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According to information released by the Centers for Disease Control and Prevention on June 24, 2007, about 43.6 million people in the United States, or 14.8 percent of the population, had no health insurance in 2006. The finding, based on a survey of 100,000 people, is lower than previous federal estimates of 46 million. The estimate is based on those who did not have insurance at the time of the interview. About 54.5 million people in the country, or 18.6 percent of the population, had no insurance for at least part of 2006. Whatever the exact numbers, there is obviously a very serious problem with health care provision in the U.S. In fact, dozens.
In her previously published book, Consumer-Driven Health Care, Regina Herzlinger explains that consumer-driven health care is "fundamentally about empowering health care consumers - all of us - with control, choice, and information." Such control will "reward innovative insurers and providers for creating the higher-quality, lower-cost services we want and deserve." What would be the role of government? She asserts that "government will protect us with financial assistance and oversight, not micromanagement." The material in this substantial volume is organized within five Parts. Herzlinger wrote the first, "Why We Need Consumer-Driven Health Care," then edited the contributions by others that comprise Parts Two-Five. She also wrote Chapter 78, "A Health Care SEC: The Truth, the Whole Truth, and Nothing But the Truth." For most of us who are not health care professionals, this volume provides about as much information as we could possibly need, much less process. I especially appreciate the fact that Herzlinger and her associate contributors make a conscious effort to avoid jargon, vague theories, oblique hypotheses, etc. They obviously believe that major health care issues are too important to be packaged as flimflam, swamp gas, and flapdoodle. Hence their rigorous focus on explaining (from a variety of perspectives) why consumer-driven health care is needed, and, how to establish and then sustain it.
In this volume, Herzlinger focuses her attention on what she describes as "America's $2 trillion medical problem" (about the current size of the economy in China) and explains why consumer-driven initiatives offer a "cure." More specifically, she exposes "the iron triangle" of third parties (i.e. Congress, health insurers, and hospital administrators) that have opposed consumer-driven health care and thereby subordinated, if not totally ignored the welfare of patients as well as their personal physicians (if they have any). These third-parties are the ones who have "killed" health care for tens of millions of uninsured or under-insured people who, Herzlinger insists, have been deprived of power, information, and choice. She is a passionate and well-informed advocate of nothing less than major, extensive, and comprehensive health care reform.
"Four armies are battling to gain control [of health care]: the health insurers, hospitals, government, and doctors. Yet you and I, the people who use the health care system and who pay for all of it, are not even combatants. And the doctors, the group whose interests are most closely aligned with our welfare, are losing the war." What to do? Herzlinger's convincing, indeed compelling and eloquent response to that question is best revealed within her narrative. However, for present purposes, here are a few key recommendations:
1. Consumers must take back the money their employers and government now take from their salaries and taxes to buy health insurance on their behalf so they can make their own purchase decisions.
2. Physicians must be empowered to design better, cheaper health care.
3. The destitute must be subsidized by "the rest of us" so that can purchase health insurance "like everybody else."
4. The federal government must help subsidize the destitute, provide transparency (a key factor for all consumers, actually), and prosecute fraud and abuse.
In Parts 1 and 2, Herzlinger explains who is killing health care and how they are doing it. She identifies both "villains" and "heroes." In Part 3, she "lays out the principles as well as the specifics of consumer-driven health care - what it is, why it will work, what it offers to all of us - and analyzes the lessons from consumer-driven systems like Switzerland's." Then in Part 4, Herzlinger provides a step-by-step plan "of the carrots, the sticks, and the laws that will make this consumer-driven system happen."
Many of those who read this brief commentary of mine may ask "So what?" Perhaps they are satisfied with their current health care coverage. It is possible but unlikely that many (if any) of those who are destitute - who have no health care insurance coverage whatsoever - check out reviews of books, much less purchase and then read them. The fact is, those who are satisfied with their current health insurance coverage are probably paying too much for their share of its total cost. And a separate but related fact is that their employer is also paying too much for its share of the health care coverage that it is required by law to provide to its full-time employees.
Herzlinger has a crystal clear vision of what health care should be and do but she is also a pragmatist. She fully understands that unless and until, in a democratic capitalistic society such as the U.S., incentives and rewards are changed, there can be no reform of the current health care system. It is wholly understandable that "the iron triangle" of third parties (i.e. Congress, health insurers, and hospital administrators) oppose consumer-driven heath care, especially given the fact that about $2 trillion is involved and would be at risk if (huge "if") patients were entrusted with the power to decide how that money would be spent.
My concerns, frankly, are these: How many people will read this review and others, then purchase and read Herzlinger's book? Then what (if anything) will they do? All change initiatives inevitably encounter what James O'Toole has aptly characterized as "the ideology of comfort and the tyranny of custom." The power and resources of those who defend the status quo of "the iron triangle" must not be underestimated. All by herself, Regina Herzlinger cannot reform the current health care system. Who will join her in doing everything humanly possible to make consumer-driven health care a reality? If you think you wish to enlist in this "war" and help win it, I suggest you read and then re-read Pages 254-258, then contact your representatives in the House and Senate and insist - not request - that they read this book or at least have a staff member do so. Will that do any good? I have no idea. But I do know that by remaining silent and compliant, we empower "the iron triangle" rather than ourselves.
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