health care meltdown: confronting the myths and fixing our failing system
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Almost five years after the original publication of Dr. Lebow’s authoritative dissection of America’s health care “system”, the situation has in many ways deteriorated. More Americans lack any health insurance, costs continue to increase faster than income, and increasing complexity is overwhelming everyone involved.
In revising this book, Dr. C. Rocky White has included recent developments in the field, and updated the relevant statistics. The bibliography has been expanded to include recently published articles, books and givernment documents. For the most part, however, Dr. LeBow’s text has proved to be as timely now as it was upon initial publication in 2002.
With a presidential election coming in 2008, Health Care Meltdown, in its revised edition, will be an essential reference for citizens of all political persuasions. There is little doubt that the failures of America’s health care “system” will be a major issue as political campaigns heat up……..
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2010-01-01
By J.L. Populist (WI,USA)
This is the revised edition of the book originally written by Robert LeBow,MD and updated by C. Rocky White,MD after LeBow’s death.
The authors make solid arguments based on personal experiences in medicine.
One objective of the book is to dispel the numerous myths that have been spread to oppose change in health care. The authors identify the sources and motivation for these myths.
An interesting idea is the proposal to disconnect health insurance from employment.
One of the points that they made regards health care “rationing”. We already have that in delayed care of those uninsured or under-insured! They discuss the higher cost of care when people pass up medical care because they simply can’t afford it because they are uninsured or can’t afford the co-pays or deductible.
Another observation was that Medicare needs to be improved or expanded rather than privatized or dismantled.
The idea that the market will work things out has proven a fallacy in health care and more visibly- on Wall Street. The common theme in both areas is profit and ultimately greed.
Two quotes from this book drive that point home effectively:
From page 167-
” If there is only one concept that the reader takes away after returning this book to the shelf, it is simply this: A profit-based, market-driven system and equitable, quality health care cannot be, and never will be, compatible. Not now, not ever!”
And from page 176-
” The [health care] system is controlled by a small handful of powerful people, economic forces, whose profit-making takes precedence over the national, and indeed, the world cause of good health.” Rep. John Conyers (D-MI).
Another excellent point about our health care system was that if we really do have “the best system in the world”, why are so many citizens uninsured? Why do global statistics indicate the opposite in several categories?
I have reservations regarding mandated participation. But overall, the solution endorsed in this book is sensible and much better than anything else that I have read about.
THE HEALTH CARE MELTDOWN is a book written for everyone. It’s sensible and coherent. To date, this is the best book I have read on the subject of health care and it’s related issues and solutions.
2009-12-09
By Dirk J. Willard (Chicago, IL)
I haven’t finished this book yet but I’ve learned so much. As a pessimist, I am always surprised when things are worse than even I expected.
The author is a doctor. Like you would expect, if you know doctors, they are mostly conservative Republicans. Hey, the AMA can’t even regulate themselves. As the author watched, the health insurance companies ruined his practice. That’s when he decided to write a book.
Here’s an interesting fact:
The uninsured pay 5 times as much as those protected by health insurance. This is the opposite of what the health insurance industry would have you believe. It turns out that hospitals can exploit the uninsured. Health insurance companies play hardball. How’s that for a revelation! There are many in this book collected from years of experience with the health insurance companies. And, these facts are supported.
Here’s another fact:
Medicare overhead is 2-3%. The average overhead, as quoted by the insurers themselves is 15%. But, many liberal think tanks estimate their overhead at 25-30%. Even at 15%, it’s too high!
Here’s another fact:
Drug manufacturers estimate that it costs $800 million to bring a drug to market. Public Citizen, a consumer protection group, estimates it takes only $110 million. Do you see the largress out there?
It will take me many weeks to finish off this book. It reads well. And, although the author is a doctor he is critical of his own blaming doctors for gaming the medicare system.
If you’d like to be an informed voter, read this book.
I hope this review was helpful. Please add your vote.
2009-07-09
By Joseph A. Domino
Dr. Lebow’s passionate plea for health care reform, although written five years ago, still resonates today. He has seen it from the trenches in public clinics. To the critics of health care reform, he will be labeled as a socialist which is nonsense. He effectively points out that insurance and pharmaceutical companies lobby for protection of their obscene profits. Dr. Lebow astutely points out many of the myths of the current system. As the chapters progress he is sometimes repetitive and preachy, but this can be overlooked.
2004-08-10
By Ellie (Wauwatosa, WI United States)
As an Adjunct instructor in the Concordia University system, I have had the opportunity to encourage my MBA students to read this book for my Special Topics in Health care class. After reviewing other possible textbooks during the last 6 months, I have decided to now use this text as the basis for my 8-week adult education class. Offering ample examples and ‘myths’ that portray our fractured health care system of today, this author has summarily provided a springboard for ongoing conversations and possible answers for this country. Granted all, the HC system will not be corrected for some time, but an accounting will be made when the public becomes a focused participant at the table.
As health care professionals, it is our responsibility to study, learn, participate and educate others, as well as ourselves.
This will begin that process and it will be well worth your effort and consideration.
Thank you
ESchwarz, RN, MBA, CCM
2004-06-28
By Michael Considine (Cambridge, MA United States)
I’d like to give this book 4 stars, but there are just too many holes for me to do so. Dr. Lebow presents many important points, but the book simply is not the answer to our prayers regarding the current healthcare mess.
As Dr. Lebow points out, in the health insurance industry, competition among health insurers has led to less efficiency rather than more efficiency. 10 different credentialing applications, 12 different contract types, no standardization whatsoever and an administrative mess for any doctor who doesn’t have the luxury of a seasoned healthcare administrator in his office. Add to that the eligibility trouble. Multiple phone calls for every patient to check eligibility for every appointment. Worst of all, the current health insurance system provides no incentive to managed care to pay for preventive care.
These are the issues that single-payer would fix for the insured population, saving billions of dollars. Dr. Lebow is right on, though I wish he spent as much time on eligibility and insurance company hassles as he did on preventive care. He also does great work in presenting the myths of healthcare today. Many of them can’t be repeated enough (like the corporate welfare given to prescription drug companies).
But I have several issues as well.
My biggest complaint is that his solution only delays the inevitable a little longer. He deals only with the healthcare funding system and has little to say about the healthcare delivery system. “Market Driven Healthcare” by Regina Herzlinger and “From Chaos to Care” by David Lawrence offer real long-term solutions to the healthcare delivery problems we face in our current environment. Unless those market principles are imposed on healthcare, single payor will only delay the final implosion of medical care. Once the financial gains from single-payor healthcare are realized and exhausted, the costs will continue to spiral out of control.
Another issue is that he gives few details in the “how” of his solutions. Focusing on prevention and public health is a good and obvious point. Everybody agrees on it, but I don’t think simply saying “it will happen once a grassroots movement demands it” is sufficiently descriptive of how he sees prevention and public health becoming the standard. Who will implement it? How?
Because of these problems, Dr. Lebow does not make a convincing case to those in power that change is good for them. He persuades the persuaded brilliantly, but I can’t imagine why someone who opposes single-payer would change his mind after reading this book. And those in power are whose minds must be changed if change is to come.
The way I see it, healthcare as we know it is a very young industry. Only 16 years ago, managed care was almost an unkown in the healthcare world. Now, it dominates. Unfortunately, that insurance model grew so quickly there was no way anyone could have planned it properly. Imagine how the computer industry would have destroyed itself if it weren’t entirely made up of systems thinkers known for their planning ability. ISO-9000 was brilliant, as is settling on the PC as the standard. Healthcare needs, and is getting, more of that now. HIPAA and state-mandated credentialing applications perfectly demonstrate the government’s role in fixing healthcare. It should be a regulator, an agent for the lowly to make sure the big guys play fair, and a standard-setter to make commercial insurance more efficient. But it’s entirely too early to declare the market dead and single payer as the only way out of this mess.
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