USA Places - A Second Opinion: Rescuing America's Health Care
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List Price: $24.00
USA Places Price: $16.32
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Manufacturer: PublicAffairs
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Average Customer Rating: 
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Binding: Hardcover
Dewey Decimal Number: 362.10425
EAN: 9781586484811
ISBN: 1586484818
Label: PublicAffairs
Manufacturer: PublicAffairs
Number Of Items: 1
Number Of Pages: 224
Publication Date: 2007-04-23
Publisher: PublicAffairs
Studio: PublicAffairs
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Editorial Reviews:
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A world-renowned physician traces the rise of the medical-industrial complex that has made a disaster of our healthcare system--and tells us incisively what we need to do to change it. The U.S. healthcare system is failing. It is run like a business, increasingly focused on generating income for insurers and providers rather than providing care for patients. It is supported by investors and private markets seeking to grow revenue and resist regulation, thus contributing to higher costs and lessened public accountability. Meanwhile, forty-six million Americans are without insurance. Health care expenditures are rising at a rate of 7 percent a year, three times the rate of inflation. Dr. Arnold Relman is one of the most respected physicians and healthcare advocates in our country. This book, based on sixty years' experience in medicine, is a clarion call not just to politicans and patients but to the medical profession to evolve a new structure for healthcare, based on voluntary private contracts between individuals and not-for-profit, multi-specialty groups of physicians. Physicians would be paid mainly by salaries and would submit no bills for their services. All health care facilities would be not-for-profit. The savings from reduced administrative overhead and the elimination of billing fraud would be enormous. Healthcare may be our greatest national problem, but the provocative, sensible arguments in this book will provide a catalyst for change.
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Spotlight customer reviews:
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Customer Rating:
Summary: A Second Opinion, Arnold Relman MD
Comment: Superb "tough love" analysis of the way commercialization of healthcare has driven behavior predictably towards financial rewards while perpetuating disparities in access and quality of care and severely eroding the primary care workforce necessary for rational care for our next generation. Dr. Relman candidly acknowledges that correction of these patterns will cause some financial hurt to entrepreneurial physicians and physicians in highly remunerative procedural niches, as well as the familiar bogeymen of the for-profit commercial insurance companies and profit-driven hospitals. If physicians fail to take active, participatory leadership in the necessary corrections, a blunt and clumsy governmental change process will likely be necessary.
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Summary: Worthy concerns, weak arguments
Comment: Dr. Relman calls for health care reform based on prepaid group practices, regulated and paid by the federal government. His objective, gradually developed in Chapters 1 through 4, is high quality health care for everyone at reasonable cost. In Chapter 5, he offers ideas on how prepaid group practices might best work. Nowhere, however, does he provide an organized case for this approach to reform, comparing it point-by-point with pertinent alternatives, citing evidence to show who benefits and who suffers and how much, under different alternatives.
Dr. Relman offers more a personal memoir than a policy analysis. His data are mostly broad-brush points and big-bucket numbers offered in editorial mode: "I reject," "I agree," "I believe" and "I envision." From a writer as eminent as Dr. Relman, that might be tolerated for an introduction and a postscript, but the book goes on in such a vein for 175 pages.
Dr. Relman probably has some sense of how his program might be achieved. However, Chapter 6 of the book comes down to this: elect more Democrats and appeal to the moral conscience of physicians (as he tries to do in Chapter 8). As he clearly knows, there have been times when we had more Democrats in office and times when we had a more vigorous climate of concern among physicians, but we still got little progress.
Dr. Relman's objectives appear worthy, and his approach to reform may be reasonable, but someone else will need to make the case. It will probably take a longer book, certainly one that is more focused and critical.
Customer Rating:
Summary: Excellent and Authoritative Information
Comment: Dr. Relman begins by asserting that America's health care system is much too expensive and its costs are rising at an unsustainable rate. Further, care is not available to many who need it most, and it is provided inefficiently and with highly variable quality.
By most measures of national health we rank well below many other advanced countries that spend less. Why is this? Dr. Relman believes it is due to the extent that private enterprise governs insurance and the provision of care, rather than public regulation and social need. Dr. Relman also sees physicians as too often part of the problem - in the U.S. they are more specialized, more likely to be paid on a fee-for-service basis, and more likely to have financial interests in facilities and products than their counterparts in other western countries.
Dr. Relman provides data comparing costs and outcomes from for-profit vs. not-for-profit entities. A 1997 study covering all acute-care hospitals found total hospital expenses/admission 10% higher in for-profits (administrative costs were 34% of the total, vs. 25% for non-profits; however, the for-profits provided less in-house clinical personnel. Thus, it is also not surprising that a 2002 study pooling all published data found the risk of patient death 2% higher in the for-profit hospitals.
Similarly, a 1999 published study of dialysis units found mortality rates 20% higher in for-profits, as well as the likelihood of being placed on a transplantation list 26% lower (would end the center's revenues). Prior studies also found lower expenditures on care within the for-profits.
Most nursing home payments are from standardized, per-diem Medicaid rates. A 1998 survey found for-profits with 40% more serious care violations than non-profits. Investor-owned insurance plans take 10-25% of premiums, vs. 5-10% for non-profits and only 3% for Medicare.
G.M.'s 2005 health care costs in the U.S. added $1,525/car built in the U.S., compared to only $197 in Canada.
Relman estimates that 40-45% of U.S. health care expenditures are wasted in overhead, marketing, and unneeded procedures. Canada has only 75% of the number of physicians/population in the U.S., but half are in primary care (vs. 1/3 in the U.S.). Thus, Canada ends up with 93 specialists per 100,000, vs. 150 in the U.S. This creates less pressure for high technology and associated high expenditures, and helps explain their lower overall health care costs. The provinces fund teaching hospitals, and have an incentive to hold down their numbers and production of specialists.
Customer Rating:
Summary: A very important issue in the U.S.
Comment: This topic is very much needed in the U.S. at this time. Each of the Presidential candidates should read it.
Customer Rating:
Summary: Second Opinion Seconded
Comment: This is a step in the right direction, but faces massive opposition from the insurance, pharmaceutical, medical device and hospital administration segments that are profiting from the present situation. But the excess money that goes to them could easily fund the uninsured. And then we need to recognize that there is at present absolutely no incentive in the present system to save money. But we'll need to re-train an army of insurance clerks and their managers to start working for the good of patients instead of the good of their employers and their stockholders. Doable with the Relman prescription? Maybe. Certainly better than simply throwing more government cash at the present players.
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