A Second Opinion: Rescuing America's Health Care [Hardcover]

Dr. Arnold Relman (Author)

Book Description

Publication Date: April 24, 2007

The U.S. healthcare system is failing. It is run like a business, increasingly focused on generating income for insurers and providers rather than providing care for patients. It is supported by investors and private markets seeking to grow revenue and resist regulation, thus contributing to higher costs and lessened public accountability. Meanwhile, forty-six million Americans are without insurance. Health care expenditures are rising at a rate of 7 percent a year, three times the rate of inflation.

Dr. Arnold Relman is one of the most respected physicians and healthcare advocates in our country. This book, based on sixty years' experience in medicine, is a clarion call not just to politicians and patients but to the medical profession to evolve a new structure for healthcare, based on voluntary private contracts between individuals and not-for-profit, multi-specialty groups of physicians. Physicians would be paid mainly by salaries and would submit no bills for their services. All health care facilities would be not-for-profit. The savings from reduced administrative overhead and the elimination of billing fraud would be enormous. Healthcare may be our greatest national problem, but the provocative, sensible arguments in this book will provide a catalyst for change.

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

See all Editorial Reviews

Product Details

• Hardcover: 224 pages
• Publisher: PublicAffairs; 1 edition (April 24, 2007)
• Language: English
• ISBN-10: 1586484818
• ISBN-13: 978-1586484811
• Product Dimensions: 8.2 x 5.8 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: #779,779 in Books (See Top 100 in Books)

More About the Author

Discover books, learn about writers, read author blogs, and more.

Customer Reviews

Most Helpful Customer Reviews

49 of 55 people found the following review helpful:

5.0 out of 5 stars Best book on healthcare policy, June 22, 2007

By 

Wendell Murray (Kennett Square PA USA) - See all my reviews

Amazon Verified Purchase

This review is from: A Second Opinion: Rescuing America's Health Care (Hardcover)

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. He recommends the establishment of a federal agency along the lines of the SEC or the Federal Reserve System to oversee healthcare policy and healthcare delivery. He proposes that physicians work as salaried employees of multi-specialty practices. He dedicates a chapter to analyzing and discussing the Canadian healthcare system. He correctly characterizes the Canadian system as a good model - in most ways - for the USA.

The book is opportune and most likely was published now because healthcare policy is a key issue at least for Democratic contenders for the Presidential election in 2008. Dr. Relman's proposals for reform are materially superior to the plans proposed by all candidates with the possible exception of Dennis Kucinich who co-authored a bill (H.R. 676) a few years ago that has some of the same features as Dr. Relman's proposal.

There is so much misinformation deliberately disseminated by all the beneficiaries of our current poorly-functioning system - ranging from the AMA to large drug companies to private insurers to large for-profit hospital chains - that it is very helpful to have a relatively short, well-written book that accurately describes the current system and makes comprehensive, intelligent recommendations for changes to it.

23 of 26 people found the following review helpful:

5.0 out of 5 stars Level-headed analysis, June 15, 2007

By 

Mr. William Y. Chan (San Francisco, CA) - See all my reviews
(REAL NAME)   

This review is from: A Second Opinion: Rescuing America's Health Care (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.

23 of 27 people found the following review helpful:

5.0 out of 5 stars Best Recent Book on Health Care Policy, August 22, 2007

By 

Ramon V. Leon (Knoxville, TN USA) - See all my reviews
(REAL NAME)   

This review is from: A Second Opinion: Rescuing America's Health Care (Hardcover)

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.