More money spent doesn't always result in better outcomes

One can usually tell if a book is good by the passion it generates among its readers. Both good and bad. And this one is no exception!
This book challenges many of the myths about our healthcare system and presents a startling view of how broken the system really is.
Starting right at the beginning, the figures are 'mind numbing'- 2.2 trillion dollars spent each year and the breakdown of where the money comes from and how it is spent is sure to be a revelation to many.
Author Maggie Mahar has clearly done the research and presented a well written and clear, account of the healthcare system. Full of data yet nicely balanced with personal perspectives and stories.
For any serious student of the healthcare system, regardless of role within the system, even political persuasion, this book will help spread some light on where the money goes. With so much money 'slushing' around its easy to see how so many organisations make huge sums of money without delivering much value in return.
As a user of the healthcare system I'm disappointed by the failure of the system to deliver better health outcomes to consumers. This book certainly alerted me to my role in demanding better care and the need for me to take more responsiblity for my own health.
This is a very different book than Porter and Teisberg's 'Redefining Health Care'. Infintely more readable and compelling.
My one regret is the author did not confront the solution!

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Misses the big targets - from a Med Student

Its the evil corporations! Its the HMOs! Medicine is broken! The world is ending, lets turn to our wonderful government, champion of handling disasters like Katrina.

I knew this book was a dud the moment she started taking about the "uninsured". Millions of people don't have healthcare - even millions of those that make upwards of $50,000. I wonder why that is? No, I don't wonder - its obvious to anyone who thinks about it for 15 seconds - sadly the author did not. Young healthy people don't get health coverage because they are making a rational assessment of risk. They may have catastrophic insurance - say something that covers trauma that has a $100,000 deductible. That's what rational people do - they save money if they don't need to spend it. And these people don't perceive a need for health coverage even though they can AFFORD it. I should have put the book down after the author had demonstrated such a lack of commonsense.

However I did not, so let me quote from the summary above. Its hard to take any author seriously that writes a thought that can be summed up as: "including the VA hospital system, which provides excellent care at modest cost thanks largely to its exemption from the pressures of competition". It does a fine job despite having no competition. Look everyone, the laws of economics that apply everywhere in the Universe have been suspended in Healthcare! Amazing. Whereas in every other industry the exact opposite happens? So odd.

This is another in a long string of books that tells people what they want to hear about American Healthcare.

So, why do HMOs exist? Why do we have businesses pay our health insurance (they don't pay our car insurance - odd)? The reason medicine is so messed up is because it is so regulated by the government. That's the bottom line. All the other players are simply making the best of the situation given the laws that our sage leaders have passed in their infinite economic wisdom (thats heavy sarcasm for those reading at home). I am always amused when the same government that completely broke the medical system by constant interference is heralded as its savior.

Let's think outside the box for once? Remove laws that urge corporations to provide healthcare, remove laws that support the HMO structure, and tone down the incredible interference. Lets tone down the lawsuits (try suing the VA- you will get a big surprise on one of the ways the VA saves money). Then what will see? The same thing we see in the long run in every industry - competition leads to better services at lower costs. Does this book have the guts to say that despite the authors supposed keen insight. No, its a total disappointment!

Or lets write books that pretend medicine is in wonder land where its eternally opposite day for economics.

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From a Patient's Point of View

First, a full disclosure: Maggie Mahar and I started at the same university at the same time on the same career path--far away from the Medical School. Both of us changed careers, we lived on opposite coasts, and lost touch over the years. But that's not why I bought this book. I bought it because I've had some serious chronic illnesses to manage for the past ten years, I've had more contact with the American medical system than most people, and I'm always asking questions. Most are questions about my own care. But I'm interested in the larger questions too, and this book gives some interesting answers.

As patients go, I'm one of the luckier ones--I have comprehensive health insurance, and many great doctors and nurses giving me both excellent care and moral support. But I've also been baffled and frustrated at times by the indifference and inefficiencies of the larger system. And I've seen these at both for-profit and non-profit hospitals, includng top-rated ones.

It's a scandal that the United States has so many uninsured people, and it's good news that a few states like Vermont and Massachusetts (if not the federal government) are at last showing some leadership on the issue. Dedicated groups in other states (certainly in California) are pushing for solutions too. But health coverage is just the most visible part of the problem. The problem is that "money-driven medicine" has too many perverse incentives to work the way medicine (or markets) are supposed to work. This well-researched and readable book tells you exactly why in both economic and personal terms--and many of the best anecdotes and insights come from inside the system, especially from frustrated physicians.

Unless you think that you and your family members will never get sick, but all die peacefully in your sleep at the age of 101, you should read this book just to protect yourself from the downside of the medical markets. It's not even an anti-capitalist thing to do. (Investors are always looking for ne3w ways to protect themselves from the downside of financial markets, after all.)

As this book rightly points out, if you haven't gone to medical school--or even if you have--when you or a family member gets sick, you have to trust your doctor. (There's reliable and unreliable information on the Internet, but it can't replace a doctor's long training and experience.) But make doctors earn your trust.

This is my personal advice, but it's confirmed by the information in this book. Ask questions; ask for some evidence that a drug or treatment will work; find out what the potential side effects are and how to avoid or mitigate them. Medicine is imperfect, and good doctors will admit what they do and don't know. (I think that's the litmus test for a good doctor.) In some situations, there may not be any evidence that one treatment is better than another, but you need to know that too. Try not ask irritating questions; but if the doctor gets irritated too easily, this may not be the doctor for you.

I have absolutely no solutions to the larger puzzle of the whole system--and neither does this book. After reading it, though, I think that doctors, nurses and other health professionals need help from some quarter to do their difficult jobs without so much interference from market forces. Eisenhower warned about the downside of the military-industrial complex fifty years ago; and it's still with us, stronger than ever. Now Americans have a medical-industrial complex to cope with too, and it affects us in an even more intimate way.

Read "Market-Driven Medicine"-it's news you can use.

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