Thursday, February 5, 2009

Costs, consumer driven care, book reviews - Why Health Care Costs So Much: Two Book Reviews

Why Health Care Costs So Much

Review # 1, Consumer-Centered Care - Richard Reece, MD,

I ran across the book review that follows this review on, the premier doctors’ social networking website. The review drew enthusiastic comments, and many doctors wanted to know where to get copies to distribute to their patients ( Alethos Press, St. Paul, Minnesota, 651-349-1911,

Here is my review. This little (76 page), inexpensive ($3.50 for single copy, less for multiple copies, down to $1 for 1000 copies) book takes a refreshing, persuasive, and different slant on why health care costs so much.

Rather than the usual blame-casting on doctors, hospitals, and technologies, it places the blame squarely on the shoulders on third parties (Medicare, HMOs, PPOs) and at the feet of unwitting, passive consumers.

This is refreshing. You hear a lot these days about “patient-centered care,” but you rarely, if ever, hear about “consumer-centered care.” Yet it is the American consumer, through our sometimes blind, acceptance of prepaid care that has led to the entitlement syndrome (we are entitled to everything modern medicine has to offer), the expectations that the system will fix our unhealthy behaviors (obesity, smoking, no exercise), and our lack of reality about the consequences of first dollar or low dollar 3rd party payment (insensitivity to real costs, relentlessly rising premiums, disproportionally procedure-oriented care, outrageous hospital and specialist fees).

That is why, argue the authors, that alert and assertive consumers, asking such questions as “How much does this cost?) and seeking insurance coverage through health savings accounts and high deductible plans (now 20% of the non-Medicare private market) are the ultimate solution of high health costs.

One last thing. The book is written in a direct, no-nonsense, 2nd person style aimed directly at consumers, more often than not hitting them directly between their eyes and inside their pocketbooks. The book follows the golden rule of writing: If you have a nail to hit, hit it on the head.

Review #2 - Two Minnesota men tell it straight: Hand this book out like a religious tract! By John R. Graham, Director of the Pacific Research Institute.

Greg Dattilo and Dave Racer are two insurance men with lots of experience and understanding of what's right and wrong in U.S. health care. Every couple of years they write a book, and they've just published Why Health Care Costs So Much: The Solution - Consumers. It's a rare book (actually a "booklet") about health policy that is fun to read (Top Ten Myths of American Health Care being another recent example.) Plus, at 76 pages (including drawings) and available in bulk for only $1.50 each, you can buy a box and hand them out like religious tracts.

For those with neither the time nor inclination to wade through economic analysis, this book explains how government interference has driven up costs and harmed choice in American health care.

Because of government intervention, almost no patients know how much their health care costs, so the "system" has to rely on a bureaucratic web to fix prices, which results in frustration and loss of control by patients and providers. They illustrate this superbly with the example of prepaid automotive care substituting for auto insurance. Instead of buying a new set of tires when he needs them, the driver pays an astronomical premium to have his car insurer take care of everything. As a result, he loses his choice of tire and tire shop. Ultimately, the auto insurer contracts with only one tire shop in the driver's neighborhood, resulting in monopoly.

They also explain how we can take control of our health spending by buying low-premium, consumer-driven health policies coupled with Health Savings Accounts, which leave patients in direct control of more of their health-care dollars.

Importantly, they teach individuals how to buy health care like we buy other goods and services. They advise patients to ask hospitals before treatment, "what would I pay if I were uninsured?", before treatment, in order to avoid the insane list prices that hospitals charge.

The authors promise that this book is the first in a series of six. I look forward to the next five.

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