Lives at Risk: Single-Payer National Health Insurance Around the World
Lives at Risk: Single-Payer National Health Insurance Around the World
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Virtually everyone agrees that our health care system needs reform. But what kind of reform? Some want a return to the system that prevailed in the 1950s. Others would like to see the adaptation of the government-run systems prevalent in other countries. The latter, national health insurance or single-payer health insurance, appears to be gaining ground in the United States. Before Americans find themselves participating in a health care system that has failed in every country it was adopted, we should be asking ourselves whether such a system is effective and efficient.
In Lives at Risk, the authors examine the critical failures of national health insurance systems without focusing on minor blemishes or easily correctable problems. In doing so, the purpose is to identify the problems common to all countries with national health insurance and to explain why these problems emerge. Most national health care systems are in a state of sustained internal crisis as costs rise and the stated goals of universal access and quality care are not met. In almost all cases, the reason is the same: the politics of medicine. The problems of government-run health care systems flow inexorably from the fact that they are government-run rather than market driven.
|Author:||John C. Goodman|
|Publisher:||Rowman & Littlefield Publishers|
|Publication Date:||August 13, 2004|
|Product Length:||6.06 inches|
|Product Width:||0.79 inches|
|Product Height:||8.98 inches|
|Product Weight:||0.91 pounds|
|Package Length:||8.9 inches|
|Package Width:||5.9 inches|
|Package Height:||0.9 inches|
|Package Weight:||0.9 pounds|
|Average Customer Rating:|| based on 13 reviews|
|Average Customer Review: ( 13 customer reviews )
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18 of 21 found the following review helpful:
Health Care May 22, 2007
By Prof. Richard
"Veteran for Peace"
Goodman and associates provide a valuable alternative look inside the single-payer, national, universal access health systems of Europe and Canada. This book is long overdue.
I teach a college class in comparative health systems that contrasts the U.S. health system with those of other nations and I use this book as an alternative text. I warn students that it is a polemic; Goodman is on a mission. But since the great mass of academic texts are written by professors in love with Europe and in contempt of the U.S. failure to insure 43 million citizens, this book is a welcome splash of cold water in the face.
The problem is that neither Europe nor the U.S. have solved moral hazard. As long as government, or our tax-subsidized employer, is pre-paying our healthcare, and we can leave your wallet at home and demand all the tests and treatments we are allowed, we are in trouble. It is a big Las Vegas buffet and we are all high-rollers pigging out and over-eating because the tab is on the house.
The result will be disaster in Europe as the aging population increases its demands on a limited supply of younger workers. The disaster in the U.S., with Social Security and Medicare/Medicaid already on track to consume the entire federal budget, is well publicized.
Goodman solution is a revamped Health Savings Account (HSAs) that make each of us responsible.
Whether agree that HSAs are the answer, or prefer some other approach, read this book. Racing to establish universal entitlement is a recipe for univeral disaster.
29 of 37 found the following review helpful:
Must read for health care reform Nov 04, 2004
By Robert F. Graboyes
"health economics professor"
LIVES AT RISK is a must read for anyone interested in reforming the U.S. health care system. Goodman, Musgrave, and Herrick, stern critics of the existing system, warn against looking to Canada, the U.K., and other single-payer systems for solutions. ..... Opponents of single-payer insurance will find their views strongly validated by the mountains of carefully documented evidence in LIVES AT RISK. At the same time, open-minded proponents will learn the weaknesses in what they advocate; the book will lead some to rethink their support, and others to work harder in honing their arguments. Either way, the single-payer proponent who reads this book will become a smarter advocate of whatever views he holds afterwards. ..... LIVES AT RISK calmly, carefully catalogs and eviscerates widely held beliefs about the virtues of single-payer schemes. The authors methodically reveal how claims diverge from reality. The evidence in LIVES AT RISK paints a sharp contrast between the current American system (which the authors wish to change) and the single-payer systems abroad. Single-payer systems solemnly pledge that all citizens have a right to health care, whereas America does not. Yet by measure after measure, it is America that provides more complete, more egalitarian, more high-quality health care than do single-payer systems. Single-payer proponents argue that Canada, Britain, and others deliver health care more cheaply, more efficiently, and more equitably, but in LIVES AT RISK these lofty claims dissolve beneath the data. Again, a reasoned proponent of single-payer insurance can dispute the data presented, but he will have to work harder to do so, and that will enrich the public debate we need. ..... Goodman, Musgrave, and Herrick are not merely bomb-throwers who demolish single-payer insurance and then retire to the drawing room. Having addressed the failings they see in single-payer systems, they then turn toward the task of reforming the American system. They propose specific ways to harness the desires and intelligence of consumers to create a better system in the U.S. Once again, whether or not the reader buys the authors' proposals, he or she will leave the book with a far greater understanding of the task ahead.
39 of 51 found the following review helpful:
Health Care in the Hands of Bureaucrats Jan 19, 2005
By Conrad F. Meier
There is little disagreement among stakeholders in the U.S. health care system--patients, insurers, physicians, policy analysts, and the like--that America's health care system must change to adjust to the twenty-first century. But what to do?
Some observers advocate a return to the fee-for-service health care arrangement that prevailed in the 1950s. Others want to move in the opposite direction, toward the government-run health care bureaucracies common in other developed countries.
Advocates of the latter approach, known as universal or single-payer health insurance, are a minority in the U.S. health policy debate--but they are vocal and well-funded. In Lives at Risk, John Goodman, Gerald Musgrave, and Devon Herrick urge that we disregard pleas for such a drastic change in our approach to health care until we carefully consider whether such a system--failing in every country where it currently exists--could possibly be effective and efficient for the U.S.
Goodman is founder and president of the Dallas, Texas-based National Center for Policy Analysis (NCPA); Musgrave and Herrick are NCPA senior fellows. In Lives at Risk, they examine in microscopic detail the many flaws in the structure of single-payer health insurance, and they provide evidence that single-payer social policy is not in the best interest of consumers.
They explain, for example, how universal health insurance systems encourage over-consumption by patients, and how such over-consumption always leads to financial crises and broken promises of universal access and quality care. "One of the cardinal beliefs of advocates of single-payer health insurance is that health care should be free at the point of consumption, regardless of willingness or ability to pay," they write. Not surprisingly, such "free" medical care is over-utilized--to the point where demand exceeds the system's ability to sustain supply.
Promise Clashes with Reality
Goodman and his coauthors reveal how the promise of "health care for all" under a single-payer system clashes with reality. "The promise of national health insurance," they explain, "is that government will make health care available on the basis of need rather than the ability to pay." But in reality, single-payer systems tend to overspend on primary care for the healthy, while denying more expensive specialist care to those with serious medical problems.
The evidence creates a sharp contrast between the U.S. health care system and single-payer systems abroad. Although single-payer advocates claim their approach delivers health care more efficiently, more equitably, and at lower cost than our system, those claims crack open under the weight of the data.
According to Lives at Risk, wherever national health care is the only option, rationing by waiting is the norm. Rationing decisions are made by local health care bureaucrats, who are responsible only for spending, not healing.
Lives at Risk should be required reading for academics and policymakers of all opinions on health policy reform--and also for the medical community, consumers, advocates of single-payer insurance, and journalists who report on the issue. Newt Gingrich, former speaker of the U.S. House of Representatives, suggests in an editorial review, "This book will be an eye-opener for anyone who thinks a government-run system is the solution for our healthcare problem."
Information Age Requires New Approach
Dr. Robert Hamilton, a retired general and vascular surgeon living in Alton, Illinois, sees Lives at Risk from a physician's point of view. "Although this book is a brilliant exposition of the grand-scale effects of single payer health care financing and the economics of health care delivery, the implications for individual physicians and their patients are enormous," he noted
"Systemic inefficiencies, which interfere with timely, appropriate diagnosis and treatment of the individual patient, are dangerous and frustrating for physicians and patients alike in a system dominated by a government health care bureaucracy."
Hamilton suggests, "The way out of our professional doldrums is not through greater control of our profession by outside forces, but by making the patient-physician relationship the driving force. This book will restore optimism to those physicians whose frustration with imposed systems has nearly led them to give up on their noble profession."
Goodman, Musgrave, and Herrick do not just make a hard-boiled assessment of single-payer systems and then run for cover. They also turn their attention to the U.S. health care system. Instead of the usual worn-out generalities and obsolete assumptions, they point to specific problems and lay out specific ways to harness the intelligence of consumers and the power of the free market to improve health care in the U.S.
"The modern era has inherited two models of health insurance: the fee-for-service model and the HMO model. Neither is appropriate for the Information Age," they write. "Both models assume that (1) the amount of sickness is limited and largely outside the control of the insured, (2) methods of treating illness are limited and well-defined, and (3) because of patient ignorance and asymmetry of information, treatment decisions will always be filtered by physicians, based on their own knowledge and experience or clinical practice guidelines."
Regardless of whether the reader agrees with the authors' conclusions, Lives at Risk helps us understand how different policy approaches might lead to two very different outcomes for the U.S. health care system: complete meltdown under single-payer health care, or transformation into a system driven by consumer demand instead of health care bureaucrats and political expediency.
Conrad F. Meier (email@example.com) is senior fellow in health policy at The Heartland Institute and Editor Emeritus Health Care News
23 of 30 found the following review helpful:
Everything you wanted to know about single payer health care Oct 14, 2004
By William G. Irwin
"W. G. Irwin, M. D."
John Goodman et.al. have provided an impressive and accurate explanation of the failures of government dominated health care as seen from the data from those western countries which have adopted this model. They also present an outline of perhaps the only viable alternative. Succinctly written, the book should be read by every professional in the trenches and certainly every policy-maker.
W. G. Irwin,M.D.
1 of 1 found the following review helpful:
Is the grass really greener on the other side? Feb 08, 2011
By William Hees
Many people in the U.S. extol the benefits of a single-payer health care system even though they've never lived through such a system. Lives At Risk examines these alleged benefits and reports how they actually play out in countries where such a system is already in place, primarily in England, Canada, France, and similar countries with cultures and standards of living that make for a relevant comparison to the U.S.
The book refers to 20 alleged benefits (a pretty complete set) as myths and debunks them. For example Myth #3 is that in a single-payer system care is allocated according to need, not wealth. The book exposes the truth -- it turns out that the poor get much worse health care than the wealthy in these countries. I don't know how many times I've heard Americans demand that "health care is a right", implying that a single-payer system would recognize such a right. That's Myth #1. It turns out that real single-payer countries don't consider health care a right. It's just something they give out to appeal to voters. If they allocated funding for 80 heart surgeries and you're #81, tough luck, they don't owe you a heart surgery they say.
So on for a total of 20 myths, though some are minor variations of others. Their treatment of each myth is backed up with pages of references to studies and all sorts of data. The rest of the book discusses why things are this way, and gives the authors' proposed solution which is kind of a takeoff on health savings accounts.
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