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Discussion in 'Pre-Medical - MD' started by venus0206, Dec 8, 2002.
Anyone know about any good reads on healthcare policy?
Health of Nations, by Laurene Graig (this one's really good...it discusses the US health care system in comparison to those of other nations)
The System, by Haynes Johnson and David Broder (focuses on managed care in the 1990's era)
Time to Heal, by Kenneth Ludmerer (very boring history of medical education and health policy in the US, lots of numbers and figures...but if you're feeling ambitious go for it)
"Understanding Health Care Policy" by Thomas Bodenheimer
I just got this so I can't give a personal critique but it has been suggested as a very thorough read on the subject by a few people here.
how thick are these books? do we really have the time to read these books on top of our busy premed lives?? i think at this point, we should be okay just reading the newspapers or TIME magazine from time to time and know how the system works in general. no need to know the entire history of every health care system that has ever existed.
on a side note: at my interview i was asked if i believed in universal health care. i said yes, and my interviewer asked me where the money for this would come from if we tried to do it in the US? i said i didnt know much about political science or how government budgets were decided on, but government officials should work closely with doctors and health care legislators to decide on a good amount to set aside from our income taxes and social security payments for health care. what else could i have said? any ideas?
I heartily second "Understanding Health Policy." It's not too long, and it's very clear, easy to follow, and interesting. You could read it in a weekend if you wanted, although a week of solid reading would probably be more reasonable (depending how busy you are.)
Not to plug or anything, but "Introduction to US Health Policy" is fantastic. It's written by a professor I had at Stanford (Donald Barr), and it's very easy to read and understand, while still giving a thorough and fairly comprehensive history.
Here's an article from the NY times about breaking news in Health Policy. Man, this stuff gets me so excited about the future. Right around the time we'll be breaking in, this whole mess is gonna reach a crescendo and, god-willing, we'll be there to make sure it gets set on the best long-term course..
December 7, 2002
Some Tentative First Steps Toward Universal Health Care
By MILT FREUDENHEIM
Worried that the growing number of uninsured patients will undermine the
nation's health care system, insurance executives across the country are
pressing for new steps toward universal health care.
Many health plans are developing or offering insurance with lower
premiums and slimmer coverage to attract customers who cannot afford
more comprehensive policies. Executives at Blue Cross Blue Shield of
Montana are pressing state legislators to raise the cigarette tax to
subsidize basic coverage. Another insurer, Blue Shield of California,
proposed a plan this week for health insurance for all state residents.
And Dr. William W. McGuire, chief executive of the UnitedHealth Group,
the largest private insurer, has written to every member of Congress
calling for "essential health care for all Americans."
Health insurers, which have long ranked high among the country's most
disliked businesses, frame many of their proposals in public policy
terms. But they also have strong business reasons to become involved in
the debate over helping the uninsured. They want to add young, healthy
members to their insurance pools to spread the cost of caring for the
sick. They are also eager to add members whose premiums would be paid
with tax money or government subsidies.
Several insurance executives also said pressures generated by the
uninsured were raising a threat to the system that could lead to
government intervention if insurers did not develop a plan first.
"If we don't do something in a darn hurry about the uninsured, the whole
health care system in this country is going to collapse and the
government will step in," said Chuck Butler, a vice president of Blue
Cross Blue Shield of Montana. "People will say, enough is enough."
Dr. Jay Crosson, executive director of physician groups at Kaiser
Permanente, the largest nonprofit insurer, said, "As insurance becomes
less affordable, more and more people will be upset and frightened, and
the industry will find itself drawn into the political process."
Most health insurers are thriving, keeping ahead of rising hospital
charges and doctor fees by raising premiums as much as 30 to 40 percent
a year for small companies and 17 percent and higher even for large
employers. But the increases, combined with disappearing jobs, are
leading many people to drop health insurance and, not incidentally,
adding to the unpopularity of insurance and managed care companies.
Each 1 percent increase in costs adds 300,000 to the 41 million
uninsured, according to the Lewin Group, a health care research
organization. Many of the uninsured are young and healthy workers in
small companies. When they go without health insurance, costs per person
soar for the sicker people who remain.
People who need care keep the coverage like "people buying fire
insurance when the house is on fire," said Randy Kammer, a vice
president of Blue Cross and Blue Shield of Florida.
Some health insurers in the Southeast are finding that as many as one in
10 small-business customers are not renewing their coverage, according
to Brian Klepper, executive director of the Florida-based Center for
Practical Health Reform, a group of insurers, hospitals and employers.
But uninsured patients still go to hospitals, which then pass along the
cost of unpaid bills in higher charges to health plans.
"The tragedy of our nation's health care system," said Dr. McGuire of
UnitedHealth, "is that in spite of its many impressive features, it has
ultimately failed to make even basic care consistently available to all
of our citizens."
Dr. McGuire is calling for building universal coverage around an agreed
national definition of what constitutes basic acceptable coverage,
"based on firm evidence" of the effectiveness and cost efficiency of the
care. He has written to every member of Congress and dispatched
UnitedHealth officials to promote his plan in Washington, D.C., and in
Minnesota and other states.
On Tuesday, Bruce G. Bodaken, the chief executive of Blue Shield of
California, one of the largest health plans in the state, called for a
statewide universal health care system, to be financed by employers,
individuals and a new tax, which he said could be a model for the
nation. More than six million California residents have no health
Mr. Bodaken said in an interview and a speech at the Commonwealth Club
in San Francisco that under his plan, all except the smallest employers
would be required to offer basic coverage. Individuals who could afford
it would have to buy their own policies, and a new tax would subsidize
those unable to get coverage.
Blue Shield has commissioned an independent study of taxing
alternatives, including raising the state income tax, sales tax, a tax
on health insurance premiums or hospital and doctors' fees and the
"We absolutely have to solve this problem," said Helen Darling,
president of the Washington Business Group on Health, a group of large
self-insured companies. "The number of uninsured will inevitably grow
because of the rapid rise in health care costs. We know it's going to
get much worse."
In Florida, 30 insurers, working with Tom Gallagher, the state insurance
commissioner, plan to introduce several lower-cost standard and basic
policies in the spring to attract small groups that have been dropping
coverage. Some policies will include high deductibles and fewer
state-mandated provisions like numerous visits to occupational and
physical therapists, said Ms. Kammer of Blue Cross and Blue Shield of
In Montana, insurers have lined up bipartisan support in the legislature
to raise cigarette taxes at next month's session to subsidize health
care for the uninsured. The package includes tax credits for employers
with two to four workers, coverage for schoolteachers and for more
children in low-income families, as well as prescription drugs for
low-income elderly people, Mr. Butler said.
Only 2.9 million New Yorkers are uninsured, reflecting the state's
extensive public assistance programs. But Howard Berman, chief executive
of Excellus, a Blue Cross holding company in Rochester, said that with a
projected budget shortfall exceeding $6 billion, the state will be hard
put to help if more residents lose their coverage.
"We need new products for middle-class people who have been priced out,"
he said. "And we need more efficiency in the system to reduce costs."
Here's a link from the AMA debunking this.
Also on their main website are plenty of articles dealing with this subject http://www.ama-assn.org. Their proposal for healthcare reform is especially interesting (at least to me since I was an accountant in a former life and did plenty of tax returns )
Another proposal for healthcare reform is at http://www.physiciansproposal.org
Here are some shorter ones reccommended by our health professions advisor:
Primer on the US Health Care System - published by AMSA, written by med students
Health Care Policy: The Basics - written by John McDonnough
The first one's more helpful IMO
Also USeF--Don't get too excited. That plan would just increase costs even MORE in the US, and maintain lack of patient choice in choosing a doctor. It wouldn't be portable care most likely, either, and wouldn't be very effective at controlling cost increases.
I gotta hand it to BS California--it's a great way to spin that, after however many years, they NOW support universal coverage, because it's a way for them to mooch even more money from the health care system.
I love this quote:
Blue Shield has commissioned an independent study of taxing
alternatives, including raising the state income tax, sales tax, a tax on health insurance premiums or hospital and doctors' fees and the tobacco tax.
gramcracker & others, didn't mean to imply that I was excited about any of those particular solutions, quite the contrary.
you're right, the Blue Shield's attempt to find even MORE $$ just goes to show that they are continuing to spiral down the wrong path and it's going to reach a point where a single-payer system may be the only solution. The fact that states, cities and insurance companies are scrambling to patch up problems is layering on the evidence for a widespread problem that will need citizens to mobilize solutions. (that's us, guys )
bump, for the sake of futureerdoc and others. . .i know i'm painfully uniformed, although i'm pretty sure i'm in favor of a single payer system. . .maybe myself and others can do some of this reading.
If anyone has million years to read up I just finish Health Economics by Charles Phelps (UofR Provost) for a Health Policy class. I had to read all 600 pages of it for my final later this week, but definitely learned a lot.