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, by Ezekiel J. Emanuel
Get Free Ebook , by Ezekiel J. Emanuel
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Product details
File Size: 10442 KB
Print Length: 400 pages
Publisher: PublicAffairs; 1 edition (March 4, 2014)
Publication Date: March 4, 2014
Language: English
ASIN: B00G1SD7BE
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Ezekiel Emanuel has written a very interesting book about the U.S. health care system. In the introduction, he tries to make sense of how three individuals were affected by this system. He then proceeds to get into the nitty-gritty of the American health care system beginning with it roots. The book is divided into three parts. In Part I we review the history of the American health care system, in Part II we explore the efforts to reform the system, and finally, in part III, we gaze into the crystal ball of the future.In the first part, he provides us with a brief history of healthcare in the U.S. It was interesting to learn how the employer-base system came to predominate in society. In the rest of the section we get a very detailed description of how healthcare is financed, who the providers are, how Americans get their healthcare, and interestingly, how this all works together to give us our current healthcare system. We are provided with many tables, charts, and diagrams, which provide some interesting statistics.In part two Emanuel discusses the history of health care reform. He first covers the history of health care from Teddy Roosevelt, to Franklin Roosevelt, to Truman, to Lyndon Johnson, and on to Clinton. Truman was a strong advocate for national health care but was stopped by the first Republican controlled Congress since 1932. Johnson did manage to introduce Medicare and Medicaid laws, and most can remember what happened to Clinton’s proposal. Interestingly in 1971, there were 22 separate health insurance bills before Congress. Not one made it out of committee. We clearly see the difficult road that was followed to achieve some sort of national health care.Emanuel continues on to explain to us the details of the enactment of the Affordable Care Act (ACA) and the immediate challenges to the law. Just minutes after being signed into law, over 20 states filed a lawsuit challenging its constitutionality. This was to be followed by an incessant barrage of lawsuits over the ensuing years, some of which the Supreme Court had to decide.In Chapter eight, we get some very detailed information about exactly what is in the ACA. This is a very valuable chapter; it contains a wealth of information on the inner workings of the ACA. Many tables and charts are presented to explain to us exactly what this law does. It would behoove anyone interested in healthcare in American to read this over and learn the wealth of benefits provided by the law. Most people have no idea of all the things provided for by the law that ensures affordable healthcare, and it manages to (after ten years) be revenue positive, according to the Congressional Budget Office. In addition to access, according to Emanuel, “The ACA also addresses cost, quality, prevention and health promotion, health care workforce issues, and many other matters.â€In a following chapter, the author shows us what the ACA means to us, before delving into Part III, where he discusses the future of health care in America. We are introduced to various “dashboards†that cover coverage, cost-control, quality, and overall health status. The author also discusses various reforms that build on the ACA to advance health promotion and prevention, cost control, and quality improvement that he says are “shovel ready.†In the final chapter, we are informed of the long-term impact of the ACA. It is the author’s belief we will eventually see the demise of insurance companies as we know them, and even the end of employer-sponsored health insurance. We will see more accountable care organizations (networks of physicians, hospitals and other providers). He also discusses four other trends.I recommend that anyone desiring an understanding of our American health care system read this book. It is as the author says, “in the longer sweep of history, beginning in 2020 or so, the ACA will increasingly be seen as a world historical achievement, even more important for the United States than Social Security and Medicare has been.†I think you will share this conclusion after reading this book.
Ezekiel Emanuel just published an important book with a great title, "Reinventing American Health Care: How the Affordable Care Act Will Improve Our Terribly Complex, Blatantly Unjust, Outrageously Expensive, Grossly Inefficient, Error Prone System." In it, he describes the history of health care reform in the US, gives an overview of the Affordable Care Act (ACA), and speculates about future trends in American health care.The concluding chapter of Emanuel's book is entitled, "Six Megatrends in Health Care: The Long-Term Impact of the ACA." I will devote this review to discussing his six "megatrends."Megatrend 1) The End of Insurance Companies as We Know ThemEmanuel argues that health insurance companies will "shift their business to focus on offering services they have expertise in, particularly analytics, actuarial modeling, risk management, and other management services...." or "transform themselves into integrated delivery systems," or they will go out of business. This seems quite plausible. However, I think it will depend on how the ACA implementation goes over the next several years. If insurance companies raise their rates, there could be major political fallout.Megatrend 2) VIP Care for the Chronically and Mentally IllEmanuel argues that "tertiary prevention" for chronically ill people with diabetes, heart disease, cancer, etc, and mental health care for people with depression/anxiety, will become an increasing focus of our health care system. I agree. I've taken care of many patients with chronic diseases and mental illness who cycle in and out of the hospital. The question is if our fragmented health system can provide coordinated, community-based care for these vulnerable people. Doctors and nurses must learn to use a biosocial approach when taking care of marginalized patients with chronic disease and mental illness.Megatrend 3) The Emergence of Digital Medicine and the Closing of HospitalsEmanuel writes: "Digital medicine will allow physicians to monitor patients remotely anywhere they are, get labs and many imaging tests done, and perform interventions once done exclusively in the hospital." I agree - sort of. We are rapidly headed into a digital era. More health care will be provided in the community, and digital devices will continue to proliferate. But will these digital devices provide value for money? Or will the hype outpace their effectiveness? Unfortunately, so far, the hype is winning.Megatrend 4) The End of Employer-Sponsored InsuranceThis controversial megatrend was analyzed in yesterday's front-page New York Times article. I think this megatrend is very difficult to predict. It depends on a number of political and economic factors. Will America's health insurance system remain constant, or will it move 1) towards a Republican system based on tax credits, or 2) towards a single payer system based on universal health coverage, or 3) a Kaiser-like group model? The latter is the most likely.Megatrend 5) The End of Health Care InflationI'm definitely not an economist, but I'm not sure I agree with Emmanuel that the ACA will succeed at controlling the growth in health care costs. In his book, Emanuel admits that the ACA didn't go far enough on payment reform, and that there remains "a serious misalignment between what we want physicians and hospitals to do in terms of improving value, efficiency, and reducing unnecessary care and how insurance companies, Medicare, Medicaid, and others pay them." As long as our fee-for-service system is around, and Medicare payments and RVUs are biased towards specialists, the growth of health care costs won't be controlled.Megatrend 6) The Transformation of Medical SchoolsI agree with Emanuel. Medical schools must change, and become much more team-oriented, community health oriented, and digital medicine oriented. The problem is that medical school curricula are very difficult to change. Can they begin to change rapidly? I'm not sure. If they can, it will require a major awakening of medical students and faculty.With the enormous amount of material for physicians to learn, does reducing the length of medical school from 4 years to 3 years really make sense? I don't think so. I think it would be preferable to keep medical school at 4 years and subsidize medical school tuition, or provide 100% debt forgiveness for medical students who enter primary care careers. The National Health Service Corps is a good program, but it doesn't go nearly far enough. If medical school is reduced to 3 years, will the training physicians receive really be sufficient?
This is truly a really good book that has a lot of depth to it. There are so many laws that are cited and what the ramifications are of each of them. It is really a good read that keeps you interested throughout the book. If I have to select a negative remark, it would have to be that the book is dated. The author tell us what will (or supposed to) happen in 2014, 2015... Some of it became true and other items did not make it but do not let that hold you back from reading this book.I purchased the audio companion version and it is read by the author. To close, I would pair this book with Remedy and Reaction by Paul Starr.
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