2024 the best healthcare system in the world review
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From a giant of health care policy, an engaging and enlightening account of why American health care is so expensive―and why it doesn't have to be
Uwe Reinhardt was a towering figure and moral conscience of health care policy in the United States and beyond. Famously bipartisan, he advised presidents and Congress on health reform and originated central features of the Affordable Care Act. In Priced Out, Reinhardt offers an engaging and enlightening account of the U.S. health care system, explaining why it costs so much more and delivers so much less than the systems of every other advanced country, why this situation is morally indefensible, and how we might improve it. Drawing on the best evidence, he guides readers through the chaotic, secretive, and inefficient way America pays for health care, dispelling the confusion, ignorance, myths, and misinformation that hinder effective reform.
Publisher : Princeton University Press (September 1, 2020)
Language : English
Paperback : 232 pages
ISBN-10 : 0691208530
ISBN-13 : 978-0691208534
Item Weight : 2.31 pounds
Dimensions : 5.4 x 0.8 x 7.9 inches
Reviewer: Athan
Rating: 5.0 out of 5 stars
Title: Brilliant and to the point
Review: Priced Out was never finished by its author. The book was completed by Uwe Reinhardtâs wife Tsung Mai-Cheng (a habitual co-author of Reinhardtâs and celebrated healthcare economist in her own right) and published posthumously.It is burdened, in my view, by having three forewords instead of one: two fawning / mourning introductions by Paul Krugman and William Frist, which merely serve to put off any Republicans from reading the book (yes, I know Bill Frist was a Republican), and one by the author himself, who explains that there are exactly two problems with healthcare in the US:1. An honest debate has never taken place on what we want from it: should the fortunate (i.e. rich and healthy) members of the public pay for the health of the unfortunate (i.e. poor and unhealthy)? Yes or no?Because this debate has never openly taken place, we have stumbled upon a system that fails on both possible aims: (i) itâs far more wasteful than it would be if we did not care to provide for the less fortunate (ii) itâs far more inequitable than it would be if we did.2. US healthcare is unnecessarily feeding far too many mouths, a fact that makes it expensive.Having established these facts in the introduction, Reinhardt goes on to make a number of important points:1. US healthcare is expensive beyond what you would expect given explanatory factors such as ability to pay (the âsuperior goodâ explanation) and demographic structure. Yes, rich countries with rich country demographics should spend more on healthcare than poor countries with a young population. But you run the regressions and the US is almost as much of an outlier after youâve corrected for all that.2. More relevantly, US healthcare is expensive compared to other nations if you allow for its effectiveness (outcomes, p.75), or adjust for obesity, diabetes etc. Americans get poor value, bottom line. They do so even after you adjust for the standard of care they receive (which is no great shakes) and they do so even after you account for the fact that âeveryoneâs fatâ / âeveryone smokesâ / âeveryone drinksâ etc.3. Only 17% of the cost of drugs is accounted for by the cost of production. Only 58% goes to pharmaceutical companies, even. The rest goes to a phalanx of intermediaries siphoning money to themselves: insurers, Pharmaceutical Benefit Managers, pharmacies and wholesalers!!!4. US healthcare costs have been spiraling up at a rate that puts inflation to shame, any way you care to measure it.5. Costs of procedures are (i) high relative to any country you care to mention (ii) amazingly varied from hospital to hospital (iii) amazingly varied within each hospital, depending on whoâs getting treated (iv) opaque / hidden: you never know what youâll pay (which makes the principle of co-paying cruel, Reinhardt adds, by-the-by.)6. The government pays directly for half all healthcare and foregoes tax on part of the rest. Medicaid, Medicare and Public Health spending is half the spending. Private Insurance is only 34.3% and out-of-pocket is 11%.7. US healthcare pays for an army of administrators. Each one of those layers of administrators, whose main function is to fight somebodyâs corner in the 34.3% of the market that is paid for by private insurance, has a job that at some point in history made sense. Collectively, however, this is a leviathan that (directly, or via the public purse) sucks money out of everyoneâs pocket, all while creating a vast lobby for the status quo, because all these people have jobs to protect.Next, the author takes you both through Obamacare and through the House proposal and the Senate proposal for replacing Obamacare.His analysis on Obamacare is not what youâd think. He basically deems it to be âa bad patch on a bad systemâ rather than the panacea weâve been told it is. He concedes, on the other hand, that for those not lucky enough to get their employer to pay for their health insurance it is a massive improvement on what went before.The main problem of Obamacare is that inevitably a line must be drawn above which you are not covered. The people right above that line ended up as the main losers: theyâre paying more than they did before.The reason is what Reinhardt calls the âdeath spiralâ of health insurance, which comes in two parts: part one of the death spiral is that the top 10% of the insured suck up two thirds of all resources, meaning that most people lose from buying insurance and a select few benefit a whole lot. This situation gives rise to two ways to charge a patient: based on either his medical circumstances (âmedically underwrittenâ) or on the fact that he has a pulse (âcommunity ratedâ). Obamacare forces insurers to take everybody based on their community rating, pays for the poor and forces everybody else to pay for the insurance themselves (or pay a fine if they opt out).Part two of the death spiral comes if not everyone is forced to buy healthcare, because then they only will if they need it. This means up to 90% of potential contributors can take their chances, leaving the 10% in the pool. So the costs to the insurers go up. This drives costs up, making the decision even more clear-cut for the potentially healthy, which in turnâ¦. you get the idea, itâs called a spiral for a reason!Now in theory Obamacare does not face a death spiral, because it forces everybody in. But life is not that simple! It turns out that the people who first ever bought healthcare under Obamacare were sicker than everybody else who was buying health insurance before. No massive surprise with the benefit of hindsight, but the result is that health insurers now need to charge more. And if youâre above the threshold for government handouts, youâre worse off, period.There are other losers, those who would prefer to take their chances but are forced to either buy insurance they donât believe they need or pay a fine. Reinhardt has absolutely no pity for them, however! The last chapter of the book penned by him is a tongue-in-cheek proposal whereby at age 26 every American has to say if he wants to be part of a national insurance plan. And if not, he can never enroll and take his chances. He gets to become, in the authorâs words, an Uninsured Rugged American Individualistâ¦The analysis of the Republican plans should have been carved out of the book in my view, as they never came to pass.The book closes with Tsung Mai-Chengâs efforts to provide relevant quotations from her husband on a range of issues he never got to.Obviously, he never wrote those bits, so we are relying here on Uwe Reinhardtâs wife to pick quotations that are in line with his beliefs, but they make for VERY uncomfortable reading.Single-payer healthcare in the US he actually views as an invitation for a free-for-all, due to âcaptureâ of the US government by private interests:âI have not advocated the single payer model here because our government is too corrupt. Medicare is a large insurance company whose board of directors (Ways and Means and Senate Finance) accepts payments from vendors to the company. In the private market, that would get you into trouble. When you go to Taiwan or Canada, the kind of lobbying we have here is illegal there. You canât pay money to influence the party the same way. Therefore the bureaucrats who run these systems are pretty much insulated from those pressures. Here you have basically a board of directors in the House Ways and Means Committee that gets money from lobbyists both at the regulatory writing stage and during normal operations. And they can call an administrator and demand they stop something from happening.âPerhaps even more unsettling is that Reinhardt finds US healthcare to be one of the better features of the American landscape. To wit:âI am actually quite optimistic about health care. First of all, it never was that bad a sector. People always say itâs the most inefficient sector in the world. Thatâs bullshine. If you compare heath care to education, health care towers over education in terms of concern about quality, concern about effectiveness et cetera. Compare it to jurisprudence. Have judges ever worried about how much time of the jury they pulverize? So I think the health care system actually is a lot better than people claim it to be. We keep beating up on doctors and nurses and they work very hard. But actually where we should start -there was an Institute of Medicine study out that said we spend $190 billion more per year on administration than we should. It seems to me that should be attacked before I hound more doctors and nurses⦠For some reason we talk about evidence-based clinical practice, but not ever about evidence-based administration⦠Say, how could you run an insurance system more cheaply than we do? How much should we save? Whatever we are spending, cut it in half.âOverall, this book was a massive eye-opener for me, both because of the rational analysis offered and because it was short and had charts and tables and graphs. But the central message is the following:The first thing we must do before assessing US healthcare is to have an honest debate on the issue Uwe Reinhardt opens with:âTo what extent should the better-off members of society be made to be their poorer and sicker brothersâ and sistersâ keepers in health care?âReinhardt strongly believed that it is our duty to be our sicker brothersâ and sistersâ keepers. But he was also a practical man.I recommend you read âPriced Outâ together with my friend Jonathan Cohnâs âSick.â
Reviewer: Mr. Burns
Rating: 5.0 out of 5 stars
Title: Excellent book
Review: While the book it is getting older it is still relevant today. With millions of Americans unable to access healthcare without ruining their finances, Uwe raises the importance of increasing access to people and improving the health and lives of Americans in the United States.
Reviewer: Frederick L. Pilot
Rating: 4.0 out of 5 stars
Title: Properly describes medical care as a âsocial good" rather than consumer commodity
Review: The late professor Reinhardt properly describes health care as a âsocial good.â Itâs important distinction since health care is so often seen as a consumer commodity, conflated with consumption of medical care. I believe health care is something we give to ourselves in order to reduce the need for medical care; good health is a social asset. As an economist, Reinhardt makes the case that medical care cannot function as a discretionary consumer marketplace. People donât purchase most medical care as they do other consumer services and products. They use it when they least expect, usually not knowing much in advance regarding price and quality and hoping they wonât get a bill they canât easily pay. In that regard, âhealth insuranceâ is really medical bill protection in the minds of most.Reinhardt aptly describes purchasing medical care like going into a department store blindfolded, ushered in by middlemen such as insurers and pharmacy benefit managers. The ultimate payers â individuals and households â cannot adequately harness market forces to hold down prices and ensure value. Without the ability to muster meaningful competition on the buy side, medical care cannot truly be called a market powered by individual buying decisions.Reinhardt notes those who choose to regard it as such also tend to emphasize individual responsibility for health to avoid medical care to the extent possible. Therein lies a nexus to guide reform efforts. As a social good, taking care of oneâs health is both an individual and social responsibility. Itâs something everyone is responsible for: to themselves, their families and loved ones and their employers and those who depend on their work. Reinhardt implores his readers to ask themselves if Americans collectively should provide care to those unfortunate enough to need a lot of it but lacking the means to pay for it. Given a finite amount of resources to provide medical care, medical care should be treated as a social asset so the best care is available to those who most need it.Good health cannot be attained merely by consuming medical care. This book would be better if it included more discussion of lifestyles and social determinants of health â getting much deserved attention lately â on the utilization of medical care. While medical care doesnât function as a competitive market, the law of supply and demand still applies. Reducing demand should be a national priority at a time when so many lead sedentary lives and develop preventable chronic conditions. Notably, this predates the Internet era. Shortly before assuming office in 1961, President John F. Kennedy called for greater attention to physical fitness as a social good. âMany of the routine physical activities which earlier Americans took for granted are no longer part of our daily life,â he wrote in Sports Illustrated. âThe television set, the movies and the myriad conveniences and distractions of modern life all lure our young people away from the strenuous physical activity that is the basis of fitness in youth and in later life.â
Reviewer: MichaelP
Rating: 5.0 out of 5 stars
Title: READ THIS BOOK!! Healthcare in detail but in a nutshell!
Review: If you want a thorough understand of the American Health care finance system and how it differs from the rest of the world and how, frankly, profoundly screwed up it is, read this book. The late Dr. Reinhardt was the preeminent healthcare economist of his time until his death in 2017. Read this book before you read or hear another media story on healthcare. You'll be glad you did.
Reviewer: merrily poth
Rating: 5.0 out of 5 stars
Title: Great book on important subject. Should be "must read".
Review: Did review of the subject (cost of health care) for teaching module. Read many sources. This book was the most relevant and usefulHe written word on the subject is all that needs to be said.He is missed, but thru this book his wisdom remains accessible.
Reviewer: Luis Monroy Gómez Franco
Rating: 5.0 out of 5 stars
Title: Great introduction to the US health care system
Review: This book is a masterful introduction to the structure and characteristics of the US health care system, becoming a must read in this time where health care lies at the heart of the political campaigns for the 2020 elections
Reviewer: Asher
Rating: 3.0 out of 5 stars
Title: Itâs ok if you donât know much about health policy
Review: I didnât really learn anything new since I have experience in the field. But good for laymen
Reviewer: Bill
Rating: 5.0 out of 5 stars
Title: A must read
Review: Excellent!!! Should be a must read for everyone who wants to understand the peculiarities of the American Healthcare system. Use is able to break down this complex issue and make it easy to read and understand.
Reviewer: Clara
Rating: 5.0 out of 5 stars
Title:
Review: As an international reader, I sincerely hope thereâd be such an informative book on the healthcare system of my own country.I learned so many things. Thank you.