Health At Riskby Jacob S. Hacker
Pub. Date: 10/01/2008
Publisher: Columbia University Press
In this volume, the nation's leading advisors on health policy and financing appraise America's ailing healthcare system and suggest reasonable approaches to its rehabilitation. Each chapter confronts a major challenge to the country's health security, from runaway costs and uneven quality of care to declining levels of insurance coverage, medical bankruptcy, and
In this volume, the nation's leading advisors on health policy and financing appraise America's ailing healthcare system and suggest reasonable approaches to its rehabilitation. Each chapter confronts a major challenge to the country's health security, from runaway costs and uneven quality of care to declining levels of insurance coverage, medical bankruptcy, and the growing enthusiasm for health plans that put patients in charge of risk and cost. Bringing the latest research to bear on these issues, contributors diagnose the problems of our present system and offer treatments grounded in extensive experience. Free of bias and rhetoric, Health at Risk is an invaluable tool for those who are concerned with the current state of healthcare and are eager to effect change.
Table of Contents
Introduction, Jacob S. Hacker1. The Transformation of American Health Insurance, by Jill Quadagno and J. Brandon McKelvey2. Uninsured in America: New Realities, New Risks, by Katherine Swartz3. Get Sick, Go Broke, by Deborah Thorne and Elizabeth Warren4. Just How Good Is American Medical Care?, by Elizabeth A. McGlynn, David Meltzer, and Jacob S. Hacker5. The New Push for American Health Security, by Jacob S. HackerList of Contributors
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Jacob S. Hacker¿s book, "Health at Risk: America¿s Ailing Health System ¿ And How to Heal It" is a refreshing attempt to bring some level-headed voices to the discussion about health care reform in the United States. Hacker notes that despite the strident tone of the debate, facts do exist about the finance, organization, and delivery of health care that can help us to generate genuine solutions. In order to ¿bring those findings and proposals more fully into public discussion,¿ Hacker has curated a series of chapters contributed by top policymakers and scholars in the health care debate, each chapter aiming to elucidate some aspect of the crises. Using clear and straightforward language, they present a ¿declaration of facts¿ intended to clarify the issues for lay readers. This is a book intended less to solve the health care quagmire in American than to untangle several of the strands knotted into the crises in the first place.
Health at Risk is also a part of a larger project on the part of its sponsoring organization, the Social Science Research Council (SSRC), to consider the ways in which economic risk in the US has changed in recent years. Hacker is a particularly good candidate to edit such a text. He cogently describes the privatization of risk as ¿the contemporary celebration of the private sector as the first and best means for dealing with problems of all kinds.¿ Thus, the chapters brought together in this book are united by a dual set of factors: their commitment to grappling with questions about what we know about health reform and what that research suggest, and the thematic preoccupation with economic risk.
All told, Health at Risk does an excellent job of meeting its stated purpose to make issues of the health care debate accessible to non-experts in an even-handed form. But while Hacker¿s book is satisfying in many respects, it is worth asking whether the reach of the presented facts extends quite far enough. The book takes for granted, for instance, the prevalent hysteria that the ills of health care spending are related to ¿over consumption¿ of medical services. But does the economic model on which this critique is based even provide a relevant `fit¿ for the decision making and spending pertinent to health care?
Insurers and some policymakers raise the prospect of ¿moral hazard,¿ a situation in which patients who are shielded from the actual costs of healthcare will incur greater (and unnecessary) expenses. This model equates patients with ¿consumers,¿ and assumes them to be rational decision makers whose choices will bring them the most value for their money. But health care is not an elastic good whose price responds to the laws of supply and demand. It is an inelastic good, like food or water, a need essential to human survival. Much of the health care debate engaged by Health at Risk is premised on the assumption that policy restrictions against the ¿over-utilization¿ of care will curb medical spending, making ¿necessary¿ care more affordable.
To reduce the costs of care, we might do better to refocus attention from the assumed moral hazards of patients to the temptations of the provider. Where, precisely, are our health care dollars going? A review of the money trail provides pieces of clarity that are omitted from most books ¿ including this one. In a volume as thorough and well-planned as Health at Risk, it is somewhat disappointing not to see an examination of these economic orthodoxies.