Your Money or Your Life: Strong Medicine for America's Health Care System
- Book Review,
by David M. Cutler
From Publishers Weekly
Not to be confused with the bestselling personal finance volume (by Joe Dominguez and Vicki Robin), this work examines the health care crisis in America. Many people readily admit they're unhappy with both the cost and the care they receive from their doctors and are very frustrated with the health-care system. However, according to Cutler, an economics professor at Harvard and health-care adviser in the Clinton administration, the advances made in health care over the past 50 years have been quite positive and have contributed to longer and more productive lives. But people have a hard time understanding their choices-paying more for medicine that will keep them alive or choosing costly surgery that may not guarantee a better quality of life. Cutler offers numerous examples of medical progress along with economic reasoning to persuade readers that more and more medical advances should be sought, along with better medical coverage for everyone. "For medical care to be effective, people must be able to afford it. The issue of affordability is clearly a concern of the uninsured. The uninsured rely on the largesse of the medical system as a whole." Cutler's discussion of managed care and how doctors are reimbursed for certain procedures but discouraged from other practices is especially clear. Cutler's position-health insurance for all and doctor reimbursement by quality, not simply service-is clear and compelling. This book will be of most interest to government officials, doctors and others in the health-care industry. Copyright 2003 Reed Business Information, Inc.
From the New England Journal of Medicine, July 22, 2004
The rising cost of health care -- and what to do about this problem -- is perhaps our nation's most pressing health policy issue. The recent spike in private-insurance premiums has alarmed both employers and employees. More telling is the lack of clear policy options designed to discourage the introduction and use of high-cost, low-benefit medical care. As if the problem were not bad enough, other research findings tell us that evidence-based medical care is dramatically underused. David Cutler makes an important contribution to our thinking on this important issue in Your Money or Your Life. The book provides a nice forum for Cutler to present much of his research that has framed how we should think about rising health care costs and whether the additional spending is worth it. Most of the popular discussion concerning rising health care spending neglects the obvious questions -- what we are buying with the additional spending and whether we are producing commensurate increases in health benefits. Cutler's conclusion is a clear "yes": the incremental health care benefits that patients receive exceed their costs. However, he provides the important caveat that we could produce the same level of health care benefits at even lower costs. The book is a good introduction to the policy debate over health care spending. It starts by appropriately framing the issue that we cannot look at the rise in spending without first measuring and comparing the benefits purchased. Chapters 3 through 5 methodically track the growth in spending to treat low-birth-weight infants, patients with depression, and those who have had heart attacks. These initial chapters contain compelling information and should be read by all who are interested in health care policy. Underlying the growth in spending is the persistent march of science. The introduction of new forms of technology allows us to treat more patients with particular medical conditions, though generally at a high price per case. The heart of the book examines these trends and, in the three case studies that it follows, compares the added spending to the change in health benefits. In each case, total spending per case has risen, driven largely by the introduction of new medical technology. In some cases, the medical returns have been impressive. In the treatment of low-birth-weight newborns, medical advances (e.g., incubator design, new drugs), although expensive, have produced a dramatic reduction in mortality rates. As discussed in chapter 3, each additional $1 spent on treating low-birth-weight babies has produced $5 of additional health benefits -- an expensive, though worthwhile, investment. Chapters 4 and 5 present the same evidence for treatment, respectively, of depression (a seven-to-one return on investment) and heart attacks (a four-to-one return on each dollar spent). Chapter 6 attempts a broader extrapolation of the medical value of health care spending -- a somewhat tougher sell. Some of the later chapters, such as chapter 8, which examines what went wrong with managed care, seem to wander slightly off target. If the health care we are purchasing is worth it, why the general malaise? Some of it is clearly traced to the perceptions of purchasers and consumers that we spend too much, that we could buy the same benefits for far less money, and that the system is hopelessly complicated. Along these lines, chapters 9 and 10 attempt to address the issue of providing better care more efficiently. One suggestion is to give physicians bonus payments for providing high-quality, evidence-based medical care. Though controversial, the idea is a good one that should be debated seriously. The final chapter wanders into the hornet's nest of universal health insurance coverage. Cutler proposes an expansion of the Federal Employees Health Benefits Program to those who want to join. This chapter is too short for such a complex topic, and it meanders slightly from the compelling story and analyses presented in the first five chapters. Who should read this book? Health policymakers and people who are troubled with the rise in health care spending and are perplexed about what to do about it. Your Money or Your Life makes an important contribution to this debate, and I highly recommend it. Kenneth E. Thorpe, Ph.D.Copyright © 2004 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
From Booklist
When economics and medicine mix, there is bound to be confusion unless someone like Harvard economics professor Cutler, who seems to effortlessly make a complex issue comprehensible, is doing the mixing. In this mighty volume, he constructs a compelling case for universal health care by taking readers through a number of orderly steps. In a clear expository voice he establishes the value of a human life, explains the contributing costs of health care to sustain a life, and weighs the cost of universal health care against the value received--namely, extended life and improved quality of life for all concerned. In the process, he defines how to determine whether a particular health-care option is effective and elaborates on how it ought to be compensated. Additionally, he examines various ways America's current system is, based upon his criterion for efficacy, succeeding and ways it is not. As long as providers are paid for what they perform rather than the efficacy of treatment, he says, medical costs will soar. An elegant investigation. Donna Chavez
Copyright © American Library Association. All rights reserved
From Book News, Inc.
Cutler's (economics, Harvard U.) prescription for reforming the health care system so that it actually improves people's health is two pronged: extend the benefits of medicine to everyone, and increase the value people--mostly through government and private insurance companies--get for the money they spend. People should pay for what they get, he says, but they should also get what they pay for.Copyright © 2004 Book News, Inc., Portland, OR
Book Description
The problems of medical care confront us daily: a bureaucracy that makes a trip to the doctor worse than a trip to the dentist, doctors who can't practice medicine the way they choose, more than 40 million people without health insurance. "Medical care is in crisis," we are repeatedly told, and so it is. Barely one in five Americans thinks the medical system works well. Enter David M. Cutler, a Harvard economist who served on President Clinton's healthcare task force and later advised presidential candidate Bill Bradley. One of the nation's leading experts on the subject, Cutler argues in Your Money or Your Life that health care has in fact improved exponentially over the last fifty years, and that the successes of our system suggest ways in which we might improve care, make the system easier to deal with, and extend coverage to all Americans. Cutler applies an economic analysis to show that our spending on medicine is well worth it--and that we could do even better by spending more. Further, millions of people with easily manageable diseases, from hypertension to depression to diabetes, receive either too much or too little care because of inefficiencies in the way we reimburse care, resulting in poor health and in some cases premature death. The key to improving the system, Cutler argues, is to change the way we organize health care. Everyone must be insured for the medical system to perform well, and payments should be based on the quality of services provided not just on the amount of cutting and poking performed. Lively and compelling, Your Money or Your Life offers a realistic yet rigorous economic approach to reforming healthcare--one that promises to break through the stalemate of failed reform.
Buy from Amazon
Compare Prices
|
|
Home
