Critical: What We Can Do About the Health-Care Crisis (Hardcover)

by Tom Daschle (Author), Jeanne M. Lambrew (Narrator), Scott S. Greenberger (Narrator) "BEFORE EXPLORING MY idea in detail, it's worthwhile to review the current state of affairs..." (more)
Key Phrases: coverage decisions, employer mandate, President Clinton, United States, Federal Health Board (more...)

Editorial Reviews

From Publishers Weekly
The U.S. is the only industrialized nation that does not guarantee necessary health care to all of its citizens, and as former senator Daschle observes, Skeptics say we can't afford to cover everyone; the truth is that we can't afford not to because U.S. economic competitiveness is being impeded by the large uninsured population and fast-rising health costs. Daschle's book delineates the weaknesses of previous attempts at national health coverage, outlines the complex economic factors and medical issues affecting coverage and sets forth plans for change. Daschle proposes creating a Federal Health Board, similar to the Federal Reserve System, whose structure, functions and enforcement capability would be largely insulated from the politics and passion of the moment, in addition to a merging of employers' plans, Medicaid and Medicare with an expanded FEHBP (Federal Employee Health Benefits Program) that would cover everyone. There is no more important issue facing our country, Daschle asserts, than reform of our health-care system, and the book's health-care horror stories bring this immediacy home. (Feb. 19)
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Review

ADVANCE PRAISE FOR CRITICAL
“I may not agree with some of the political statements but Senator Daschle is right on target on the need to start a serious dialogue on health care for Americans.  His thoughtful health-care proposals will move the process forward.  Senator Daschle and I agree on the need for nonpartisanship in coming to grips with this number one domestic problem.” —Bob Dole, former Senate majority leader
“The American health-care system is in crisis, and workable solutions have been blocked for years by deeply entrenched ideological divisions. Sen. Daschle brings fresh thinking to this problem, and his Federal Reserve for Health concept holds great promise for bridging this intellectual chasm and, at long last, giving this nation the health care it deserves.” —Senator Barack Obama (IL)
 “This book provides real solutions for America’s broken health care system.” —Senator Harry Reid (NV), Senate majority leader
“Critical provides answers to one of the most vexing challenges of our time.” —John Podesta, president and CEO of the Center for American Progress and a former White House chief of staff
“It is a must-read.” —Jerome H. Grossman M.D., senior fellow and director of the Health Care Delivery Project at Harvard University’s Kennedy School of Government
“Senator Daschle adds to his reputation as a clear thinker and leader. Critical shows us not only why we must solve our health care crisis but that—with political will—we can.” —Judy Feder, professor and dean at Georgetown Public Policy Institute

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Product Details

• Hardcover: 240 pages
• Publisher: Thomas Dunne Books; 1 edition (February 19, 2008)
• Language: English
• ISBN-10: 0312383010
• ISBN-13: 978-0312383015
• Product Dimensions: 8.4 x 6 x 1.1 inches
• Shipping Weight: 12 ounces (View shipping rates and policies)
• Average Customer Review: 3.3 out of 5 stars See all reviews (47 customer reviews)
• Amazon.com Sales Rank: #47,570 in Books (See Bestsellers in Books)

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Customer Reviews

Most Helpful Customer Reviews

89 of 97 people found the following review helpful:

3.0 out of 5 stars Physician Response, December 11, 2008

By	Physician Reviewer (New York, NY) - See all my reviews

Why is Tom Daschle (who interestingly is not a physician, but a lawyer, politician, and lobbyist) in charge of the health care arena in the first place? It's insulting to us physicians that the president elect couldn't find one of the many talented physician leaders to head up this project.

With that said, Daschle's main ideas gleamed from reading the book are:

1) Set up a Federal Health Board to regulate policy and provide evidence-based practices - The idea of a Federal Health Reserve is a good one. It would allow a nonjudgmental board to improve medical care at the federal policy level without political biases.

2) Expand Medicaid - This, although reasonable, is scary. Medicaid is amongst the lowest of all reimbursers. Many treatments and procedures simply cannot be done at the Medicaid reimbursement level, such that major academic centers with Federal support eat the costs of doing business with these patients. Any expansion will have to see reimbursement rates dramatically increased or physicians protesting.

3) Mandate by law (like in Massachusetts) that individuals have insurance - This seems like a good way to increase "insured individuals." What it does for quality of care remains to be proven.

4) Pay physicians based on their success - This is a slippery slope as it will reward physicians who are less apt to take risk. Also, deciding upon which outcome measures and variables to reward will be no easy task - the scientific community has only defined the variables for a very small subset of patient care items to date.

5) Open up the federal health insurance "group policy' to all employers and individuals to obtain an economy of scale - I don't know anyone with this insurance, but it seems like a fine idea.

6) Implement an electronic medical record - this is already being implemented around the nation. The best idea would be to implement one or a few that all interact, but that would take serious organization, time, and money.

7) Criticize the US health care system as mediocre at best - There is no one best way to measure health care systems. Proxy measures such as life expectancy and infant mortality do exist, but they are confounded by different demographics in different countries, different genetic susceptibilities, different risk taking activities by health care systems, etc. The US health care system has driven most of the critical advances in health and for sure health care education in the last century and it is where many international diplomats, athletes, etc. receive their care. The real issue at hand is the massive amount of money being wasted in the system.


Interestingly, Daschle does not comment upon:
1) Malpractice claims and the cost of malpractice insurance
2) Insurance agencies and their lack of regulation and the fact that they do nothing for the system but put money in their own pockets

Any future system in the US should satisfy 3 basic groups:

1) The patients
2) The caregivers (Physicians, etc.)
3) The facilities (Hospitals, etc.)

There is no reason why lawyers, insurers, politicians, lobbyists, etc. should benefit from the system more than those crucial to it's existence.

173 of 199 people found the following review helpful:

5.0 out of 5 stars Illuminating, February 19, 2008

By	Kat Bakhu (Albuquerque, NM United States) - See all my reviews (REAL NAME)

A big part of me resisted the idea of buying a book on health care written by a former Senator. It just seemed way too wonkish for me. But I am into politics and a minute does not go by without a candidate screaming about "Health Care" and "Universal Health Care" so I figured I should get up to speed on what the debate is all about.

I'm really glad I did. In truth, Critical is a well written book and is quite interesting. Daschle cogently explains why our current health care system is broken and why there is, in fact, a desperate need to fix it. I'd heard that said many times before but did not understand why. Now I do, thanks to this book.

I am a strong believer in the free market as the best means for providing most of the goods that people want at the best price. But I now have to admit that the free market is not working when it comes to health care. It really isn't. And I am not saying this as a Democrat. I am a registered Republican.

For those who might think that this book is nothing but a left-wing, socialist rant, they would be wrong. In fact, many of Daschle's recommendations for "fixing" the system are to make our system work the way it would in a true free market environment. That is, to provide the highest quality care at the least cost to the consumer. It was really eye-opening to learn how very far away from this ideal our current system is.

Daschle's book covers most of the bases. It describes our current system and why it is so flawed (the number one cause for bankruptcy in our country cannot be called a good system of health care!) He then describes the history of trying to create a better health care system in our country, starting with Truman, up to Clinton, and on up to the current day. He outlines the players who consistently get in the way of needed reform. And, finally, he puts forward his own idea of how we might create a viable health care system that affordably takes care of people when they fall into disease.

I got a great deal out of this book. For one, I've learned that right wing talk radio is REALLY clouding the issue when they talk about health care, and is doing the country a great disservice. Daschle persuaded me on a lot of important points and made me aware of the nature of the problem. I thank him for the time he put into writing such an informative, readable book on such an important issue. If you want to educate yourself on the state of our health care system, this is the place to start.

24 of 26 people found the following review helpful:

5.0 out of 5 stars Possibilities, November 23, 2008

By	Oscar T. Feagin "retired doc" (Readfield, ME USA) - See all my reviews (REAL NAME)

Daschle, having just been named Secretary of HHS, will be a major voice in the reformation of our health care system. While his book does not really address adequate methods for controlling costs, it does posit a potential method for organization---a Federal Health Board modelled on the Federal Reserve. He also proposes a way to expand coverage by using an existing insurance plan---the Federal Employees' Health Plan. I would highly recommend this book as well as Ezekiel Emmanuel's (Rahm's brother) "Healthcare Guaranteed" to readers wanting to anticipate what the Obama administration may be proposing.