- ISBN13: 9780060580469
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Product Description
America’s health care system is unraveling, with millions of hard-working people unable to pay for prescription drugs and regular checkups, let alone hospital visits. Jonathan Cohn traveled across the United States—the only country in the developed world that does not guarantee its citizens access to medical care—to investigate why this crisis is happening and to see firsthand its impact on ordinary Americans. Passionate, powerful, illuminating, and often devastating, Sick chronicles the decline of America’s health care system, and lays bare the consequences any one of us could suffer if we don’t replace it. … More >>
Sick: The Untold Story of America’s Health Care Crisis—and the People Who Pay the Price
July 21st, 2010 at 6:20 am
The author is great at presenting anecdotes of the ills of America’s failing healthcare system. But his proposed cure is worse than the disease. His premise is that the capitalist method is bad, and only the socialist method of health care will correct all ills. While it’s true the capitalist system is far from perfect, and the US health care system in crises, a socialist takeover of healthcare is NOT the answer. The only people who love that are the Big Brother politicians and the activist who want to rob from the rich.
Unfortunately for any serious reader, the author only examines and chronicles the ills of private health centers. He completely ignores the ills of government run health care systems. (I’ve been in some … they are SCARY places indeed.)
The idea of the government — the same one gave us the Katrina mess — should take on health care and manage and control all doctors, hospitals and research is not a good idea. Just look how politicians are interfering in and bungling medical marijuana, physician assisted suicide and abortion. Anything that puts politicians (mostly all lawyers) in charge of doctors and medical science is very scary indeed.
The main reason the author’s central premise is fundamentally flawed, he assumes that the ONLY way to get to universal coverage is through government run health care. But that clearly is not true. Everyone agrees that universal coverage is good. We simply disagree on how to get there. But we could very easily get there simply by preventing insurance companies from their current practices of excluding certain people based on their health status, and their efforts to deny coverage to covered persons based on obscure policy rules as judged by a claims adjuster. This one simple rule change — full coverage, with no discriminating against anyone based on their health status — would dramatically change the coverage landscape. If we prohibited such discrimination, saying insurance companies can only charge one price for all of their customers, must cover everything considered “medically necessary” as judged by the DOCTOR (not a politician!), and can never deny coverage to anyone who can pay the premium, then we would grow to universal coverage very quick. It would take us back to the original premise of insurance, which is to spread the risk. The profit incentive then, rather than trying to exclude poor or sick people, instead would be to bring as many people into the program as possible to spread the risk. The problem of universal coverage would be solved without having to take on a huge government takeover of medical care as the author suggest. But this, and other such solutions, are not even considered or examined.
Another major flaw with this book, it examines in detail why insurers do not have people’s health at heart, but then leaps over gaps in logic to conclude that government will do better, without examining other alternatives. While the arguments presented against insurers interfering with coverage are sound, it apparently never occurs to the author that there’s a whole other group of people who could do a better job of handling our health care than either insurers or politicians — namely doctors and health care professionals themselves.
This book could be better if it examined whether perhaps the better persons to be in charge of health care would be, not politicians or insurers, but doctors and health care professionals. But it doesn’t even explore that possibility.
Are you ready to trust your politicians to take care of your health instead of your doctor? If so, then this book is just the pill for you to swallow. For the rest of us who know better, any book suggesting that your medicine should be delivered to you by politicians all too happy to tax you for the privileges they grant to you is hardly worth the paper on which it is printed.
Rating: 1 / 5
July 21st, 2010 at 8:11 am
The author argues for single tiered universal health care – probably government administrated. As both a middle class consumer and a retired surgeon I agree (don’t we all) that our medical insurance system needs fixing. But let’s consider this further: Are the people of this nation really willing to pay for great health care for everyone? It won’t be cheap. In the past 15 or so years Americans have shown that they want first-rate services, but have not been willing to vote for tax increases to cover them. By contrast, many of the European Countries that are cited as having successful healthcare financing systems have notably higher taxes.
So what are we really likely to get? At minimum a two-tiered system – the wealthy and the rest of us. Do we want that? If not, how many tiers are acceptable and who should administer them? The federal government? The private insurance companies?
So far the nationally-administered systems in this country have manifested several weaknesses. The MCARE system is a highly regulated system, setting prices, frequency of service, deciding the criteria for who can receive what treatment, how long a patient can stay in the hospital and much more. About 15 years ago, to contain costs, HCFA coined the phrase “the best the system can afford” and has since continued to reduce MCARE reimbursement, hospital stay length and covered services. MCAID is even more subject to economic pressures, and a quick review of its history shows that Congress has consistently balanced their budgets by cutting MCAID. Most recently, Congress passed a pharmacy reimbursement bill which prevents MCARE from negotiating pharmaceutical prices, a standard HMO practice.
In the short run patient’s may be getting a bargain, but many of the finer physicians are opting out of being MCARE providers, or leaving practice because of the low compensation and heavy regulation that inteferes with their ability to effectively treat patients. And among those that are staying in practice, more and more doctors are choosing to provide non-covered services such as plastic surgery or diet counseling and products, creating a shortage of physicians in many areas.
Finally, contrary to popular belief, MCARE is a tiered system, in that it requires a monthly premium (which some can’t afford), and allows for purchase of a secondary insurance (that many more cannot afford) to cover the required copayment.
We all know that conventional insurance has many of the same weaknesses and consequences. So what now?
I think a satisfactory system is developing through the efforts of state politicians that are working to design complex systems to meet a multitude of health care needs. This has spurred a dialogue that is highly educational and, I believe, over time will result in multi-tiered systems that will; provide a variety of choices for those that can afford health care coverage, eliminate discrimination against folks with pre-existing conditions and aging bodies, and fund a respectable level of health care (that can’t be reduced by a budget-stressed Congress) for those who can’t afford health care coverage.
Rating: 2 / 5
July 21st, 2010 at 10:02 am
The premise is sound but the stories are anecdotal and do little but inflame an already impassioned debate in this country — Can we afford our current healthcare system? The book added nothing new to this discourse. If you’re a novice about healthcare this might help frame the discussion but you could do better — Steve
Rating: 3 / 5
July 21st, 2010 at 12:07 pm
Human beings are fundamentally flawed. The doctrine of Original Sin is at least metaphorically true. Unfortunately, Jonathan Cohn seemingly believes that we are innately good. Never once does he deal with the moral hazard dilemma. Only on page 158 does he even cite an instance when somebody is caught defrauding the system. Much of our health care crisis is the result of so many Americans believing someone else is paying the bill. Such a mindset inevitably encourages individuals to make stupid choices. On page 220, the author asserts that Bush and his allies merely conclude “Public insurance programs are bad because they have to be financed with taxes, inevitably imposing the largest penalties on either the wealthy or big business.” Continuing onto the very next page, Cohn adds “this represents yet another nod to shed the burden of financing generous employee benefits.” Alas, the harsh reality is that the employer never pays for one’s health benefits. They merely deduct money from your salary to pay for the health insurance. The middle class pays the majority of the tax bill. There are simply not enough wealthy people. You might tax Bill Gates, Warren Buffett and other billionaires 100% of their income—and it would barely be noticeable. “Big business” also never really pays any taxes. The large corporations merely pass the added costs along to the consumer. At the end of the day, we will spend more for our products and services.
Jonathan Cohn is admittedly a well meaning guy. However, this is not good enough. Mushy sentimentalism will not get the job done. Devising social policies premised upon a mistaken notion of human nature is utopian and ultimately doomed to fail. They will likely even make matters worse. Meaningful improvement in healthcare will not occur unless Americans directly feel the impact in their own wallets. You should also read Crisis of Abundance: Rethinking How We Pay for Health Care by Arnold Kling and David Gratzer’s The Cure: How Capitalism Can Save American Health Care.
Rating: 4 / 5
July 21st, 2010 at 2:39 pm
Everyone has an opinion. I’ve been a family practice physician now for 30 years, and see the situation from the patient, hospital and personal viewpoint. The best, most honest and straight forward written information I’ve seen comes from William C. Waters III, MD. The small book, or pamphlet, called “2 days that ruined your health care”, came from AAPS. I ordered 30 more copies, and my hospital administrator ordered 100, to give to board members and interested others. Unfortunately, I’m afraid there is irresistible political pressure insure more of the same.
Rating: 3 / 5