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A Second Opinion: Rescuing America's Health Care Hardcover – April 24, 2007

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Editorial Reviews

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)
Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved.

From Booklist

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 Olson
Copyright © American Library Association. All rights reserved

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Product Details

  • Hardcover: 224 pages
  • Publisher: PublicAffairs; 1 edition (April 24, 2007)
  • Language: English
  • ISBN-10: 1586484818
  • ISBN-13: 978-1586484811
  • Product Dimensions: 8.3 x 6.1 x 0.8 inches
  • Shipping Weight: 13.4 ounces
  • Average Customer Review: 4.5 out of 5 stars  See all reviews (13 customer reviews)
  • Amazon Best Sellers Rank: #1,338,472 in Books (See Top 100 in Books)

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Customer Reviews

Most Helpful Customer Reviews

53 of 60 people found the following review helpful By Wendell Murray on June 22, 2007
Format: Hardcover Verified Purchase
I work currently as a consultant and entrepreneur in healthcare. Although my professional focus is specifically on electronic medical records and similar clinical information technology, I have read widely and done research in many aspects of healthcare and healthcare policy. Two other outstanding books which provide somewhat different perspectives. one written in the 1970s and one in the 1980s, but fully relevant today, are Who Shall Live? by an eminent economist, Victor Fuchs and The Social Transformation of American Medicine by an equally eminent sociologist, Paul Starr. I highly recommend both to anyone who reads Dr. Relman's book. There are many other good to excellent books on healthcare policy or specific aspects of healthcare financing and delivery.

Dr. Relman's book provides an excellent summary and analysis of the current healthcare "system" in the USA and recommends specific, fundamental changes to how the system is financed and how care is delivered. His background as a practicing physician, author, professor and medical journal editor in addition to his native intelligence and compassion for people stand him in excellent stead to write this book. Dr. Relman analyzes succinctly and clearly the various aspects of the healthcare "industry", then recommends changes to the "system". He correctly identifies and criticizes the universally negative role of the commercialization of healthcare in its various manifestations: for-profit hospitals, for-profit health insurers, procedure-based reimbursement for physicians and so on. His recommended solution is for a single payment and single insurance system that is funded primarily through federal taxes and administered by a centralized federal government entity.
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25 of 28 people found the following review helpful By Mr. William Y. Chan on June 15, 2007
Format: Hardcover
I think of this book in two parts, the first of which is analysis of how America's healthcare system became so inadequate yet so very expensive, and the second, the author's policy recommendations.

I've read a few books on this topic (including Critical Condition) and this is by far the best researched and level-headed. The author writes analytically by basing his assertions on numbers and throughout the book avoids being sensationalist. If you want to read one book about how the US healthcare system got to where it is now, this is it.

As for policy recommendations (which some other books don't even have), his recommendations are not necessarily the best, but then again any ideas for real reform are going to be controversial. At the least, they are thought-provoking.
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23 of 27 people found the following review helpful By Amazon Customer on August 22, 2007
Format: Hardcover Verified Purchase
This book is very persuasive and informative.
It is lucid with 200 short, well written pages.
It is full of facts and statistics and in spite of this it is very clear.
The arguments in it are extremely persuasive.
It is indispensable to read this book if one wants to understand the reasons we are in such a mess in health care and the optimal solution for the mess. Read it, you will be pleased and enlighten.
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16 of 19 people found the following review helpful By Loyd E. Eskildson HALL OF FAME on November 17, 2007
Format: Hardcover
Dr. Relman begins by asserting that America's health care system is much too expensive and its costs are rising at an unsustainable rate. Further, care is not available to many who need it most, and it is provided inefficiently and with highly variable quality.

By most measures of national health we rank well below many other advanced countries that spend less. Why is this? Dr. Relman believes it is due to the extent that private enterprise governs insurance and the provision of care, rather than public regulation and social need. Dr. Relman also sees physicians as too often part of the problem - in the U.S. they are more specialized, more likely to be paid on a fee-for-service basis, and more likely to have financial interests in facilities and products than their counterparts in other western countries.

Dr. Relman provides data comparing costs and outcomes from for-profit vs. not-for-profit entities. A 1997 study covering all acute-care hospitals found total hospital expenses/admission 10% higher in for-profits (administrative costs were 34% of the total, vs. 25% for non-profits; however, the for-profits provided less in-house clinical personnel. Thus, it is also not surprising that a 2002 study pooling all published data found the risk of patient death 2% higher in the for-profit hospitals.

Similarly, a 1999 published study of dialysis units found mortality rates 20% higher in for-profits, as well as the likelihood of being placed on a transplantation list 26% lower (would end the center's revenues). Prior studies also found lower expenditures on care within the for-profits.

Most nursing home payments are from standardized, per-diem Medicaid rates. A 1998 survey found for-profits with 40% more serious care violations than non-profits.
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12 of 15 people found the following review helpful By Tralfamidorian on March 30, 2009
Format: Hardcover Verified Purchase
At the beginning of my medical career, physicians feared inroads from socialized medicine. Three decades later we were pawns of capitalized medicine as insurers dictated what drugs to use, tests to order, and how long to keep a patient in the hospital. HMOs tout preventive care, and there are actually billing codes for this, but they are largely not reimbursed. During this time Dr. Relman held many prestigious positions that puts him near the top of the list of the most important physicians of our era. In this small book he succinctly outlines the history of patient care and the doctor-patient relationship over five decades. He reproves the entrepreneurial spirit that overtook physicians in the 1950s and how it created conflicts of interest. He describes how Medicare and Medicaid may have helped many patients, but almost destroyed the concept of a physician or surgeon giving free care to the poor. As insured health plans became more common in the 1970s and 80s, he castigates the unconscionable profit motive that effectively restricts health care to those who need it most. He outlines the socialized systems in Great Britain and Canada, good aspects and bad. Finally, he proposes a single payer plan for the United States.

It's hard to disagree with Relman when the current system is in such a mess. Nevertheless I maintain that any new or revised system should not eliminate entrepreneurship. Socialism has already demonstrated that if you fail to reward excellence and ambition, you only reap mediocrity.
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