From Publishers Weekly
Relman, a professor emeritus at Harvard Medical School and former editor-in-chief of the New England Journal of Medicine
, offers his diagnosis of what has gone wrong with American health care, along with a radical solution. In clear, eloquent prose, Relman explains how the rush to commercialize medicine harms both physicians and patients. Contrary to free-market dogma, Relman asserts, in medecine the profit imperative "increases costs; it may also jeopardize quality or aggravate the system's inequity." Relman's proposal: a single-payer insurance program supported by an earmarked, progressive health care tax, coupled with a reformed delivery system in which all hospitals would be not-for-profit and most physicians would be salaried employees of not-for-profit prepaid group practices. Relman acknowledges that today's political reality doesn't favor his program. Instead, it is fueling the drive for so-called consumer-driven health care (CDHC); in theory, by forcing consumers to pay for their own health care (for example, through high-deductible catastrophic insurance), CDHC promotes more prudent choices. But Relman calls CDHC "an illusion that bears little resemblance to the realities" for seriously ill patients.. He predicts that in a decade or so, when CDHC has failed to solve the health care crisis, the country may be ready to try his plan. (May 23)
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Relman's 60 years as researcher, clinician, teacher, government consultant, licensing board member, and editor in chief of the New England Journal of Medicine
give him enormous credibility on the subject of health-care reform. He's for national single-payer insurance but believes America's health-care system must change, too, or spiraling costs--and spiraling inequity--won't be contained. The greatest threat to U.S. health care, as he sees it, is the commercialization of medicine since the late 1960s, which, according to free-market ideology, should bring better care at lower cost but hasn't delivered (and never will, Relman believes). Doctors need to renew the sense of themselves as disinterested and compassionate healers rather than money-grubbing entrepreneurs. Relman proposes that most physicians be salaried by a national financing system, associate in self-run group practices to pool expertise and resources, and reclaim the professional self-regulation lost in a 1943 Supreme Court antitrust decision (exemption from antitrust law should be sought, Relman thinks). Everyone interested in its issues must read Relman's argument. Ray OlsonCopyright © American Library Association. All rights reserved