, for sure. Perhaps the only flaw.

The strength of the book, again, is to give us hope that overall health care costs can, over time, be reduced and controlled. To get another $1,300 annual reduction, on top of the $1,200 above, he says "We need to reduce the costs of care by improving care." Among his suggestions for this are:
* Focus on the conditions that cost the most within the chronic conditions
* Reduce the number of doctors, now averaging 17, for patients with multiple chronic conditions
* Decrease the number of medication errors and post-operation infections
* Improve the "linkage" among doctors, especially the specialists, and, especially, when one patient has multiple specialists
* Reduce the payments to specialists, relative to those for primary care doctors
* Provide financial incentives for prevention of sickness and disease
* Build strategies for containing costs of age-related conditions via evidence-based methodology

As the CEO for Kaiser, Halvorson cites his organization as benefitting from its "vertical integration," which ensures that doctors with different specialties work effectively together. He also raves about Kaiser's Electronic Medical Records system, which is the result of a $4 billion data processing effort that "is probably the biggest single business systems project ever done in any industry anywhere in the world."

Halvorson thinks that we need universal care in our country. As part of his push for it, he tells us we need the "Double Mandate:" First, everyone must buy coverage, and, second, every private plan must sell coverage to anyone who applies. The question that leaps out at this point, of course, is why Kaiser does not immediately announce that it was complying with the second mandate? He goes on to tell us that "risk screening" is only implemented on about 5% of those who seek insurance, and that none of those are within employer-provided group plans. He says that the health care industry should be happy to welcome into existing insurance pools the 5% of folks now being denied individual insurance plans. O.K., Kaiser, how about starting this off first? Seems easy enough.
Also, Halverson at this point does not mention that all the other developed countries add another mandate, that of government oversight and control of the costs of drugs, procedures and services. Later, he calls for a National Commission on Health Care Costs, but he stops short from suggesting that it should have direct controls over the components of health care costs.

Near the end of the book, he tells us that "Premiums are always based on the average cost of care." I don't buy it. He obviously avoids any discussion about profits by insurance companies, including Kaiser, which apparently, as a not-for-profit, rakes in about $2 billion in a good year for its deferred earnings. And, later, he says, "we need to look at every category of spending - fees, hospital costs, drug costs, imaging costs, new technology costs, etc." Conspicuous by their absence are insurance company overhead costs, overblown CEO salaries - not necessarily at Kaiser -- and profits that go to shareholders or deferred earnings.

Says Halvorson, "Health care in America is comprised of hundreds of thousands of unrelated, unlinked, financially self-contained, self-focused, and self-optimizing business entities that are each set up to generate revenue and create financial success for themselves..." That sounds like an industry with opportunities to reduce costs and to, at the same time, improve its value to consumers.

Again, I recommend the book for those looking for more information on how the American health care industry can be reformed for the "public good."

This book is probably the best explanation I've read on why we have the health care mess that we do in the United States. We read a lot about health care in the papers and hear stories on the news but few articles get into the real reason for the problems and even fewer into what would be a really good solution. I learned far more from this book than I have from all the other sources put together. It was interesting in the way it discussed the health system in this country compared to that of some of the other countries in a manner that was easy to understand with many examples.

I didn't realize until I finished the book that George Halverson is the CEO of Kaiser Permanente, the largest not-for-profit health plan and care system in America with over eight and a half million members. My sister worked for a company that was insured by Kaiser and she was very impressed by the electronic medical record system at Kaiser. She was able to see all of her medical test results as soon as they came back from the lab just by logging onto a password protected website and was able to see comments from any doctors or specialists she had seen in the system. She was also able to make doctor's appointments online and email her doctors. They in turn could see any medications prescribed by any of the other doctors and any comments on any condition. Halverson talks about such a system for everyone in the country and mandating that everyone be insured which would help to slow down the increases in the cost of healthcare.

According to Halverson, at least 50% of the visits to an emergency room for asthma attacks don't need to happen. Treatment for the condition varies so much from doctor to doctor and the outcomes can be very different. But hospitals and doctors in our system don't make as much money by preventing an attack as they do with a visit to the emergency room. Our system makes big money on procedures after a crisis rather than preventing them from happening in the first place. That's one of the shortcomings of the system we have. Using Kaiser an example, Halverson shows how changing how we treat just four or five conditions could save huge amounts of money that we spend now on healthcare.

Probably one of the things that surprised me the most is how many mistakes and bad outcomes we now have in hospitals in this country. What I thought was a fairly consistent system turns out to actually be very haphazard in many ways. Most medical records are now kept on paper, in files, in each doctor's office and aren't shared with any other doctor who might be treating the patient. The results of treatments also aren't shared among other doctors in most cases, so we don't always have a consistent way of treating conditions. Electronic records of outcomes with different treatments would help to establish new and better ways of treating specific conditions because doctors would have a larger sample of outcomes to compare.

I didn't find this book to be political or partisan, but rather some very good ideas of how to change our current system and make it better for everyone involved. I hope a lot more people read this book.

George Halvorson is on to something here. You're never going to reduce health care costs until you improve health care quality. Providing better, proactive or preventive care reduces the severity of disease, complications, hospital stays, etc. When you provide quality care to a patient, his or her lifetime medical costs go down. When you provide poor quality care, the costs go up because the patient is sicker and needs more care. It is pretty simple when you think about it, but the current U.S. health care system does not provide incentives for doctors and hospitals to provide quality care, it only provides incentives (in the form of payments) for the volume of care they deliver.

If health care providers care about reducing costs now, there are actually steps they can take today, as Halvorson describes in chapter 3, "Set Goals and Improve Care." There are a handful of preventable medical events that are enormously expensive because of the hospital stays and expensive treatments that go with them. Picking three examples, Halvorson says we can reduce by 50 percent the number of kidney failures, asthma crises and heart attacks. With rare exceptions, no one in America should end up in an emergency room with an asthma crisis, because it is preventable through education and preventive care. At a local level, health care providers can start planning today and setting goals to reduce these incidents.

But as much as I like George's book and approach, I fear that the majority of our nation's health care providers are more concerned about their bottom line than patients like you and me.

Mr. Halvorson succeeds yet again. In this 4th book of his healthcare trilogy, Mr. Halvorson presents the problems of our current healthcare system and prescribes simple and highly effective remedies in layman's terms. This is a great book for people who don't know much about healthcare reform and for those people who think they have all the answers. It shows that we need universal coverage (not necessarily from a single payer system), vertically integrated health IT, better communication, patient centered service, and we need to instill a healthier American culture. Great book, Mr. Halvorson. I highly recommend it.

Wonder why the the Affordable Care Act is 2600 pages in length and requires years to write proceedures to make it operational? Halvorson provides a cogent executive summary of why this huge government program is needed. But the path is hazardous and the guides are blind. An excellent, well documented read. Federal intrusion may not be affordable and is ripe for a host of unintended consequences. (Added challenge: find the 2 graphical & 2 text typos.)

One of the most compelling reasons to read Health Care Will Not Reform Itself is the fact that it is written not by an academician, politician or even a doctor. It's written by one of the people at the very top of the health care industry, George Halvorson, CEO of Kaiser Permanente. He is one of the people making real decisions about what happens in your hospitals.

For a businessman (technically KP is a non-profit although it runs about $1 billion in the black) whose sole interest is ostensibly money, Halvorson delivers a very impassioned case for better and cheaper care. The reader can sense the smoldering anger Halvorson harbors for outdated and inadequate health care delivery with headings like 'Paper Records Are Entirely and Almost Criminally Inadequate'.

Another frequent target of Halvorson's tirades are re-imbursement mechanisms and payment structures. Halvorson argues that hospitals who prevent complications don't generate a billable event and thus don't generate cash flow. It is because of this, he says, that 'Screw-Ups Can Be Profitable'. This is the logic behind the title of the book. Since improving quality of care may be financially straining on hospitals, it won't happen on its own. One step Halvorson argues for is phasing out re-imbursement of events that are known to be preventable.

The book isn't entirely inflammatory. Halvorson highlights some spectacular accomplishments as well. For example, he says, a new 'care registry' implemented by KP in Colorado resulted in a reduction in the death rate from two major heart conditions of 72% in a couple of years (p. 72). One of the books central points is that better and more mobile health records are necessary to improve care. In this age of co-morbidities when the sickest patients see an average of 17 doctors every year (p. 5), Halvorson says doctors need access to 'all of the information about all of the patients all the time' especially at the point of care.

For most of the book, readers who have been looking for a practical guide to improving health care will not be disappointed. It delivers facts, figures and opinions in an impassioned, though businesslike manner. Halvorson doesn't dazzle with charm but he delivers where it counts, and does it in a quick 139 pages. Where Halvorson may lose some readers is late in the book when he begins advocating for public fitness and nutrition programs and points to Finland as a success story. It is disconnected from the rest of the book and using Finland as a model is a political non-starter in the US. Overall, HCWNRI is great, informative, and easy reading. Recommended for workers in health care as well as anyone interested in what can be done to improve care.

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Medical Nemesis

It is a short read compared to most books on this subject. The book is crisp and focused right on all aspects of our problem with health care in the United States. The subject is handled objectively without undo spin. It also has excellent suggestions about how concerns might be resolved. It was written before the 2008 presidential elections and I still find is helpful in defining the problems objectively minus the flood of twisted tales we are still drowning in that only prevent fixes that must be made. Our present situation is not sustainable and is perceived by the rest of the developed countries in the world as being very difficult to understand what we are doing in this country.
The author has a wealth of experience beyond his present CEO position. He has been involved in the improvement of health care here and around the world for decades.
If the author will forgive me, I must mention the more recent publication of " Healing America " by T. R. Reid which to my perspective further complements "Health Care Will Not Reform Itself".

George Halvorson gave a fascinating podcast interview on this book last week at BEA in New York City. It's a must read for anyone who cares about the future of healthcare in this country.

Check this out...
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Excellent and easy read. Honest look at health care. Helped me tremendously in focusing on the care provided by caregivers for my mother.

I'm a satisfied user of K-P Mid-Atlantic, Medicare component.

I moved from rural Virginia two years ago where I experienced good, but fragmented medical care, unfortunately care that required lots of driving to various appointments and facilities. Now I can take a bus and get lots of basic care at a central K-P facility in downtown Washington, D.C. Get your blood work, physical, X-rays, etc. Seeing a specialist is a little trickier, since I've chosen a K-P urologist/oncologist who practices in Falls Church and I've had to go to Tyson's Corner, VA, for treatment of prostate cancer at a private clinic. Nevertheless, the drives in each case are less than 30 minutes.

Overall, the availability of virtually all my medical record stuff online, combined with centralization of medical services plus ready access via e-mail to K-P physicians and information, makes for an entirely new way of doing my medical business. Of course, K-P's business model smacks of socialized medicine, because one's choice of doctors is limited to those who are employed on a salary by K-P. You will not find hot-shot specialists who drive Lexus automobiles and golf at fancy country clubs on the K-P roster of physicians. On the other hand, K-P obviously works hard to keep its salaried physicians abreast of new developments in treatments, since this is where cost savings can be large.

So I think Halvorson offers a useful model for the delivery of health care. But for the life of me I do not see how his model can be adopted nationwide. Mr. Halvorson says it can be done, but given the thousands of individual practitioners and the utter lack of interoperable databases, I don't see it happening. My advice: join K-P if you can and thereby avoid to a great extent the tremendous disruptions that are on the way in the U.S. medical care business.

I do offer an important caveat: while the scientific care available from Kaiser-Permanente is excellent, there is no personal care. The role of the "Primary Care Physician" (PCP) is strictly limited and, so far as I can tell, none of the specialists with whom one comes in contact ever speak to the PCP or to one another. The K-P medical system turns out to be a classic "stovepipe" operation, where care is totally uncoordinated. No one has an overall view (or responsibility) for your personal health, hence there's no one to answer the question, "How am I doing, doc?". If you are up to picking and choosing among the specialists available and coming up with your own courses of treatment, you're in fine shape. Just don't expect any significant, long-term interaction with any of K-P's doctors.