12 of 15 people found the following review helpful
The American Enterprise Institute has come out with a variety of very helpful books on reforming health care in America. This fine book takes a look at overall health care spending, the profit motive, and competition in our current system versus single payer systems such as Canada. The current debate in our society seems to focus on two extremes: single payer versus a totally free market (actually the latter is hardly ever advocated - but those promoting the former usually characterize anything with private choice as free market).
The book has five chapters plus a brief final chapter titled "Conclusions and Policy Implications". There are many pages of endnotes and references and an index.
The first chapter examines the claim that the system of healthcare in the United States overpays for worse outcomes than other developed nations. The authors show that the shape of the regression line chosen can make the premium paid in the United States very great or not so much. Then they examine the outcomes controlling for race. Frankly, I was shocked by how poorly African Americans fare in death rates and longevity. Then they controlled for deaths unrelated to healthcare such as intentional injury (including murder) and accident, and things normalized quite a bit. Still not equal or perfect, but much better.
The reality is that insured people do have generally better health and longevity than uninsured individuals. So, why not do a single payer system and insure everyone? It turns out that the supposed universal access promised in other countries, including Canada, is in practice "equally limited access for all". You might personally still prefer that to the highly unequal access in the United States, but you should read this book to really understand the implications of the change. We have this fantasy about the Canadian system, for example, which the people experiencing the system do not share. In many ways the Canadian system is frozen in the 1960s and there are rising complaints about the politics being played with people's health care. Never mind the waits of the patients in single payer countries.
The authors then examine the impact of profit in health care. It turns out that it spurs efficiency, innovation, and more care for more people. When institutions are given tax credits, for example, to care for the indigent the amount of care given extends only to the value of those credits and provided with less efficiency. They also examine the notion of specialty hospitals and find generally positive effects on the delivery of health care. They trace the history of the general hospital and then demonstrate why it isn't the one and only true model of patient care.
Getting more people insured has to be one of the nation's health care objectives, but it isn't obvious that mandating a one size fits all insurance is the way to go. The authors show how managed care and regulation add costs and less care than the kinds of efficiencies and innovation that can come with sufficient competition, even with its "wastefulness". I would also recommend "Healthy, Wealthy, and Wise" also from the AEI on free markets and health care.
Another of the things assumed true in our current debate is that Direct To Consumer Advertising leads to wasteful spending by the drug companies and over prescription by doctors. The evidence provided in this book show this to not be so. There are also positive effects when people who can be treated go to the doctor instead of living with the problem because they are unaware that they can be helped.
Obviously, I can't present all the authors' evidence and arguments. Since the book is just more than one hundred pages and health care is such a vital issue, I would encourage you to read this with an open mind. Is it really so hard to believe that reducing regulation, demanding greater transparency in evaluating health technologies and between insurers and their enrollees, getting a bit more price sensitivity into insurance pricing, and reforming government insurance to be more sensitive to market forces would improve health care for everyone? It works in every other aspect of our lives where it is tried. Why do we think health care is so different?
13 of 19 people found the following review helpful
on October 8, 2009
Be aware that one of the most surprising conclusions in the book - that the U.S. healthcare system, when you take away injuries and accidents, actually has the best life expectancy in the world - is based on a very clever twist of the underlying data.
Instead of looking at real-world life expectancy and then taking away deaths due to injury and accident (a method that puts the U.S. at 17th) Mr. Ohsfeldt uses an equation that begins with an ESTIMATE of life expectancy BASED ON GDP PER CAPITA (a measure of how rich the country is), not on actual real-world data. Then he adjusts for injuries and accidents. Of course the U.S. remains at the top of the list, as we are one of the richest countries in the world.
Here's his equation, from the book:
LifeExpit = 50.78 + 3.020 * log(GDPPCit) - 0.077 * [mean(Trans)]
- 0.137 * [mean(Falls)] - 0.133 * [mean(Homicide)]
- 0.0326 * [mean(Suicide)] + year-effectsit
The equation includes "log(GDPPCit)", which is GDP per capita in country i, year t, and it includes factors for transportation accidents, falls, homicide, and suicide. Mr. Ohsfeldt suggests in his writing that the equation and graph are based on real world life expectancy data, which figure into the equation nowhere at all.
I find it deceptive.
4 of 6 people found the following review helpful
on March 7, 2008
I chose this from a book list for required reading in graduate class on "Issues in Health Care". It was as much un-biased as you could probably ask for. Not a lot of rambling as you will find in many other similar subject books. I did learn a lot about how politics and healthcare are uniquley intertwined even though I am very familiar with the health care field. Summary pages at the end of the Chapters are helpful to bring all the points together. I thought the most intersting section was about specialized hospitals ans whether they are harmful to general hosptials. 118 pages of easy to read text, the remaining pages are references.