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The Health Care Mess: How We Got Into It and What It Will Take To Get Out Paperback – May 30, 2007

ISBN-13: 978-0674024151 ISBN-10: 067402415X Edition: 1st

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Product Details

  • Paperback: 320 pages
  • Publisher: Harvard University Press; 1 edition (May 30, 2007)
  • Language: English
  • ISBN-10: 067402415X
  • ISBN-13: 978-0674024151
  • Product Dimensions: 5.5 x 0.8 x 8.2 inches
  • Shipping Weight: 12.8 ounces (View shipping rates and policies)
  • Average Customer Review: 2.5 out of 5 stars  See all reviews (4 customer reviews)
  • Amazon Best Sellers Rank: #2,391,725 in Books (See Top 100 in Books)

Editorial Reviews

From Publishers Weekly

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.)
Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved. --This text refers to an out of print or unavailable edition of this title.


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 2005-07-11)

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 2006-01-05)

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 2006-03-23)

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Customer Reviews

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Most Helpful Customer Reviews

34 of 40 people found the following review helpful By Faith on January 3, 2006
Format: Hardcover
As a student of health care economics (due to being employed in a managerial position in a health care enterprise,) I embarked on reading this book with great anticipation and was left with great disappointment. My disappointment stemmed from faults in both style and substance.

As to style, the writing is replete with complex sentences with subordinate clause following on subordinate clause until one can no longer remember what the subject or the verb is, much less make any sense of the meaning of the sentence. I read extensively in professional journals as part of my employment and feel that the stylistic mannerisms of this book significantly diminished its impact. There were a number of simpler grammatical errors that should have been caught by the editors at Harvard Press. I was dismayed that two so presumably eminent scholars should write in such a confusing and obfuscating way.

As to matters of substance, I was surprised that some of the more significant influences on the current state of the US's health care "system" were either ignored or brushed aside as being uninmportant. The three that immediately come to mind are the complete neglect in discussing the impact that the cost of pharmaceuticals has had on the overall cost of health care, the impact that malpractice litigation and the threat of malpractice suits have had, and the incredible cost of the administrative labyrinths that exist for most providers. Also glossed over is the exorbitant amount of money being taken out of the health care system in the form of profits for shareholders of for-profit healthcare entities (not just big pharma)and salaries and bonuses for the high-flying executives of these for-profits.
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12 of 13 people found the following review helpful By C. K. Dark on May 4, 2006
Format: Hardcover
In reading the previous reviews, I must say that they are quite accurate in many of their findings - the style of writing tends to be verbose and there isn't much in the ways of "how to do fix the US health care system." But that is not what this manuscript is about.

Let me quickly rebut a few points from each of the previous reviews.

From Mr. Weston: " When I bought the book, I was hoping the authors' would answer the question "What is equitable health care?" Is it equitable for the government to pay for medications that control blood pressure, insulin response, and bone density when all of these could be managed by diet and exercise? Americans have a problem giving welfare to those who can work. Why give "healthfare" to those who can diet and exercise? "

First of all, equity is in the eye of the beholder. This is an area where even the most brilliant health economist cannot give a true answer. Our basis for equity depends upon our own moral upbringing.

Secondly, it is obvious from the latter half of his comment that he does not have anything to do with the health care delivery system. Lifestyle modifications for hypertension, diabetes, and osteopenia/osteoporosis, while certainly beneficial, are not effective to the degree needed to prevent stroke, heart attack, or hip fractures. However, I will concede that doctors often over-utilize healthcare resources of limited benefit.

Moving on to Ms.
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12 of 14 people found the following review helpful By Paula L. Craig on March 24, 2006
Format: Hardcover
This book does a good job at pointing out how broken the American health care system is. I really enjoyed the retrospective look at how we got where we are today. Some of the reasons for the problems are pointed out well, as in the discussion of community rating of insurance. Unfortunately, the book misses some of the most important reasons for the health care mess. The solutions proposed also strike me as at best unworkable.

The book's authors are big fans of national health insurance. As they point out, national health insurance does have some things going for it. However, I just don't see how national health, if implemented in today's health care climate, would bring about any savings at all. The Medicare program is the closest thing we have now to national health insurance; far from saving us money, from what I see its costs are completely out of control and headed through the roof. The book never discusses this. The book makes no mention at all of how to deal with bringing down costs at the high end; the 5% or so of patients who create probably 80% or more of all health care costs. The fact is that at some point you have to be willing to say no, we are going to send this patient to a hospice to die instead of treating him, because his treatment is just too expensive.

I see the American health care system as caught in a trap of diminishing returns. In terms of quality of life, we get by far the most benefit from the first few dollars spent on a patient. By the time you get up to spending millions of dollars on a single patient, you are getting next to nothing for your money. Keep in mind that money has to come from somewhere; taxes, or premiums, or cuts in quality of service.
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