From Publishers Weekly
Not to be confused with the bestselling personal finance volume (by Joe Dominguez and Vicki Robin), this work examines the health care crisis in America. Many people readily admit they're unhappy with both the cost and the care they receive from their doctors and are very frustrated with the health-care system. However, according to Cutler, an economics professor at Harvard and health-care adviser in the Clinton administration, the advances made in health care over the past 50 years have been quite positive and have contributed to longer and more productive lives. But people have a hard time understanding their choices-paying more for medicine that will keep them alive or choosing costly surgery that may not guarantee a better quality of life. Cutler offers numerous examples of medical progress along with economic reasoning to persuade readers that more and more medical advances should be sought, along with better medical coverage for everyone. "For medical care to be effective, people must be able to afford it. The issue of affordability is clearly a concern of the uninsured. The uninsured rely on the largesse of the medical system as a whole." Cutler's discussion of managed care and how doctors are reimbursed for certain procedures but discouraged from other practices is especially clear. Cutler's position-health insurance for all and doctor reimbursement by quality, not simply service-is clear and compelling. This book will be of most interest to government officials, doctors and others in the health-care industry.
Copyright 2003 Reed Business Information, Inc.
From The New England Journal of Medicine
The rising cost of health care -- and what to do about this problem -- is perhaps our nation's most pressing health policy issue. The recent spike in private-insurance premiums has alarmed both employers and employees. More telling is the lack of clear policy options designed to discourage the introduction and use of high-cost, low-benefit medical care. As if the problem were not bad enough, other research findings tell us that evidence-based medical care is dramatically underused. David Cutler makes an important contribution to our thinking on this important issue in Your Money or Your Life. The book provides a nice forum for Cutler to present much of his research that has framed how we should think about rising health care costs and whether the additional spending is worth it. Most of the popular discussion concerning rising health care spending neglects the obvious questions -- what we are buying with the additional spending and whether we are producing commensurate increases in health benefits. Cutler's conclusion is a clear "yes": the incremental health care benefits that patients receive exceed their costs. However, he provides the important caveat that we could produce the same level of health care benefits at even lower costs. The book is a good introduction to the policy debate over health care spending. It starts by appropriately framing the issue that we cannot look at the rise in spending without first measuring and comparing the benefits purchased. Chapters 3 through 5 methodically track the growth in spending to treat low-birth-weight infants, patients with depression, and those who have had heart attacks. These initial chapters contain compelling information and should be read by all who are interested in health care policy. Underlying the growth in spending is the persistent march of science. The introduction of new forms of technology allows us to treat more patients with particular medical conditions, though generally at a high price per case. The heart of the book examines these trends and, in the three case studies that it follows, compares the added spending to the change in health benefits. In each case, total spending per case has risen, driven largely by the introduction of new medical technology. In some cases, the medical returns have been impressive. In the treatment of low-birth-weight newborns, medical advances (e.g., incubator design, new drugs), although expensive, have produced a dramatic reduction in mortality rates. As discussed in chapter 3, each additional $1 spent on treating low-birth-weight babies has produced $5 of additional health benefits -- an expensive, though worthwhile, investment. Chapters 4 and 5 present the same evidence for treatment, respectively, of depression (a seven-to-one return on investment) and heart attacks (a four-to-one return on each dollar spent). Chapter 6 attempts a broader extrapolation of the medical value of health care spending -- a somewhat tougher sell. Some of the later chapters, such as chapter 8, which examines what went wrong with managed care, seem to wander slightly off target. If the health care we are purchasing is worth it, why the general malaise? Some of it is clearly traced to the perceptions of purchasers and consumers that we spend too much, that we could buy the same benefits for far less money, and that the system is hopelessly complicated. Along these lines, chapters 9 and 10 attempt to address the issue of providing better care more efficiently. One suggestion is to give physicians bonus payments for providing high-quality, evidence-based medical care. Though controversial, the idea is a good one that should be debated seriously. The final chapter wanders into the hornet's nest of universal health insurance coverage. Cutler proposes an expansion of the Federal Employees Health Benefits Program to those who want to join. This chapter is too short for such a complex topic, and it meanders slightly from the compelling story and analyses presented in the first five chapters. Who should read this book? Health policymakers and people who are troubled with the rise in health care spending and are perplexed about what to do about it. Your Money or Your Life makes an important contribution to this debate, and I highly recommend it. Kenneth E. Thorpe, Ph.D.
Copyright © 2004 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
When economics and medicine mix, there is bound to be confusion unless someone like Harvard economics professor Cutler, who seems to effortlessly make a complex issue comprehensible, is doing the mixing. In this mighty volume, he constructs a compelling case for universal health care by taking readers through a number of orderly steps. In a clear expository voice he establishes the value of a human life, explains the contributing costs of health care to sustain a life, and weighs the cost of universal health care against the value received--namely, extended life and improved quality of life for all concerned. In the process, he defines how to determine whether a particular health-care option is effective and elaborates on how it ought to be compensated. Additionally, he examines various ways America's current system is, based upon his criterion for efficacy, succeeding and ways it is not. As long as providers are paid for what they perform rather than the efficacy of treatment, he says, medical costs will soar. An elegant investigation. Donna Chavez
Copyright © American Library Association. All rights reserved
Review
"This slender but important book...makes some exceedingly valuable points. Its passionate argument that modern medicine works is persuasive. It argues equally convincingly that there is both an economic and a moral case for medical spending. Perhaps most notable, it points out the many perverse incentives in our current system of financing medical care, and it argues that we should correct the system by providing financial incentives for the medical treatments and the approaches we truly want. The book, in sum, represents a significant contribution to health-policy literature and ideally, would be used to inform present and future discussions of health care in America."--St. Louis Post-Dispatch
"Concise and persuasive...avoids most of the ideological shoals of the health care debate.... Cutler shows how the current system could be redesigned so that everyone is insured, the quality of care improves and the overall costs remain roughly the same."--Washington Post
"Cutler has paved the way for a unique new understanding of health care in America: policy makers and providers should focus on increasing the value of dollars spent rather than rehashing the tired distinction between cutting costs and paying more. For everyone interested in improving health care in the United States, this is original and inspiring--actually, indispensable." --Bill Bradley
"A thoughtful analysis of the problems afflicting our health care system. His creative proposals will interest every citizen concerned about improving American health care." --Edward M. Kennedy
"This highly-readable volume explores all of the major issues that confront us as we attempt to improve America's health care system. David Cutler provides a clear and concise guide to how one should think about the costs and benefits of health care, the value of medical advances, and options for reforming the health care system. This is the book to buy if you want to understand how we can improve health care in America." --Robert D. Reischauer, President, The Urban Institute
"Cutler presents a refreshingly optimistic path for the future of America's health care system--promoting policies focused on increasing the value of medical services and improving health outcomes. He finds over and over that while health care expenditures are significant, we get a great deal more in return. His work is a major contribution to what I believe will become an increasingly interesting and important debate--is more medical spending necessarily bad?" --Art Collins, Chairman and CEO, Medtronic, Inc.
"Cutler's upbeat book delivers a welcome message to a public wearied by reports of medical errors, the rising number of uninsured, and the relentless growth in medical expenditures. Anyone with a serious interest in the U.S. health care system--and its future--should read this engaging and provocative book by one of the most insightful health policy experts in the nation." --Alan Garber, Center for Health Policy, Stanford University
"When economics and medicine mix there is bound to be confusion unless someone like Harvard economics professor Cutler, who seems to effortlessly make a complex issue comprehensible, is doing the mixing.... An elegant investigation."--Booklist
"It's also important for readers to understand the cost effectiveness behind developments in treating such conditions as cardiovascular disease, infant mortality and mental illness; chapters devoted to these are the best material in Cutler's book. His case studies are well researched and offer a tremendous amount of information about medical history and its economic significance."--Los Angeles Times
About the Author
David M. Cutler is a professor of economics at Harvard University. He is a member of the Institute of Medicine and regular advisor to governments and corporations.
