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In the introduction he states that our health care system is expensive and not as good at delivering results as other countries. His conclusion is to introduce free market economics as the solution. So the answer to fixing the only health care system which operates on free market principles is to double down. We operate in a free market he might not like the market or the rules since he failed at running his first business.
He harps on several points but does not seem to have any knowledge of the realities.
1. Overpriced hospitals. Here he is confused by costs vs charges. Hospitals are required by law to care for all patients regardless of their ability to pay. Since at many emergency departments over a third of all patients do not pay. So the hospital must raise charges to cover these patients. As specialty hospitals grow taking away paying patients this only makes it worse. Hospitals are struggling throughout the country. Many are closing or selling themselves because they can not survive.
2. Customer satisfaction is bad because there is no free market. If you look at press ganey the largest surveyor of patient satisfaction doctors and hospitals are doing great. Over 90 percent of hospitals and 99 percent of doctors score over 4 on a 5 point scale. Much better than Airlines which have been deregulated and are more free market or restaurants as a group.
3. There is no innovation. This is just looking at the facts he wants and ignoring all others. there has been great innovation. Pick a specialty cardiology has gone from 2 weeks bed rest for myocardial infarction to stents in 90 minutes from arrival. We have better tests to find heart attacks. Surgery has gone from large incisions to laparoscopic and in some cases robotic.
4. If only people could choose things would be better. This is nonsense. When someone is sick they rely on doctors to help guide them. Also many would say that they do not feel spending 100$ more on a meal which might increase there chance of enjoyment of the meal by 1% is clearly not worth it to them however, spending money on a better chance to survive an illness? They would spend that. Also look at all the money spent on alternative medicine. Here people have the freedom to choose and they choose options that offer no benefit. The National Institute of Alternative medicine just completed a 10 year review and found no evidence to support use of anything tested as alternative medicine.
5 Choices are needed in insurance. Health insurance is not like cable TV. I do not know which illness I am going to get this year. I am sure if I do not want ESPN today I will not want it later this year. People will opt out of lots of choices then when they become ill they get covered by the either the government or the hospitals that provide the service. We removed the moral hazard. I am not advocating not treating people I am saying that if we are arguing for free markets you are arguing for letting people suffer because of their choices which we do not do.
I do agree with him when he talks about information, reducing overhead and getting rid of fee for service. A free market tries to maximize one thing and that is profit. If it can do it my delivering expensive less effective health care it will as it has proven. So eliminating fee for service is a start. Going to a single payer is another good step. Less paperwork and back office support is needed with a single payer. However, these will not reduce lawsuits which contribute to costs of healthcare. Doctors win about 90% of malpractices cases so most cases are about poor outcomes not medical care. The free market would say if we can make money by suing we will sue. Many cases are settled to avoid the years of pretrial and trial costs which only encourages more lawsutis.
4 of 4 people found this review helpful
Has the drive and data of Tom Peters’ Liberation Management and the soul of Tracy Kidder’s Soul of a New Machine. Thank you.