Rx for Health Care Reform

Ken Terry

Description

In this readable and well-researched book, Ken Terry analyzes the current state of health care reform and finds it wanting. Instead of tackling the core problems in our failing system, he argues, politicians, insurance executives, and health care leaders have embraced ideologically driven initiatives that pursue impractical objectives or will take too long to bear fruit. Among these are such widely hailed trends as disease management, pay for performance, cost and price ìtransparency,î consumer-directed care, and health information technology, none of which will reverse the rising tide of health spending. What is creating this nightmare scenario, according to Terry, is the sheer profitability of the health care industry. Insurers, physicians, hospitals, pharmaceutical companies, and device manufacturers are all striving to maximize their profits, and there is no effective competition or regulation to restrain them. Only a complete overhaul of our system for financing and delivering health care can get us out of this mess, the author maintains. In the second half of his book, he presents a bold vision of how to do this: First, he says, all primary care physicians should join group practices that are large enough to take financial responsibility for professional services. And second, competition among those physician groups, based on cost and quality, should replace competition among health plans. There should be only one government-regulated insurer per region, he says, and it should have no role in managing care.

Sujets

• Public Policy
• Public Health
• Health Care Issues
• Political Science
• Health
• Fitness

Informations

• Publié par: Vanderbilt University Press
• Date de parution: 15 septembre 2007
• Nombre de lectures: 1
• EAN13: 9780826592323
• Langue: English
• Poids de l'ouvrage: 2 Mo

Extrait

for HealthCare Reform

“Just the kind of bold analysis needed today to put reason and common sense back into health policy.”  —Joseph E. Scherger, MD

KenTerry

Rx for Health Care Reform

for Health Care Reform

Ken Terry Foreword by Pau B. Gînsburg

 Vanderbilt University Press • Nashville

© 2007 KeN Terry Published by Vanderbilt University Press All rights reserved

First EDitioN 2007

This book is printed on acid-free paper made from 50% post-consumer recycled paper Manufactured in the United States of America

Library of Congress Cataloging-in-Publication Data Terry, Ken, 1948- Rx for health care reform / Ken Terry.—1st ed. p. ; cm. Includes bibliographical references and index. ISBN 978-0-8265-1570-4 (cloth : alk. paper) ISBN 978-0-8265-1571-1 (pbk. : alk. paper) 1. Health care reform—United States. 2. Medical policy—United States. 3. Medical care—United States. I. Title. [DNLM: 1. Health Care Reform—United States. 2. Health Care Sector—United States. WA 540 AA1 T329r 2007] RA395.A3T455 2007 362.1’04250973—dc22 2007007055

To Lîsa, whose ove sustaîns me every day

Contents

Acknowledgments  ix Foreword by Paul B. Ginsburg  xi Introduction  xiii

Part I Whither Health Care Reform? 1 How We Got Into This Mess  3 2 ’Round and ’Round on the Reform Carousel  16

Part II The Emperor’s New Clothes 3 The Two Faces of Disease Management  35 4 Paying for Performance  46 5 EHRs: Necessary But Not Sufficient  61 6 Can Consumers Direct Their Own Care?  78 7 The Limits of Evidence  95

Part III The Money Machine 8 SupplyInduced Demand  109 9 Physicians Go for the Gold  121 10 Hospitals Flex Their Muscles  132 11 Why Do Drugs Cost So Much?  142

viii

Part IV Rx for Health Care Reform 12 This Market Needs Regulation  161 13 Putting Doctors Together  164 14 Why Groups Should Take Financial Risk  174 15 A RealWorld Model for Reform  185 16 The End of Insurance As We Know It  197 17 Getting Down to Nuts and Bolts  209 18 Universal Health Care  225 19 Toward Uniform Hospital Pricing  240 20 Let “Hospitalists”Take Charge  249 21 Health Planning and the CON  260 22 What Works Best in Practice?  271 23 Must Technology Break the Bank?  282 24 Toward a Rational System of Rationing  296

Notes  305 Index  355

Acknowledgments

It is impossible to acknowledge the contributions of everyone who made this book possible. But I would like to thank Marianne Mat- tera, the former editorof Medîca Economîcs Magazîne, for giving me the time and space to pursue my dream. Also, Leslie Kane, our current editor and former articles editor, supported my project from the begin- ning. So did Joseph Scherger, MD, a professor of family medicine at the University of California, San Diego, who devoted many hours to reading and critiquing my book in its formative stages. I also received valuable feedback from Paul B. Ginsburg, president of the Center for Studying Health System Change; Jacque Sokolov, MD, a health care consultant and former member of the Clinton health care task force; and Robert Berenson, MD, a fellow at the Urban Institute whose sharp criticisms of the prevailing paradigm undergirded my own. These experts, and many others, gave me faith that I was going in the right direction.  Many friends and colleagues also supported my work. Among them are Jeff Burger, Wayne Guglielmo, Robert Lowes, Charles Paikert, and Ken Schlager.  Finally, I’d like to thank my family—and particularly my children, Selene, Alycia, Justin, and Adam—for their love and support. Without them, and without the love of Lisa Lucas, I would never have had the courage to complete this book.

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