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ForbesLuft has written a sober, thoughtful volume...It may also prove very influential.
— David Gratzer
Proposals to reform the health care system typically focus on either increasing private insurance or expanding government-sponsored plans. Guaranteeing that everyone is insured, however, does not create a system with the quality of care patients want, the flexibility clinicians need, and the internal dynamics to continually improve the value of health care.
In Total Cure, Hal Luft presents a comprehensive new proposal, SecureChoice, which does all that while providing affordable health insurance for every American. SecureChoice is a plan that restructures payment for medical care, harnessing the flexibility and responsiveness of the market by aligning the incentives of clinicians, hospitals, and insurers with those of the patient. It uses the accountability of government to ensure transparency, competition, and equity.
SecureChoice has two major components. A universal pool covers the major risks of hospitalization and chronic illness, which account for almost two-thirds of all costs. Everyone would be in the pool, irrespective of employment, income, or health status. The second component emphasizes choice, flexibility, and responsibility. People will be able to choose any physician to serve as their “medical home,” to keep track of their health records, provide much of their care, and suggest referrals. Clinicians will have the information and incentives to continually enhance quality. SecureChoice also facilitates improvements in areas ranging from malpractice to pharmaceuticals and establishes new roles for key stakeholders such as health insurers.
While some offer broad-stroke suggestions for reforming the U.S. health-care system, Luft (Palo Alto Medical Fdn. Research Inst.) has taken the time to craft a proposal in staggering detail. Acknowledging the reality that any reform would face opposition from a wide range of entities and would emerge only after multiple compromises, he presents a complete, carefully thought-out system that, he argues, provides universal coverage without discarding what works currently and is grounded in improving quality. Among those affected, hospitals would work more closely with doctors, becoming Care Delivery Teams (CDTs), and insurance companies-potential big losers-could choose to transform themselves into Payment Intermediaries (PIs). Much of the financing, but not all, would be handled at the national level. As the explanation evolves, the many new names and acronyms make the glossary included here a necessity. The plan is unique, but the amount of detail may be far more than a casual health-care consumer would want to wade through. Most appropriate for academic libraries or public libraries with large health-care reform collections.
List of Tables and Figures
1 Build on What You've Got, but Recognize Real-World Constraints 13
2 Overview of a Restructured Health Care System 32
3 Covering the Cost of Care: Rethinking Health Insurance 59
4 Organizing Care and Paying Providers 89
5 Choices: Harnessing Data to Inform Decisions 117
6 Financing SecureChoice 151
7 Malpractice, Pharmaceuticals, Medical Education, and Prevention 178
8 How SecureChoice Would Work for Patients and Physicians 202
9 Getting There: Policy Choices, Implementation, and Transition 221