In this impassioned and often vitriolic book - a follow-up to the author's bestselling Bleeding Edge: The Business of Health Care in the New Century - U.S. health care industry expert J.D. Kleinke offers an unflinching look at our broken health care system. Throughout the book, Kleinke - who was once a vocal advocate of the managed health care system - explains what went wrong and attempts to answer such perplexing questions as:
Who's in charge of the American health care system? How does managed care work . . . or not work? Why have hospitals become so complex? What are the prospects for reform? Does the Internet change anything? Can we solve the growing problem of the uninsured?
"In his first book "Bleeding Edge," and his editorials in The Wall Street Journal and elsewhere were his argument on behalf of managed care, then "Oxymorons" is his mea culpa." (The Wall Street Journal, 12/11/01)
"The book is interesting, easy to read, and flows smoothly." (Journal for Healthcare Quality, October 2002)
Review
"J.D. Kleinke takes us on a fearless, often harrowing journey to the beating heart of the U.S. health care system, dispelling much of the conventional wisdom about what is wrong with that system, and focusing our attention on what will and will not work to fix it. Oxymorons is a comprehensive, uncompromising, and durable milestone in the annals of health policy, medical, and business literature." — John Iglehart, national correspondent, New England Journal of Medicine and founding editor, Health Affairs
Though it's my third book about health care, Catching Babies is my first published novel. I started researching and writing Catching Babies in 2003 as a non-fiction expose of the messy and often fierce technical, moral, and cultural conflicts at the heart of high-risk obstetric medicine and womens' health. Earlier study of the clinical practice patterns of childbirth and gynecologic surgery, combined with fortuitous friendships with physicians and midwives at critical moments in their training, coalesced in a stark idea I had yet to encounter in the health services literature: obsterics and gynecology stand at ground zero of a broader health care system pulled apart by polarizing forces that often have little to do with medicine, ethics, or patients' real needs.
Our nation's permanent civil war over abortion rights--electrified with religious passion, political hypocrisy, and gruesome rhetoric scarcely related to the clinical and behavioral realities of abortion--is the most glaring example of how America's philosophical and psychological conundra play themselves out in our health care system. Our neurotic obsession with breast cancer, highly out of proportion with the disease's actual prevalence and lethality, is one of the more subtle examples of the same phenomenon. The political, financial, and legal fights over the way we care for women and deliver their babies are the supercharged versions of this spillover effect, of America's most intractable conflicts perennially finding their angriest voices in arguments about health care. For clearest proof, one look no further than the often bizarre rhetoric spewed during the 2009-2010 health care reform debate - and the jarring fact that passage of the entire legislation hinged, in the 11th hour, on the funding of abortion.
Catching Babies was originally intended as a clinically detailed study of how these wildly problematic and deeply misunderstood medical subjects play out in the real world. It was conceived as the general public's first hard look behind the medical curtain into the practice, politics, and often bizarre culture of obstetrics and gynecology, as smashed together into a single specialty and "organized" in the most disorganized health care system in the world. It would also map out the complex turf war between most (but not all) OB/GYNs and the growing and diverse ranks of midwives.
As I dug more deeply into these cases and their often unlikely outcomes, I noticed the recurrence of an odd phenomenon that has confounded health researchers for decades: medical decisions and outcomes often have less to do with what the patient needs or even what society demands, and more to do with what's eating at the doctor, what's making the patient act out, or what's wrong back at either one's home. Fast-forward through a few rough drafts and a few rough years, and suddenly the medical cases I had assembled to illustrate some of health care's thornier problems struck me as far more interesting than the problems themselves. Many of the cases began and ended not with medical facts, economic prerogatives, or philosophical positioning, but with the full spectrum of human impulses: fear, control, compassion, repression, projection, self-hatred, self-aggrandizement, the search for meaning, the leap of faith. The human compulsions at work in these cases begged questions not only about a unique patient's irrational response to her medical situation, but also about the pathological drives of her caregiver.
Who exactly are these physicians, midwives and nurses all thrown--as forcefully as their pregnant patients--into a maddening system not of their own design and often in conflict with their most deeply held values? The systematic brutalization of these caregivers, in particular OB/GYNs during their long and difficult training, has turned many into heroes, some into detached technicians, and a few into monsters--each, of course, in his or her own exquisite way. The closer I looked for patterns, the more elusive such patterning became, until I had crossed, perhaps inevitably, into the realm of narrative fiction. Fast-forward through a few more years and my own terrifying encounter with the realities of the health care system, and the "medical cases" had metamorphosed into human stories.
Catching Babies still seeks to tell the larger story of how and why we deliver most babies and care for most women in the odd and often maddening ways we do. But somewhere in the long process of research, composition, revision and reflection, I discovered that the real story is best told through the myriad fractures and fissures of the human drama - through the doctors, nurses, midwives, patients, family members and others struggling inside the system as they have found it.
In the meanwhile, I'll still be struggling there too! In my "day job," I'm a medical economist, author, and patient advocate. I've helped create four health care information organizations, served as a health care business columnist for the Wall Street Journal, and advised both sides of the political aisle on health policy and legislation. In 2004, I established the Omnimedix Institute, the Portland-based non-profit that helped define, lead and safeguard the way for patients' access to their own medical information on the Web. I also helped establish Health Grades, a health care information company based in Denver, and HCIA (now Solucient), the nation's pioneering health care database research company.
I've been a regular contributor to the policy journal, Health Affairs and The Wall Street Journal. My work has also appeared in JAMA, Barron's, the British Medical Journal, Modern Healthcare, and numerous other publications. My first book, Bleeding Edge: The Business of Health Care in the New Century (Aspen, 1998) was a foundational textbook for many physician-executive MBA programs and health administration graduate programs in the U.S. My follow-up, Oxymorons: The Myth of a US Health Care System (Wiley, 2001), was a scathing and oft-cited criticism of what is wrong with the health insurance industry, and one of the earliest calls for systemic health care reform.
This review is from: Oxymorons: The Myth of a U.S. Health Care System (Hardcover)
Oxymorons is an outstanding book. It is very well written, interesting, comprehensive and insightful.
Kleinke makes a compelling case of what is wrong with our employer-based health care system (which he calls dysfunctional). He argues that the best answer for the U. S. is to get employers out of the picture and come up with a counsumer-choice plan (through tax credits or other means, consumers purchase their own health plans).
I especially liked Chapter 9 where Kleinke reviews where he is coming from. For a period of his life, he and his wife could not afford health insurance and were among the ranks of the uninsured. He tells what it is like to scrounge for antibiotics to fight a serious sinus infection, and other experiences in trying to receive health care without the ability to pay. Naturally, he is strongly in favor of some form of coverage for the 44 million people in the U. S. who are uninsured.
In the last sentence of the book, Kleinke says that only three elements in health care really matter -- patients, caregivers and medical technologies, including new drugs. I would add money, or finance. It seems to me that the payment system is the primary driver of the fragmentation we are experiencing, and that most proposals for change in health care relate to financing.
In conclusion, Kleinke has written a valuable book, and one that should generate plenty of discussion among those interested in the future of health care in the U. S.
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This review is from: Oxymorons: The Myth of a U.S. Health Care System (Hardcover)
J.D. Kleinke uses 90% of the book to describe the woes of the US healthcare system. The tone is very very negative and the author uses words such as "moronic" way too much. It is tiring to read so much unbalanced negativism. The critique may be warranted but is not properly structured; there is a lot of focus jumping from anecdotes about payers, providers, government, consumers, consultants, etc. Kleinke even tries to explain the problems using Complexity Theory about which he clearly knows nothing. (Attempting to draw analogies between our healthcare system and sets of stiff differential equations). In the last 10% of the book Kleinke presents a solution that he does not tell how could ever be implemented. It is a combination of old utopic ideas. In short, buy this book only if you need more reasons why our healthcare system is broke.
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This review is from: Oxymorons: The Myth of a U.S. Health Care System (Hardcover)
Oxymorons represents perceptions of the healthcare system at the time the book was written. When Kleinke wrote Bleeding Edge, many healthcare leaders felt that managed care was going to rejuvenate the healthcare system in the US. Oxymorons reflects the failure of managed care to deliver a fix to the system and the disappointment that everyone felt at the time. It should be read as a reflective work which chronicles a point in time. As such, it delivers an interesting perspective and one that is helpful to remember as we track the evolution of healthcare in the US.
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First Sentence:
In 1943, at the height of World War II, a forty-eight-year-old shipyard laborer had a major heart attack, spent a week in the hospital, and was unable to return to work for two months. Read the first pageKey Phrases - Statistically Improbable Phrases (SIPs): (learn more)
standard benefits plan, tax parity, disenrollment rates, benefit plan designs, actual medical care, connectivity companies, benefit mandates, managed care industry, health insurers, charity care, health insurance market, reimbursement rules, managing care, giveaway programs
Key Phrases - Capitalized Phrases (CAPs): (learn more)
United States, Wall Street, Community General, Health Affairs, Joe Olson, Modern Healthcare, Twaddle Echo Factor, New York, University Hospital, Inertia Factor, Second-Class Medicine, New England Journal of Medicine, Consumer Reports, Elaine Chang, Leapfrog Group, Peter Agnello, United Healthcare, World War, Big Brother, John Cook, Richard Scott, Supreme Court, The New New Thing, The Social Transformation of American Medicine
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