Showing posts with label healthcare reform. Show all posts
Showing posts with label healthcare reform. Show all posts

8/28/2012

Partners in Health: How Physicians and Hospitals can be Accountable Together (J-B Public Health/Health Services Text) Review

Partners in Health: How Physicians and Hospitals can be Accountable Together (J-B Public Health/Health Services Text)
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A review of the need for collaboration between hospitals and doctors to improve quality and safety while increasing cost. Demonstrates how the reimbursement and legal environment create skewed and inappropriate incentives, but leaves out nursing and addresses outpatient medicine only superficially. As far as it goes, it is timely and practical. Its insights are useful for physicians in particular, especially physician managers. It does give an impression of some of the successful institutions, but the discussions are dry and technical but leave one wishing for more depth and detail. Storytelling would have strengthened the arguments.

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2/08/2012

Who Killed Health Care?: America's $2 Trillion Medical Problem - and the Consumer-Driven Cure Review

Who Killed Health Care: America's $2 Trillion Medical Problem - and the Consumer-Driven Cure
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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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1/30/2012

Doctor in the House: A Physician-Turned-Congressman Offers His Prescription for Scrapping Obamacare -- and Saving America's Medical System Review

Doctor in the House: A Physician-Turned-Congressman Offers His Prescription for Scrapping Obamacare -- and Saving America's Medical System
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The last two chapters ("Seven Things Your Doctor Wishes You Knew" and "A Prescription for What's Really Ailing Us") are the most important. This part of the book could stand alone, published as a mini-book or as a pamphlet, available for wide distribution.
Chapter 11 goes into detail about the nature of family practice today. It examines the world doctors inhabit under the weight of regulations, paperwork, lawsuits, and insurance companies. On pages 141 & 142, Dr. Burgess praises Governor Mitch Daniels from Indiana for his "Healthy Indiana" program, which empowers its state employees to be in charge of their own health care (via a "High Deductible Health Plan with a Health Savings Account.") This is what what David Goldhill promoted in his essay "How American Health Care Killed my Father" (published in the "Atlantic Magazine," September 2009 issue).
Chapter 12 gives us nine prescriptions for fixing our health care system. Michael Burgess writes succinctly, in only 18 pages, those nine remedies (pages 151-169). They include: insurance reform, tax fairness, portability, price transparency, etc.
On page 167, the "Prescription 8 -- Preventative Care and Wellness Programs" certainly makes sense. As in auto insurance where premiums are raised for motorists who like to speed and drive recklessly, health insurance companies should be allowed to raise premiums on individuals who live an unhealthy lifestyle (and reward those of us with lower premiums who exercise regularly and watch our weight). These kind of incentives should be available to everyone, including independent contractors. (Under Obamacare via "The Safeway Amendment," the wellness program is available only to **EMPLOYEES** of self-insured corporations; its regulations are so complex that a business attorney would be required -- lawyers are expensive!).
The author Michael Burgess is on our side -- us ordinary Americans, us health care consumers. His book is mainstream and "Middle America." He is no right-wing windbag like Rush Limbaugh (who recently attacked Mitch Daniels in one of his usual tirades.) Those of us in the "Tea Party Movement" are neither left nor right. Please write another book!

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In 2010, the United States House of Representatives passed ObamaCare into law - an overt step away from liberty toward socialism. And while the powers at be claimed a sweeping victory bolstered by national pride, many saw what the legislation truly promised. In Doctor in the House, Congressman Michael Burgess applies his three decades of experienceworking inside our nation's health care system to the diagnosis of our true ailments. In doing so, he offers a clear, common sense prescription for making our system more excellent, more efficient, and less expensive--for all Americans.A third generation physician, Burgess writes with obvious passion for the healing arts and powerful convictions about the limits of government intervention in the doctor-patient relationship. Doctor in the House brings clarity and common sense to the perplexing national debate over the new health care bill.

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10/25/2011

Chronic Crisis: Critical Care for America's Collapsing Healthcare System Review

Chronic Crisis: Critical Care for America's Collapsing Healthcare System
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The perfect book for what is on the agenda in the U.S. today. Selvoy M. Fillerup covers not only the health care system we have in the U.S. but compares it to the health care systems in several other industrialized countries. For example, Canada, Great Britain, Switzerland, Germany, etc. A collection of policies that work - and ones that don't work - are proposed and explained not only in the context of effective health care but in the context of why they make good economic sense. An effective health care system is not only accessable it must also be solvent which is to say sustainable. Ironically, with universal health care individual health care costs in the U.S. go down.
What might an effective national health care policy look like?
1) Everyone has a choice between private or public health care coverage. Offering both private and public options leverages the strength of both systems. Private systems are good at innovating, reducing costs and expanding infrastructure. Public systems implement the social contract that everyone in a civilized society has access to basic health care services.
2) Everyone is enrolled in either the public or private system. This can be default or mandatory enrollment default being preferred as there are no penalties - legal actions - involved if someone fails to enroll thus the system is simpler.
3) Community rating for coverage pricing. Individual risks are not evaluated thus, again, simplifying the system and reducing one of the biggest coverage administration costs - risk analysis. The need for risk analysis of individuals is greatly reduced when coverage is guaranteed.
4) Guaranteed issue. Coverage under the uniform benefits package cannot be denied for prior history or any other reason. When you walk into a public or private health insurance office and ask for the basic coverage package you cannot be denied.
5) A uniform benefits package that includes catastrophic care. Public and private care compete on the uniform benefits package based on price, reputation, convenience and other factors but not on what the uniform benefits package actually covers.
It has been said that the U.S. has the best health care in the world... and the worst way of paying for it. Policy needs to set the guidelines or "playing field" in which the health care free market operates. With an effective policy - as outlined above - the free market can be an effective mechanism for health care delivery.

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The United States healthcare system leaks lives and dollars like a sieve. It neglects the needy and the poor. It is immoral. It is expensive. It is inefficient. It is, quite simply, broken. Dr. Selvoy Fillerup is an expert on international healthcare policy. As such, he has a uniquely informed perspective on why healthcare systems of other countries work, and why the US healthcare system does not. Chronic Crisis is straightforward, accessible, and direct to the point about one of the hottest political topics of our time. Explicitly nonpartisan, Dr. Fillerup offers a fresh look and reasonable solutions for this growing domestic crisis. Concerned Americans cannot afford to neglect this book!

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10/12/2011

Why ObamaCare is Wrong for America: How the New Health Care Law Drives Up Costs, Puts Government in Charge of Your Decisions, and Threatens Your Constitutional Rights Review

Why ObamaCare is Wrong for America: How the New Health Care Law Drives Up Costs, Puts Government in Charge of Your Decisions, and Threatens Your Constitutional Rights
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I highly recommend this book! I thought that I understood ObamaCare and what it meant for me and my family but after reading Why ObamaCare is Wrong for America, I realized I had no idea just how dangerous this law really is. The book's well-written and succinct (but very easy-to-read) chapters outline the impact of ObamaCare on families, seniors, young adults, taxpayers and examined how the legislation impacts my relationship with my doctors and my employer and its affect on my constitutional rights. I was terrified by what I read!
However, the book did not end there. The last chapter provides what I think is the best collection of ideas and action steps that I've ever read on what I can do to stop ObamaCare. I had thought it was a lost cause after the legislation passed last year but I am excited to know that not only can ObamaCare be stopped but I can do something about it!
If you've ever been curious about what ObamaCare is and its impact on your life, then you have to read this book. And if you want to know how it can be repealed and what you can do about it - this is a must read!

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Most people initially had high hopes for health reform. There clearly are problems that must be fixed. The president had promised that if reform passed, everyone would be able to get health insurance, costs would go down, and we would be able to keep both our doctors and our coverage. And we were told that reform would even cut the deficit and make Medicare stronger.

But the law that actually passed became a Rube Goldberg contraption that can't possibly work and that fails to meet its promises-and it will make many problems worse. Officials say it will leave at least 23 million people uninsured, it is already making health insurance more expensive, and it threatens major changes to the coverage that tens of millions of Americans have today. Seniors are frightened that its cuts to future Medicare spending will jeopardize their care, and taxpayers see a flood of red ink far into the future.

ObamaCare is leaving a comet tail of broken promises as it steamrolls its way through our economy and into our lives. What happened? How could there possibly be such a big gap between promise and reality?

In Why ObamaCare is Wrong for America, the authors-who work for four different conservative think tanks and have led the fight to educate the American people about the impact of ObamaCare-explain exactly what the law stipulates and how the law will affect each of us: as patients, as employees, as taxpayers, and as citizens. They also lay out a plan for reforming the law so we can get health care right. Finally, the authors share concrete steps each of us can take to put the breaks on ObamaCare.


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10/01/2011

Best Care Anywhere: Why VA Health Care is Better Than Yours Review

Best Care Anywhere: Why VA Health Care is Better Than Yours
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Philip Longman makes the case that current U.S. healthcare is a fragmented, market driven system that lags behind much of the industrialized world in both quality and access of healthcare. According to Longman, the problem with our healthcare system is that it isn't really a system and that it doesn't reward the one thing that it should - health improvement. In fact, he offers proof that in the U.S. doctors and hospitals are rewarded for providing treatment, but not necessarily providing health to their patients. To illustrate this, he offers examples from two of the nation's premier hospitals - Beth Israel and Duke Medical Center. Both initiated programs that were so successful at improving health that they became unprofitable and were ultimately terminated.
This book is filled with understandable, but often shocking statistics. For example, every year in the United States 98,000 people die due to medical errors while in the hospital, another 90,000 die due to infections that they get while in the hospital, and 126,000 needlessly die because their doctor failed to use evidence-based protocols for just four of the most common conditions.
The solution? Longman speaks effusively about the VA healthcare system. And rightfully so. It is the only fully functioning, evidence-based healthcare system in the country. The book explores the history of the VA and speaks honestly about some of the warts that mar the VA's reputation. But the truth of the matter is that the VA has turned all of that around and is currently at the front of the healthcare revolution.
Longman's book contains sections on safety, quality improvement, the concept of lifetime healthcare, and the Kizer Revolution at the VA, which dramatically improved quality and altered forever the course of veterans' healthcare.
The section on VistA, the software program that is revolutionizing healthcare, is worth the price of the book. This open source software program is really a bundle of 20,000 programs written in open source code. Surprisingly, it is being adopted extensively around the world - but not right here at home.
Longman proposes a reform of the U.S. healthcare system that incorporates the best of VistA and many other VA best practices and innovations. If you are interested in the healthcare debate and what is possible in future U.S. healthcare, I highly recommend this book.
For those interested in learning more about the healthcare debate and want to explore other opinions, I would also recommend the following three books: A Second Opinion: Rescuing America's Health Care; Who Killed Health Care?: America's $2 Trillion Medical Problem - and the Consumer-Driven Cure; and Redefining Health Care: Creating Value-Based Competition on Results.

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The long-maligned Veterans Health Administration has become the highest-quality healthcare provider in the United States. This encouraging change not only has benefited veterans but also provides a blueprint for salvaging America's own deeply troubled healthcare system. "Best Care Anywhere" shows how a government bureaucracy, working with little notice, is setting the standard for best practices and cost reduction while the private sector is lagging in both areas. Author Phillip Longman challenges conventional wisdom by explaining exactly how market forces work to lower quality and raise prices in the healthcare sector, and how U.S. medical practices have a weak basis in science. The book, expanded from a widely praised article in the "Washington Monthly," mixes hard facts with author Philip Longmans' compelling human story of the loss of his wife to cancer. Part manifesto, part moving memoir, "Best Care Anywhere" offers new hope for addressing a major problem of contemporary society that affects all of us.

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9/27/2011

Healthy Competition: What's Holding Back Health Care and How to Free It Review

Healthy Competition: What's Holding Back Health Care and How to Free It
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I enjoyed the book and found it presented a well organized argument for why it is so critical to allow the markets and consumers to experiment with new methods of controlling health care costs and improving access. I also appreciated the author's acknowledgement that health care is a special service that is critically important in our lives. That is what makes reforming the system so challenging.
The book makes clear that market based proposals to reform health care are designed to lower the cost of care and increase coverage. These are proposals that are critical to all Americans.

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9/24/2011

Obama Health Law: What It Says and How to Overturn It (Encounter Broadsides) Review

Obama Health Law: What It Says and How to Overturn It (Encounter Broadsides)
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A key point made by Betsey McCaughey is that there is no reason for a health care bill to be roughly two thousand pages long. "Twenty pages should be enough," declares the former lieutenant governor of New York. This relatively short pamphlet is of great value to those who need to quickly get a handle on the current crisis. We have the best health care of any large country in the world. The medical professionals living in the United States also lead in the effort to develop new medicines. ObamaCare threatens our freedoms---and ultimately the health of our loved ones. We will also be financially bankrupt. Everyone should heed McCaughey's great advice. It might also behoove you to purchase a number of copies to give to your relatives and friends.


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9/10/2011

Best Care Anywhere, 2nd Edition: Why VA Health Care Is Better Than Yours Review

Best Care Anywhere, 2nd Edition: Why VA Health Care Is Better Than Yours
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Best care anywhere? The VA? You better believe it.
The second edition of "Best Care Anywhere: Why VA Health Care I Better Than Yours" just hit the bookstore shelves and I just lapped it up. I was offered the first edition of this book back in 2007 when I was new to working in health care and so very uninformed about it. This book really swept away the cobwebs in my mind in that I had no concept that the incentives imbedded in our system of medical care delivery did not always encourage the *best* care. It, in fact, encourages *more* care which as we know from decades of work in comparing medical effectiveness (see Dartmouth Atlas of Health Care) actually suggests a negative correlation to outcomes.
In that way, this book very much undersells itself - it's about way more than just the VHA. It does what it sets out to do by spelling out what researchers have found which is that in a broad range of metrics, the care provided our veterans in the Veterans Health Administration is the best care available in America today. It's also telling that this second edition is made available some 3+ years after the original and the data still hold true.
What is this data, you might ask:
* New England Medical Journal noted that the VHA was "significantly better" in all measures connected with fee-for-service Medicare
* Annals of Internal Medicine reported that the VHA was the best in all seven measures of quality in comparison to its private industry counterparts
* RAND study concludes that the VHA outperforms all other sectors of American health care in 294 measures of quality
* National Quality Research Center in Michigan found that the VHA had the highest patient satisfaction of any public or private sector health care system
* Journal of the AMA wrote in 2005 that the VHA "quickly emerged as a bright start of patient safety"
That's not even the whole list. And, by the way, they do it at a per-member cost that is 8% less than private sector counterparts. More value at lest cost. I thought that was only supposed to be possible in the private sector.
Well, as it turns out, another thing the author succinctly points out is medical care does not behave like other markets. The author refers to this phenomenon as Roemer's Law. Put succinctly: in typical markets, increased supply leads to lower prices, in medical care more supply just results in more utilization and higher costs. See, all this stuff in a very small package - and extremely quick read - and you have the makings of a classic. And it is.


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9/03/2011

Why Obama's Government Takeover of Health Care Will Be a Disaster (Encounter Broadsides) Review

Why Obama's Government Takeover of Health Care Will Be a Disaster (Encounter Broadsides)
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Excellent short book on all that's wrong with ObamaCare. Dr. Gratzer is a former Canadian psychiatrist who has had exposure to both Canadian and US health care systems. He provides evidence that many health outcomes are significantly better in the US on average. The major tenets of Obama's health care reform are provided and critiqued. The book also provides a much needed reminder of how we got into our current situation. In the 1940s, as a result of wage and price controls, employers started offering health insurance when they couldn't offer higher salaries. Then the IRS made insurance premiums paid by employers non-taxable. Gradually, most services became covered by employment based health plans, thus separating the cost of the service from the consumer. This could only lead to rising costs, leaving those without employer based coverage unable to afford care. It has been government intervention, not the free market, which has lead to many of our current problems. The book offers a useful quick summary to anyone concerned about the current health care reform.

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8/25/2011

Market-driven Health Care: Who Wins, Who Loses In The Transformation Of America's Largest Service Industry Review

Market-driven Health Care: Who Wins, Who Loses In The Transformation Of America's Largest Service Industry
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No one will accuse Ms. Herzlinger of being a great writer, but her conversational style is easy to read and she does have some good ideas for how the healthcare industry should be. Ideas that still haven't been implemented even now, 8 years after it was written. She does make a fairly convincing argument for how focused factories could reduce costs. In addition, suggestions that everybody should have health insurance, that healthcare providers should not be insulated from market forces, that consumers are the ones with the real power to stop the soaring healthcare costs, and that they'll only curtail spending when given incentive to do so are good points that can't be made often enough. Points that seem even more relevant today given the continued increase in healthcare costs, the inability of the HMO system to manage them, and the spiraling problem the growing uninsured population is creating (the more uninsured people there are, the more insurance costs, which increases the number of uninsured, etc.). She has good ideas, I think it's time people listened. It's of vital importance that the healthcare system incorporate what's great about America, what has made America a leader in every other industry: innovation and sensibly regulated free markets. Ms. Herzlinger gives us a good way to get it done.
I also have to ask if some of the other reviewers actually read the book. The author gives a pretty good analysis of how focused factories would reduce costs, using that 20% of the people produce 80% of the costs as a cornerstone of her argument. Also, she cites physicians' inability to deal with market forces as a cause of the problem and gives suggestions for how to deal with it.

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8/20/2011

Strong Medicine: What's Wrong with America's Health Care System and How We Can Fix It Review

Strong Medicine: What's Wrong with America's Health Care System and How We Can Fix It
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While this may be considered a primer for those familiar with healthcare administration, insurers, and payors of healthcare today, it offers insights for consumers of healthcare that put the issues in context. A great summary of the need for accountability, and for reward for positive behavior in delivering healthcare and appropriate use of healthcare resources

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