Healthcare, Guaranteed: A Simple, Secure Solution for America [Paperback]

Ezekiel J. Emanuel (Author), Victor Fuchs (Foreword)

Book Description

Release date: May 26, 2008

America spends more than any other developed nation on healthcare—$2.1 trillion in 2007 alone. But 47 million Americans remain uninsured, and of those Americans who are insured, many suffer from poor health. In his ground-breaking proposal, Dr. Ezekiel Emanuel offers up a plan to comprehensively restructure the delivery and quality of our healthcare. By eliminating employer-healthcare and establishing an independent program to evaluate healthcare plans and insurance companies, he offers a no-nonsense guide to how government can institute private insurance options that will allow each of us a choice of doctor and plan.

With the rate of healthcare costs rapidly outpacing our gross domestic product, we can no longer afford to maintain our fragmented delivery of care, or entertain reforms that seek to patch, rather than cure, a fractured system. Accessible, straightforward, and revolutionary in its approach, Healthcare, Guaranteed is an inarguable guide to lasting healthcare reform.

Editorial Reviews

Review

Financial Times
"The best of recent books on this question is happily the shortest and clearest and comes out this month. I think it has the answer. The proposal laid out in Healthcare, Guaranteed by Ezekiel Emanuel ... has convinced me. Whether it will convince others is in doubt for reasons I will come to. But if you are going to read one book on the subject, make it Mr. Emanuel's."

The Spine
“How to Fix Healthcare: Readers may recall an article by Ezekiel Emanuel and Nobel Laureate in Economics Victor Fuchs in TNR a while ago about their truly brilliant and, in my view, ineluctable proposal for paying for basic health care in America. Some time later we alluded in an editorial to the provocation of their plan to all the other policy contortions that pass as the foundations of legislation. Zeke has now expanded this work into a book, Healthcare, Guaranteed, published by PublicAffairs. By the way, he has a PhD in political philosophy from Harvard and an MD from the Harvard Medical School, and is now chairman of the department of bioethics at the National Institutes of Health. Years ago, he started his career as an intern at The New Republic. What a story that would make: those who began right here. In any case, Clive Crook has written a rave review, a truly rave review of the book in Monday's Financial Times. Before you read the review and the book, you should know that at the base of the financial plan is a value-added tax. This is one value-added tax that you might like.”

Newsweek, June 1, 2008
"This Monday a modest little paperback will show up in bookstores offering a suggestion for health-care reform. It won't contain any wrenching human stories like those in last year's big health-care book, Jonathan Cohn's "Sick." It won't be accompanied by gonzo stunts à la Michael Moore's "Sicko." But "Healthcare, Guaranteed," by Dr. Ezekiel Emanuel, may nonetheless be the most exciting book yet to come out of the country's medical crisis. What it offers is a radical yet straightforward proposal, one a layperson can understand. If the complexities of health-care policy give you a headache, this book is aspirin. Read it twice and call your congressman in the morning."

Ezra Klein, American Prospect, August 12, 2008
“Healthcare, Guaranteed is beautifully written. It describes many flaws of American healthcare with maddening clarity. Some of its building blocks should be included in anyone’s health plan”

New England Journal of Medicine, August 21, 2008
"Healthcare, Guaranteed is a broad discussion of pervasive problems in our health care system, and it lays out a comprehensive plan to remedy them...Policymakers and all Americans troubled by [the system's] injustices will find Healthcare, Guaranteed a valuable resource for considering solutions to our health care dilemmas."

New York Times, 33: Zeke and book featured in piece about Obama’s health policy team
“Another influential voice at the White House is that of Dr. Ezekiel J. Emanuel, an oncologist and medical ethicist. Dr. Emanuel, a brother of Rahm Emanuel, the White House chief of staff, is working for Mr. Orszag and is sometimes described as the kibitzer-in-chief on health policy….In a book published last year, for example, Dr. Emanuel proposed “a guaranteed health care access plan,” under which all Americans would receive vouchers to enroll in health plans offering a standard package of benefits like those available to members of Congress. The program would be administered by a National Health Board, modeled on the Federal Reserve Board….”

About the Author

Dr. Ezekiel Emanuel is the Chair of the Department of Bioethics at the Clinical Center of the National Institutes of Health and a breast oncologist. A visiting professor at the UCLA, John Hopkins Medical School, and Stanford Medical School, and the author of several books, he lives in Evanston, Illinois.

Product Details

• Paperback: 240 pages
• Publisher: PublicAffairs; 1 edition (May 26, 2008)
• Language: English
• ISBN-10: 1586486624
• ISBN-13: 978-1586486624
• Product Dimensions: 5.5 x 0.7 x 8.3 inches
• Shipping Weight: 11.2 ounces (View shipping rates and policies)
• Average Customer Review: 3.9 out of 5 stars  See all reviews (24 customer reviews)
• Amazon Best Sellers Rank: #346,152 in Books (See Top 100 in Books)

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Most Helpful Customer Reviews

48 of 52 people found the following review helpful

2.0 out of 5 stars Utopian aspirations February 1, 2009

By Bookworm

Format:Paperback|Amazon Verified Purchase

This book came highly recommended to me as a practical, non-ideologically driven approach to our present healthcare delivery system woes. I agree with Dr. Emmanuel that our present system is not sustainable and will bankrupt our country if we continue on our present path. His analysis of our present system, its history, problems with employer based systems, and alternative approaches including mandate and single payer approaches is well written.

His ideas for how an ideal system might be constructed de novo are not without merit. However, his prescription for how to arrive at such an outcome is terribly flawed.

The book describes using private insurance companies which will compete for the business of every American who will receive a health care certificate, However, to avoid our present circumstances, Dr. Emmanuel proposes the creation of an entirely new infrastructure consisting of both national and regional boards which will be charged with ensuring quality of care, appropriateness of care, coordination of care, cost control, fair funding, dispute resolution, and choice. Dr. Emmanuel likely made a tactical decision to write a focused book without getting bogged down in details and at least some criticism could be deflected on this basis. However, this entire proposal is based upon infrastructure which does not exist and is not likely to come into existence for a long time.

Not only do organizations, which would be charged with these various tasks, not exist, the tools they would need to function would require years of investment and study. Outcome measures such as life or death or surrogate measures linked to the same (blood pressure, blood sugar, weight) are fairly easy to measure. As Dr.... Emmanuel points out much of medicine deals with chronic conditions and suitable outcomes deal with quality of life (pain, function, depression, malaise, or overall function) where metrics are much more difficult to assess. Much of current medicine practice is not strongly evidence based, but perhaps is still effective. The development of guidelines for what is acceptable for payment and the ongoing revision will be a Herculean task...not undesirable. Do we have the trained workforce in place? Do we have the information systems in place? I don't think so. Should we invest in building this? Absolutely, but don't expect to yield much fruit for a decade or more.

The author puts forth a system where 100% of Americans are covered.. specifically not 95% or 97%. if history is any guide, the marginal costs of those last increments will be frightfully high. Perhaps Dr. Emmanuel would be best served by remembering the adage perfection is the enemy of good.

Administrative cost control may sound attractive and have a certain populist bent. However, there is essentially no historical precedent for its success. From the Emperor Diocletian to contemporary New York City rent control, the results are all the same. This perhaps is the weakest link of the entire program. Who will set the prices and on what basis? Dr. Emmanuel speaks much about getting incentives correct. Without a correct pricing systems, incentives will always be wrong. It is a major problem with our current system.

On page 89 of this book is a passage which I believe reveals much about the author and his outlook. He states that "The current health care system to so complex that no single person understands all of its inner workings." This should not be a surprise that no single person understand how it works. Under no system can I imagine that this could be the case. The classic example of the lowly pencil as described by L.E. Read illuminates this for those who pursue the most rudimentary understanding of economic systems. No single person holds all the knowledge required to make even a simple pencil. It is inconceivable that any person could ever know all the inner workings of the entire health delivery system.

Making health care work is all about coordinating human efforts whether those efforts are made by physicians, those who answer the phones, those who negotiate the contracts, those who make the drugs, those who run the power plants to generate the electricity, or those who build and maintain the buildings. This coordination cannot be choreographed like River Dance by someone or some group which aims to understand and hold all the knowledge needed to make a large and complex organization work. That is not possible. Complex systems work because we all benefit from the activity of people who we will never know, who hold knowledge that we do not know.

Dr. Emmanuel rejects an further attempts at incremental change. We are implored to seize his vision of how an ideal system might look and push for immediate implementation. The political stars are now aligned (he is probably correct). The old system, unplanned and poorly engineered has almost no merits. Reading Dr. Emmanuel's rejection of incremental change reminded me of a passage from Thomas Sowell's "Quest for Cosmic Justice". "...that is, on the extent that what currently exists as the fruits of centuries of efforts and sacrifices is inferior to what they can produce in their imagination immediately at zero cost..."

Conceptually, some of Dr. Emmanuel's ideas have merit but there are big holes (thus the two stars). Logistically, the meritorious elements (investment in IT, health outcomes research, dumping of employer based insurance) will have to implemented incrementally to have any sort of impact and avoid too much top-down control. Investment in information systems is the key element that will allow for better systems to evolve. Dr. Emmanuel's universal aspirations will be unfulfilled. Ultimately, whatever is put in place will have to rely heavily on market forces to set prices, allocate scarce resources, and coordinate human activity. Man has found no substitute as of yet. Read more ›

26 of 30 people found the following review helpful

5.0 out of 5 stars Healthcare Reform, Understood June 6, 2008

By J. Russell Teagarden

Format:Paperback

If the United States hasn't passed the threshold of interest in health care reform, it must be darn close. Thus, now is the time for a clear and concise argument for any particular approach. Dr. Emanuel puts forward a specific proposal for health care reform that would address the seven goals he views as essential to success. His proposal has a strong appeal to common sense, and as such, it is one that will surely suffer the slings and arrows of outrageous ideologs. But, besides presenting his own distinct proposal for reform, Dr. Emanuel gives enough background on our present plight, along with a heuristic tool to equip us to evaluate the many different reforms out there already and the many yet to come. And, he does this without resorting to the use of extreme case histories, which have become the coin of the realm for authors of books on health care reform and which can have distorting effects on any objective analysis. Even members of Congress will not be able to get away saying they do not understand the concepts in this book.

This is an important book at an important time, and one that invites everyone into the health care reform debate whether they agree with Dr. Emanuel's proposal or not (count me among those who do). But, alas, important as this work is, it would never get Dr. Emanuel tenure at a major research university; it's much too accessible. He'll have to keep his current job.

23 of 28 people found the following review helpful

5.0 out of 5 stars Another excellent book on the healthcare system in the USA June 23, 2008

By Wendell Murray

Format:Paperback|Amazon Verified Purchase

Dr. Emanuel has been writing for some time on the subject of health care policy, usually in collaboration with Prof. Victor Fuchs, an eminent, but now-retired, health economist. Prof. Fuchs collaborated with Dr. Emanuel on this book, as Dr. Emanuel notes in it, but apparently the final version as published is mostly the work of Dr. Emanuel.

This and two other books that I highly recommend on health care policy, A Second Opinion and Health Care Policy, are written by physicians who know the science and practice of medicine as well as the economics of medical services. Another, also very good, book, Health Care Half Truths, is co-authored by a physician.

The book is fairly short, very well-written and well-organized. Dr. Emanuel spends the bulk of the book analyzing the current medical services delivery (and to a lesser extent the funding of the system), then at the end of the book makes cogent recommendations on reform.

Although my personal opinion on the particular form that the financing of medical services should take (I strongly favor a single payer/insurer scheme) differs from Dr. Emanuel's view, Dr. Emanuel presents compelling evidence why a single payer/insurer scheme is inferior to his recommendation: a voucher system that is funded by a dedicated value-added tax. Dr. Emanuel recommends the continued existence of private health insurers, asserting that their presence furthers choice and potentially at least engenders competition. My perspective is that private insurance simply has no place in a medical services system. The forces that drive private health insurance companies are immutable. Private insurers inevitably increase the administrative cost of effecting payment for services. They also have no ethical role as deciders of what treatment should occur.... In particular very expensive treatments with whatever probability of lengthening a patient's life should not be decided by an employee of a private company. They also will continue to seek to exclude the sick and try to enroll the healthy in their insurance plans. Those are unavoidable characteristics that, at least in my mind, argue for a single payer plan, regardless of the pitfalls that Dr. Emanuel correctly notes. Read more ›

6 of 7 people found the following review helpful

4.0 out of 5 stars retired private practice physician reluctantly agrees December 28, 2008

By RTK

Format:Paperback|Amazon Verified Purchase

I highly recommend Zeke Emanuel's book Health Guaranteed (we are on a first name basis since I watched him and his brothers being interviewed on Charlie Rose). The author is a practicing physician who outlines a very well thought-out system to fix many of the problems with our health care system. He compares his plan to other types of reform that have been proposed for the USA. He also explains briefly how we arrived at our health care delivery and financing system. Furthermore, he explains that the system, not the individuals who work within the system, that is to blame for its serious flaws.
Incoming Presidential Chief-of-Staff Rahm Emanuel's smarter brother's proposal includes: 1. guaranteed coverage (mandates and incremental reform fail here) 2. effective cost controls (mandates and IR fail here, too) 3. high quality coordinated care (incremental reform unlikely be effective; mandates and "single-payer" fail here) 4. choice of plans and providers (incremental reform and mandates only help some here, "single-payer" doesn't) 5. fair funding (mandates and incremental reforms fail here, and no fair funding proposal has been proposed for single payer) 6. reasonable dispute resolution (no such solution has been offered with mandates, single-payer, or incremental reforms, and here even Emanuel's plan is not bullet-proof) 7. economic revitalization (none of the other plans address this adequately) Emanuel's GHA proposal completely removes healthcare financing from employers, freeing them to do what they do best.
Dr. Emanuel answers so many questions that I cannot start to list them here. I kept reacting "yeah, but what about...?" and then he would answer. My only complaint is that for as short as the book is, it could have been much shorter, given the content.... It is very repetitive, but I understand that part of its design must be to sell an idea which has been presented and refined in recent years. I do wish he had compared and contrasted it with the existing systems of other developed countries (especially recently designed ones like Taiwan and Switzerland), but I will have to find that information elsewhere.
Given his connections, I trust that he will be given an opportunity to try to sell his plan to HHS Secretary-designate Tom Daschle, since it appears that Daschle's plan (I haven't read his book yet) is only an incremental reform plan, the likes of which Emanuel convincingly argues have always failed. Read more ›