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, by Jonathan Engel
Free Download , by Jonathan Engel
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Product details
File Size: 907 KB
Print Length: 296 pages
Publisher: University of Wisconsin Press (February 20, 2018)
Publication Date: February 20, 2018
Sold by: Amazon Digital Services LLC
Language: English
ASIN: B078V5TSG4
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Amazon Best Sellers Rank:
#500,821 Paid in Kindle Store (See Top 100 Paid in Kindle Store)
This fact-packed book demonstrates author Jonathan Engel’s encyclopedic knowledge of US healthcare from Medicare’s inception to present day. He concisely describing the issues, accompanied by supporting statistics and sources, that have led us to our unaffordable state. Across the 223-pages, the book cites more than 600 supporting documents. No specific remedies or prognostications are provided. Instead the author identifies the winners and the losers that result from our technically brilliant but economically punishing system.How did our healthcare become unaffordable? If anything, it is by our general unwillingness to use any kind of cost-benefit analysis to assess the value of care, in either newly discovered innovations, or long-standing institutions. Even evidence-based medicine, where treatments are guided by data-driven information on what works best, continues to face disinterest and disbelief by providers and payers in the 21st century.Without a doubt, Jonathan Engel’s “Unaffordable†is the Goldilocks of healthcare history books. It’s modest size, very readable style, and depth of coverage make it “just right†for those who want to know how our current healthcare system came to be.[Below are a few points that I would like to make about the affordability of healthcare which complement and expand upon Jonathan Engel’s text.]---Influence of Lobbying---The author argues that changing the US healthcare for the better will require federal legislation. But as his recounting of our healthcare history shows, there are countless forces influencing the system beyond just our nation’s belief in individualism and entrepreneurship. These are the thousands of organizations seeking to shape legislation and regulations through lobbying at state and federal levels. Across all industries, healthcare is the most lobbied sector by a wide margin.Readers of “Unaffordable†would also enjoy Jonathan Rauch’s landmark 1994 book “Government’s End: Why Washington Stopped Working†which explains how our representative democracy has evolved to a state of ineffectiveness that can make only incremental changes. Today’s healthcare innovators should be aware of the fate of many past national champions of government reform such as Ronald Reagan, Bill Clinton, and many others, who came to Washington to upend the system and confront the special interest groups. But in the end, Reagan and Clinton were defeated by the powerful interests that represent thousands of business and social groups, says Rauch. Throughout our economy and society, a political gain by one entity invites an opposing position by another group. The result is an escalating arms race for influence that funds armies of lobbyists and associations which water-down or outright prevent adoption of large and small solutions to our nation’s problems.---Physicians and Patients Are Still in Command---The author notes that the influence and fortunes of physicians have varied over the last 50 years but clearly declined with the rise of corporate medicine since the 1990’s. Still, in many parts of the country physicians and their patients retain a power reminiscent of earlier times. For example, it has been 35 years since the Medicare program established in 1984 strict hospital admission criteria through its prospective payment system (aka DRGs). But today, physicians at the behest of patient and their families, can bend the rules.A young nurse recently told this reviewer about physicians “checking-in†their elderly Medicare patients for the Christmas holidays at her small-town hospital. Apparently, many patients’ chronic conditions had worsened and now required hospital supervised observation while their families traveled out-of-town. In terms of physicians’ power we remain in the 1970’s.---Technology Won’t Make Healthcare Affordable---This book should be required reading for entrepreneurs and start-ups working in healthcare. Not because their expectations should be set by our history, but to understand that only the rarest of innovations is likely to make a difference. Peter Shaywitz’ book “Tech-Tonics: Can Passionate Entrepreneurs Heal Healthcare with Technology†examines IT’s place in modern healthcare and concludes that the problem for the Silicon Valley entrepreneur/innovator is that they don’t know health care and can’t resolve this shortcoming on their own without the help of healthcare specialists. But IT solutions will ultimately face the many healthcare special interests that may delay or stop their deployment on a national program.---But Unaffordable Healthcare Feeds Many---A theme only lightly examined by the author is that healthcare accounts for very large portion of jobs in the US with about 1 in 8, or 12%, employed in the industry. Engel counts these as among the winners within our healthcare system, albeit a sizeable segment works at low, but steady wages.Nearly every working age person pays dearly for their care, the legions of clinical and managerial healthcare professionals balance those costs with comfortable six-figure incomes. Bruce Vladeck, former head of Medicare’s Health Care Financing Administration (now called Centers for Medicare and Medicaid Services), told the audience at an early 2000’s health care financial management conference to “Look in the mirror†when seeking answers to healthcare’s rising costs that threatened their hospitals and managed care companies.Michael GramboLinden, VA
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