Of Obamacare and Medicine (The Conservative Chronicles (Volume II) Book 2)
Contents:
- Pygmalion (A Modern Fantasy Erotica);
- Salvation by grace through faith alone!
- Fille de roi : Saga des Cavendish, vol. 3 (French Edition).
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There was a problem filtering reviews right now. Please try again later. Kindle Edition Verified Purchase. For any one who is seriously interested in healthcare, it is critical reading, if sometimes heavy going reading. Brill focusses on the history of Obamacare, and in doing so makes it clear that the root of the U. Healthcare now accounts for one sixth of the US economy, and that means that the money and influence t that can be rallied against any change are formidable.
This made the enactment of Obamacare so torturous a process, and explains why the result is a U. Another reviewer refers to Bismark's dictum that one should not watch either laws or sausages being made, and the first half of Brill's book demonstrates that -- exhaustively and and times exhaustingly. He shows how it was that, even with a Democratic majority in both houses, lobbyists for special interests the drug companies, the insurers, the hospitals, the device makers, the patient's groups, and on and on and on were able to force those in favor of reform to water down proposals, compromise, buy off, and on and on an on.
In so doing, I learned a lot about the economics and the power structure of the U. I also learned or was confirmed in my belief that within the Obama administration there were major divisions of opinion and major shortages of communication. The second part of the book, on what happened after the legislation was passed, was more interesting -- or perhaps more accurately less exhausting.
First, in this part, Brill intersperses the political narrative with stories of individuals who ran into financial catastrophe through illness, and looks at what varioius institutions mostly hospitals did to bring these individuals close to financial ruin. Second, his narrative of the failed launch of the Obamacare website is eyeopening -- the launch failed because the project was badly run from its inception, and that reflected bad management by the administration, all the way up to the top.
That, however, is followed by the livliest part of the book, in which a "Geek Squad" of mostly private sector techies saves the day. There is a lot in this section to gratify anti-Obama types and anti-govenment types, but only if you read it in isolation from the context. That context is one of "non profit" hospitals with CEO's who earn millions a year, drug companies whose devotion to research is far exceeded by their devotion to their profit margins, and an overall situation in which the consumer of healthcare comes in last.
At the end of the book, Brill argues that there is no way that the U. That would mean single payer, it would mean Medicare drug price negotiation if not drug price regulation, it would mean serious research on comparative outcomes and costs, and it would mean a whole lot of other violent change to one-sixth of the U.
That sixth has a very powerful interest in resisting change, while the five-sixths of the economy that would benefit has a more diffuse interest. Granted that, he proposes that perhaps we should consider making the institutions that directly provide more and more U. S, medical care --the hospitals -- into insurers as well as providers. It's an interesting idea that sounds a little like handing the whole henhouse over to the fox, but it bears discussion. As to Obamacare, Brill concludes that it was a major accomplishment, in that it brought healthcare into the reach of many more Americans.
Still, Brill argues that it was essentially tinkering with the jalopy, not putting in a new engine. This book is the best overall summary of the U. It could have been a better book, better organized and more readable. You were in the frontline many years ago.
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I heard an interview in which you said that if this was a corporation, things would be tweaked as they go along. But the big problem has become affordability. We need to get our handle around affordability. There are a lot of things that can be done to try to bring the cost down, but we have paralysis. The thing that I find so strange is that President Trump did run on the issue of affordability in insurance. He kept talking about how high expenses were, how high drug costs are.
How does this match up with what the American public wants? Part of the problem is the political problem. No company would put in place a policy and not revise it over seven years. That is an insane system. But we have people on the board of directors of the Affordable Care Act. That is no way to run a system.
When Hillary Clinton ran, she had a list of things she wanted to do to fix on the Affordable Care Act. Most people say we should repair it. Even conservatives say we should repair it and not throw it out. One of the other things you talk about in the book are these mega trends you would like to see occur, specifically about specialties in the health care sector.
One of the problems we have in the United States — and this has been long recognized — is that we have too many specialists compared to primary care doctors. We need more primary care doctors, and it is a challenge to both. When you have too many specialists, you end up with a lot of specialists doing a lot of primary care. That is not a good system. You should have primary care doctors doing most of the management and then bringing in the specialists as consultants for patients who are really sick or have complex problems.
Again, places that have transformed have had this different relationship between primary care doctors and specialists, mostly using specialists as consultants to confirm diagnoses, to confirm a course of treatment. Not using them to take over the management of bread-and-butter health problems. Why do you think there has been this run towards specialists in the last 70 years? A large part of it comes after the war. Specialists get paid more, so more people go into specialties. In the VA system, specialists had higher rank. Specialists who had procedures, like cardiologists with catheterization and stuff, got paid for those procedures and could make a lot more money.
It really incentivized people to go into specialties. We have to reverse that.
Read more Read less. In a gripping narrative, his thorough reporting is made all the more powerful by his own scary experience looking up from a gurney. In the VA system, specialists had higher rank. Views Read View source View history. This was my first "official" book for grad school and certainly did not disappoint. The movement has sponsored protests and supported political candidates circa Amazing history of the US health care system.
In England, primary care doctors are the highest-paid doctors on average in their system. The specialist has prestige of the specialty, but the primary care doctor needs something else to keep them in and keep them attractive.
But what does focusing on more primary care physicians do to the industry? That is a really good question. I spent time writing an essay about the changes we need in American medical education, and one of the big changes we need is to move a lot of the training out of the hospitals. If you go to medical school, roughly the first two years is book-learning about anatomy and biology. But the last two, two-and-a-half years is about training on your clinical studies, so clinical rotations.
Typically, they are in the hospital. It turns out that hospital care has really gone down in this country and outpatient care has gone up. Yet we train our doctors in the hospital as if that is where they are going to see most of their patients, but that is just not true. One of the big changes we need is to train our doctors differently, train them more in the outpatient setting and less in the hospital. That is a hard thing to do.
I particularly like three aspects of this book: Anyone seriously interested in understanding healthcare reform should look carefully at the proposals offered here. As we stand on the brink of hyper-regulating our system further, Goodman cogently argues that our answer is to free our system from the traps policymakers, insurers and providers have built over the decades. Goodman brings his clear thinking as an economist to explain how we could employ market forces in health care to realign incentives so patients, doctors, and all of the players in the health care marketplace are seeking greater efficiency, higher quality, and better value.
Generations of health reformers have tried to engineer a new system based on regulation and centralized control, only to find higher cost for health care that too often fails to provide value to patients. Goodman has a better idea: Antos , Wilson H. John Goodman is the welcome exception and his innovative work has been influential in his creation of health savings accounts. His book Priceless is now full of equally useful ideas for restoring healthcare to the market, and when the ACA disappears this book will provide the framework for truly reforming healthcare for all.
When we free the patients and the healthcare professionals from payer and government shackles, we will drive quality up and price down and eliminate an enormous amount of waste. Curing the Healthcare Crisis John Goodman deftly explains how to jettison the overgrown dysfunctional gridlock that prevents reform of healthcare and healthcare entitlements.
Goodman on Special Report with Bret Baier: Goodman on Stossel Thursday, June 21, Can Healthcare Be Fixed? More Videos of John C. Goodman, author of Priceless: Priceless author John C. Goodman to speak at Utah State University. Goodman to speak at the Junior League of Dallas.
ACA Architect Ezekiel Emanuel's 12 Ideas to Fix U.S. Health Care
Goodman to speak about Priceless at the Robert J. Dole Institute for Politics at the University of Kansas. Goodman to speak at Lyndon B. Goodman to speak at St. Goodman to speak at Mercer University. Goodman to speak at the Bastiat Society of Indianapolis. Goodman to speak about Priceless at the P. Festival in Tampa, FL.
Goodman to speak about Priceless at special reception hosted by the Competitive Enterprise Institute. Goodman to speak on Priceless: Research Fellow John C. Goodman to testify before the U. Goodman at BookExpo America at Goodman, author of Priceless Op-Ed in Forbes. Goodman, author of Priceless Op-Ed in Townhall. Goodman, author of Priceless appears on the Lars Larson radio show. Goodman, author of Priceless in Forbes. Goodman, author of Priceless appears on Fox News Channel.
Goodman cited in Forbes. Goodman, author of Priceless appears on The John Batchelor radio show. Goodman, author of Priceless in TownHall. Goodman, author of Priceless cited in Indianapolis Business Journal. Goodman, author of Priceless in Townhall. Goodman, author of Priceless cited in Michigan newspaper syndicate MLive.
Fellow and author of Priceless John C. Goodman, Author of Priceless mentioned in letter to the editor in the Kalamazoo Gazette.
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