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Oxymorons: The Myth of a U.S. Health Care System Hardcover – September 27, 2001

ISBN-13: 978-0787959708 ISBN-10: 0787959707 Edition: 1st

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Product Details

  • Hardcover: 272 pages
  • Publisher: Jossey-Bass; 1 edition (September 27, 2001)
  • Language: English
  • ISBN-10: 0787959707
  • ISBN-13: 978-0787959708
  • Product Dimensions: 9.3 x 6.5 x 0.9 inches
  • Shipping Weight: 1 pounds (View shipping rates and policies)
  • Average Customer Review: 3.0 out of 5 stars  See all reviews (8 customer reviews)
  • Amazon Best Sellers Rank: #2,241,444 in Books (See Top 100 in Books)

Editorial Reviews

Review

"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

More About the Author

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.

Customer Reviews

Cure would put them out of business.
LAWRENCE J. OBRIEN
In the last 10% of the book Kleinke presents a solution that he does not tell how could ever be implemented.
M. Engel
If you buy and read this book, you will feel sick that you spent the money and the time on it.
Health Reader

Most Helpful Customer Reviews

22 of 25 people found the following review helpful By Dean Coddington on February 1, 2002
Format: 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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12 of 14 people found the following review helpful By M. Engel on September 23, 2002
Format: Hardcover Verified Purchase
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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3 of 3 people found the following review helpful By Reader on December 28, 2010
Format: 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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5 of 8 people found the following review helpful By A Customer on March 12, 2003
Format: Hardcover
Oxymorons is the first book that dares to look at the whole mess that is the US health care system without a political or business agenda. The author explains exactly why the system is stuck in political and economic gridlock, and how this gridlock actually benefits all those denouncing it the loudest - the health insurance companies, consultants, lawyers, and various business schemers who make money on the system's complexity and dysfunction. After discrediting so much of the nonsense that pundits and policy types like to generate about health care using real data, Oxymorons then dares to put forth a concise and simple plan for how the federal government and a non-governmental non-partisan health benefits task force (notably not any one state government or any newfangled managed care scheme) can change a few simple rules, establish some actual standards, and flush out a lot of the waste that defines the non-system of health care in the US. Kudos to the author for calling it like he sees it, and still having the guts to propose a real solution.
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