2 of 2 people found the following review helpful
My congressman should read this book,
This review is from: Health Care Will Not Reform Itself: A User's Guide to Refocusing and Reforming American Health Care (Hardcover)This book is probably the best explanation I've read on why we have the health care mess that we do in the United States. We read a lot about health care in the papers and hear stories on the news but few articles get into the real reason for the problems and even fewer into what would be a really good solution. I learned far more from this book than I have from all the other sources put together. It was interesting in the way it discussed the health system in this country compared to that of some of the other countries in a manner that was easy to understand with many examples.
I didn't realize until I finished the book that George Halverson is the CEO of Kaiser Permanente, the largest not-for-profit health plan and care system in America with over eight and a half million members. My sister worked for a company that was insured by Kaiser and she was very impressed by the electronic medical record system at Kaiser. She was able to see all of her medical test results as soon as they came back from the lab just by logging onto a password protected website and was able to see comments from any doctors or specialists she had seen in the system. She was also able to make doctor's appointments online and email her doctors. They in turn could see any medications prescribed by any of the other doctors and any comments on any condition. Halverson talks about such a system for everyone in the country and mandating that everyone be insured which would help to slow down the increases in the cost of healthcare.
According to Halverson, at least 50% of the visits to an emergency room for asthma attacks don't need to happen. Treatment for the condition varies so much from doctor to doctor and the outcomes can be very different. But hospitals and doctors in our system don't make as much money by preventing an attack as they do with a visit to the emergency room. Our system makes big money on procedures after a crisis rather than preventing them from happening in the first place. That's one of the shortcomings of the system we have. Using Kaiser an example, Halverson shows how changing how we treat just four or five conditions could save huge amounts of money that we spend now on healthcare.
Probably one of the things that surprised me the most is how many mistakes and bad outcomes we now have in hospitals in this country. What I thought was a fairly consistent system turns out to actually be very haphazard in many ways. Most medical records are now kept on paper, in files, in each doctor's office and aren't shared with any other doctor who might be treating the patient. The results of treatments also aren't shared among other doctors in most cases, so we don't always have a consistent way of treating conditions. Electronic records of outcomes with different treatments would help to establish new and better ways of treating specific conditions because doctors would have a larger sample of outcomes to compare.
I didn't find this book to be political or partisan, but rather some very good ideas of how to change our current system and make it better for everyone involved. I hope a lot more people read this book.
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Initial post: Oct 8, 2009 5:24:38 AM PDT
Last edited by the author on Oct 8, 2009 5:38:58 AM PDT
A. Dent says:
Is the author discussing Medicare's relationship with hospitals? I believe that most hospitals are in the red because Medicare almost always pays them 'below cost'. This forces the hospitals to charge 'the big insurance companies' more for their services in an attempt to compensate. The insurance companies, in turn, raise the premiums of the insured. Of this, Medicare comes out smelling like a rose - they keep the costs under control and the consumers and politicians blame the insurance companies and 'big pharma'. Does the book offer any statistics showing how many hospitals are actually profitable? Or whether Medicare pays hospitals 'below cost' and by how much?
I'm not saying that everyone is innocent here but consider this: big pharma too is under pressure to recoup their investments. Thanks to government's stringent - some justified but not all - regulations, developing a new drug can take many years and costs hundreds of millions or even over a billion. And not all the new drugs get the eventual FDA approval or actually find a market. The successful drugs have only a few years of patent protection left (the patent clock starts ticking the second the patent is filed and it can be 10 years between that time and a final FDA-approved product) to make sufficient profit as to pay for their development and for the development of drugs that failed. It's only a few years because, when the patent expires, the 'generics' come in the market and sell at a fraction of the branded product. They can afford to do that and make a profit because they do not invest billions in R&D. At the same time, countries like Brazil and Canada demand that the drug makers sell the drugs in their country at much lower prices or they will encourage the bootlegging of those drugs. This is possible because our government doesn't believe that it's worth protecting 'our' patents. Of course, 'the pharma' has no choice but compensate for lack of protection abroad by raising the prices even more in the domestic market. In addition, being under such pressure to keep costs down and stay alive, a lot of what used to be US work - tens or hundreds of thousands of jobs in drug manufacturing, even research - has to move abroad. Latin America is the first stop, then on to India an China. The IT is cut to the bone, tens, hundreds of thousands US-resident IT workers working for 'big pharma' and the big insurance companies lose their jobs and are replaced by knowledge workers in India. Thousands more are brought in as low-paid 'guest workers' paid ridiculously low wages and displacing even more US residents.
And what happens to all these people who lose their jobs? Some of them get sick and they simply can't afford to pay for their care any more. Others find lower wage jobs that have little or no insurance coverage. Their children can no longer attend better schools and some drop out and join the ranks of 'juvenile' criminals. Families break or maybe domestic violence increases.
As for the super-profitable emergency rooms, let's not forget that many of the ER patients aren't insured and can't afford to pay and quite a few aren't even 'documented'. The hospitals are not going to make any money from those patients so they must charge the insurance companies more to compensate for insolvent ER patients.
I hope that issues such as the above are discussed in the book. Are they?
I am only saying that there are always larger contexts and if we really want to look for the real root causes, then let's do that.
In reply to an earlier post on Oct 8, 2009 11:13:10 AM PDT
PT Cruiser says:
Medicare is discussed in the book, but not to a great extent, as well as the pharma costs. The book centers more on our actual care in this country and the outcomes which aren't always good as some people seem to think they are. We kill a lot of people each year due to mistakes in hospitals causing infections, drug errors and interactions and other errors. We also do a lot of duplicate, unnecessary (and expensive) testing. The book addresses possible solutions to that and to the actual care we get.
Don't forget that roughly half of the big pharma companies are headquartered outside the the US. We still pay far more than any country in the world for drugs. Do a search on the profitability vs. R & D for drugs to get a better idea of the profit margins of big pharma.
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