As Americans become healthier and live longer, we increasingly concentrate on preventing illness or injury from making some of those extra years an agony. We spend far more than any industrialized country on health care—and get far less for it. How did we get here? Former surgeon general Richmond and medical economist Fein offer a judicious, account making it blindingly clear that any decentralized system with multiple centers of influence (HMOs, employer-sponsored insurance plans, etc.) will force each segment of the health-care world to act in its own interest: the young and healthy opt out of mass coverage plans, which prevents their contributions from being spent on the aged and infirm; companies pass costs on to government or its own employees. In such a climate, what starts as rational self-interest inevitably morphs into a never-ending "quest for profits," which is where we are today. Bringing to this dry yet important subject authoritative knowledge and insight, the authors slice through the intricacies like an experienced surgeon. Their proposed solution is government-financed universal health insurance, though they admit our legislators have not had the stomach for it in the past. (Sept.)
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In this authoritative and thoughtful book you will find what we need to know if we are to do anything about health care in America. (Daniel Schorr, Senior News Analyst, National Public Radio, and author of Don't Get Sick in America!
From their vast experience as both policymakers and respected scholars, Richmond and Fein have produced an authoritative account of the circumstances that created our present predicament and, more important, a thoughtful roadmap for how we can extricate ourselves from the quagmire. Their message is both practical and hopeful: the future of health care in this country is not 'preordained' by past decisions but will emerge from the choices still to be made. Their abiding optimism is both refreshing and timely. (Jordan J. Cohen, M.D., President, Association of American Medical Colleges)
The book is a tour de force, a cogent, comprehensive and deeply informed review of the condition of the American health care system. Highly readable and carefully referenced, it is a guided tour over the very complex terrain of American health care, including the complexities and disparities that make its potential benefits unavailable to so many and so expensive to all. The authors' plan for universally available health care offers a basis for a renewed national debate around the ideal of equity and justice in our health care system. This wonderful book should be read by everyone interested in better health for the American population. (Jeremiah A. Barondess, M.D., President, The New York Academy of Medicine)
Two of the giants of American medicine, public policy, and health policy have combined to produce a masterpiece detailing how our healthcare system came to be what it is, and how we can take it to the next level--providing quality care and access for all. It is must reading for students of medicine, public health and health policy. (David Satcher, 16th US Surgeon General and Assistant Secretary for Health)
Rashi Fein and Julius Richmond bring a wealth of knowledge, long practical experience, and a welcome historical perspective to this excellent volume on the many aspects and causes of the steadily worsening health care crisis facing the nation. It's a continuing outrage that in today's America, the best and the worst in health care have existed side-by-side for so long in countless communities across the country. In this extraordinary era of nearly miracle-a-day new medical breakthroughs to prevent, treat, and even cure disease, inaction is unacceptable in the face of vast numbers of Americans with no health insurance, soaring inflation in the cost of health care, huge profits for the health insurance and pharmaceutical industries, and the very real danger of terrorist attacks with biological weapons. Genuine health reform is more urgent than ever, and the impressive recommendations of Fein and Richmond give us timely and important ideas about the direction such reform should take. Other modern nations have met and mastered this challenge, and America can too. (Senator Edward M. Kennedy)
We spend far more than any industrialized country on health care and get far less for it. How did we get here? Former surgeon general Richmond and medical economist Fein offer a judicious account...Bringing to this...important subject authoritative knowledge and insight, the authors slice through the intricacies like an experienced surgeon. (Publishers Weekly
What sets Julius Richmond and Rashi Fein's The Health Care Mess
apart from the pack is its expanded perspective. Rather than approaching health as a purely political issue, they detail the evolution of the health-care industry, especially the research sector, teaching infrastructure, and hubs of care delivery. For them, health care is a story not merely of failed political machinations but of new medicines and more advanced treatments. As both were involved in government efforts to expand care during the 1960s and 70s, they're particularly strong when discussing the 'bumper crop' of transformative health legislation and failed efforts to achieve universal coverage during that period. (Ezra Klein American Prospect
Over the course of their distinguished careers, the authors have participated in innumerable debates on matters of health care policy, large and small. They are veterans of fights over covering the uninsured, physician training, mental health, and substance abuse, and over funding for research, patient care, and medical education. They have extensive experience with the behavior of federal and state agencies, academic medical centers, insurers, and bureaucrats and bureaucracies, along with deep knowledge of the varying ways in which the United States has financed and delivered health care services. This book distills these experiences into a sophisticated historical and institutional perspective on why our health care system looks the way it does...The book is worth reading for the authors' perspective on how we ended up where we are and on ways and means of getting somewhere else. (David A. Hyman New England Journal of Medicine