Herzlinger , Consumer-Driven Care - An Encounter with Regina Herzlinger and a Review of Her Book

I recently spoke to Regina Herzlinger, PhD, the first tenured woman professor at the Harvard Business School, and author of Who Killed Health Care? America’s $2 Trillion Medical Problem –And the Consumer Driven Cure (McGraw-Hill, 2007, $24.95). She suggested I review her book and offer a free book as a prize for someone describing their “worst health care experience” under the present system.


One of the joys of dealing with Regina and reviewing her book is that you know exactly where she stands. There’s no mincing around – no parsing, no qualification, no equivocation. Many of her stands come from her experiences in teaching a class to “20 or so doctors” in her class “Innovating in Health Care” at the Harvard Business School.


What She Is For


Regina is for doctors. She thinks of us as a very bright, innovative, entrepreneurial group of professionals capable of transforming the system – and making the lives of our patients better. This belief stems from her association with bright MD/MBA doctor candidates who have gone on to change the system for the better. Besides, her daughter is an endocrinologist at Joslin in Boston, and through her daughter’s experiences Regina has seen first hand how the system can hamstring doctors.


Regina is for consumers. She thinks consumers are very smart people, and given choice and opportunity to spend their own money in their own ways, will make the right decisions for their own care and will change health care into a convenient, compassionate, competitive, and efficient system with lower prices and higher quality care. She notes such a system is compatible with universal coverage and cites the examples of Switzerland and now the Netherlands.


Regina is for innovators. She has preached the gospel on health care innovation in her books – Market-Driven Health Care, Consumer-Driven Health Care, and Who Killed Health Car?, in the Harvard Business Review – “Why Innovation in Health Care is So Hard (Mawy,2006), and in the Wall Street Journal (“Where are the Innovators in Health Care? (July 19, 2007). She says innovators will make our health care economy’s goods and services cheaper, better, and more accessible.


What She Is Against

Who Killed Health Care? is a non-holds barred attack on those forces that resist innovation in the present system. Here are a few snippets of her theme.


“The U.S. health care system is in the midst of a ferocious war. The prize is unimaginatively huge - $2 trillion, about the size of the economy of China – and the outcome will affect the health and welfare of hundreds of millions of people…The American people must win this battle. A system controlled by the insurance companies or hospitals or government will kill us financially and medically – it will ruin our economy, deny us the health care services we need, and undermine the important genomic research that can fundamentally improve the practice of medicine and control its costs. The current system is well on its way to doing all of these terrible things right now.”


I won’t go deeply into why she regards the health insurers, the general hospitals, the employers, the U.S. Congress, and the academics as the six big “killers’ of the current system. But you might be interesting in knowing she thinks of the New England Journal of Medicine as hopelessly naïve and misguided by publishing a “steady stream of articles purporting to the demonstrate the lack of charity of business and the efficiency of quality of nonprofit and business organizations in health care.” She says that the Journal’s analytic framework is “deficient” and that “it never met a single-payer proposal it didn’t like.” She finds its “business-bashing” regrettable and short-sighted since innovators in other economic sectors have made the U.S. economy the most productive in the world.


Who Killed Health Care? is a provocative book, a fine read, and a brilliantly articulated vision of the way things could be.