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Where Does It Hurt?: An Entrepreneur's Guide to Fixing Health Care

Where Does It Hurt?: An Entrepreneur's Guide to Fixing Health Care

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by Jonathan Bush, Stephen Baker

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A bold new remedy for the sprawling and wasteful health care industry.

Where else but the doctor’s office do you have to fill out a form on a clipboard? Have you noticed that hospital bills are almost unintelligible, except for the absurdly high dollar amount? Why is it that technology in other industries drives prices down, but


A bold new remedy for the sprawling and wasteful health care industry.

Where else but the doctor’s office do you have to fill out a form on a clipboard? Have you noticed that hospital bills are almost unintelligible, except for the absurdly high dollar amount? Why is it that technology in other industries drives prices down, but in health care it’s the reverse? And why, in health care, is the customer so often treated as a mere bystander—and an ignorant one at that?

The same American medical establishment that saves lives and performs wondrous miracles is also a $2.7 trillion industry in deep dysfunction. And now, with the Affordable Care Act (Obamacare), it is called on to extend full benefits to tens of millions of newly insured. You might think that this would leave us with a bleak choice— either to devote more of our national budget to health care or to make do with less of it. But there’s another path.

In this provocative book, Jonathan Bush, cofounder and CEO of athenahealth, calls for a revolution in health care to give customers more choices, freedom, power, and information, and at far lower prices. With humor and a tell-it-likeit- is style, he picks up insights and ideas from his days as an ambulance driver in New Orleans, an army medic, and an entrepreneur launching a birthing start-up in San Diego. In struggling to save that dying business, Bush’s team created a software program that eventually became athenahealth, a cloud-based services company that handles electronic medical records, billing, and patient communications for more than fifty thousand medical providers nationwide.

Bush calls for disruption of the status quo through new business models, new payment models, and new technologies that give patients more control of their care and enhance the physicianpatient experience. He shows how this is already happening. From birthing centers in Florida to urgent care centers in West Virginia, upstarts are disrupting health care by focusing on efficiency, innovation, and customer service. Bush offers a vision and plan for change while bringing a breakthrough perspective to the debates surrounding Obamacare.

You’ll learn how:

• Well-intended government regulations prop up overpriced incumbents and slow the pace of innovation.
• Focused, profit-driven disrupters are chipping away at the dominance of hospitals by offering routine procedures at lower cost.
• Scrappy digital start-ups are equipping providers and patients with new apps and technologies to access medical data and take control of care.
• Making informed choices about the care we receive and pay for will enable a more humane and satisfying health care system to emerge.

Bush’s plan calls for Americans not only to demand more from providers but also to accept more responsibility for our health, to weigh risks and make hard choices—in short, to take back control of an industry that is central to our lives and our economy.

Editorial Reviews

Kirkus Reviews
With the assistance of former BusinessWeek senior writer Baker (Final Jeopardy: Man vs. Machine and the Quest to Know Everything, 2011, etc.), Bush, nephew of George H. W., offers an alternative to Obamacare based on his own experiences as CEO of athenahealth, Inc. Despite the author's family connections, this is by no means a vitriolic attack on the Affordable Care Act but rather an appraisal of why, in his opinion, it is not up to the necessary task of reforming the American health care system, since escalating costs (whether borne by individuals or government) are not sufficiently addressed. The author charges that the ACA has failed to address the "legions of powerful stakeholders" who profit from the system. At the top of his hit list are insurers and hospitals. He holds large hospitals accountable for providing many primary care services at inflated prices—"in hospitals we pay for a Ritz experience, but the service we get is below the YMCA." Based on his experiences as a medic during the first Iraq war, he contends that the skills of highly trained specialists are being wasted on jobs that semiprofessionals could be trained to handle. After receiving a master's degree from Harvard and serving as a consultant, Bush decided to launch a series of birthing clinics. In 1997, the venture failed, but he salvaged athenahealth, an online data-processing system for medical record-keeping that is now a $4 billion business. The author contends that the cost of medical treatment could be vastly reduced by the expansion of clinics staffed largely by semiprofessionals (perhaps attached to big-box stores such as Wal-Mart), which would treat minor injuries, colds and immunization. He advocates making medical records available to patients so that they can freely shop for affordable care from a pool of competing providers without the need of government intervention. Likely to find its way onto the Republican platform but worthy of serious consideration on its own merits.

Product Details

Penguin Publishing Group
Publication date:
Sales rank:
Product dimensions:
6.20(w) x 9.10(h) x 1.10(d)
Age Range:
18 Years

What People are Saying About This

From the Publisher
“I loved this book. Jonathan Bush is a goggle-eyed radical foaming for revolution in the house of health care—with the crucial, page-turning difference that for years he’s actually been delivering on it. His story alone is worth the price of admission. He’s driven ambulances in New Orleans, remade child delivery in San Diego, and built an Internet company that is transforming the way people practice medicine. And along the way you’ll learn more about the real world of how health care works than should be possible for a book this interesting. Jonathan Bush is a singular new voice in American health care.”
Atul Gawande, surgeon, professor, and author of The Checklist Manifesto

“This is a compelling, entertaining story—an insider’s perspective on American health care by someone who has been closely involved in its reshaping. Few people amass Jonathan Bush’s kind of experience or articulate as clearly what lies ahead.”
Abraham Verghese, physician and author of Cutting for Stone

“Jonathan Bush is not only a brilliant visionary but he walks the talk when it comes to tackling the dysfunctions of our health care system. Reading this book will help you understand why things are as broken as they are and inspire you to be part of the fix.”

Regina Herzlinger, Nancy R. McPherson Professor of Business Administration, Harvard Business School, and author of Who
Killed Health Care? 
America’s $2 Trillion Medical Problem—and the Consumer-Driven Cure

“Health care has successfully resisted organizational innovation to the detriment of our health and our economy. In Where Does It Hurt? Jonathan Bush gives exciting accounts of current innovation, and irreverently imagines an attainable future in which a vibrant medical marketplace is driven by health entrepreneurs, of which he himself is a prime example. Patients, physicians and policy wonks alike would be well served to take the provocative and illuminating tour.”
Jeffrey Flier, MD, dean of Harvard Medical School
Where Does It Hurt? teaches us all that great entrepreneurship does for reform what yeast does for bread. Jonathan Bush has done it, and now he’s sharing the recipe.”
Governor Mike Leavitt, secretary, U.S. Department of Health and Human Services (2005 to 2009)

“Jonathan Bush is one of the most charismatic and outspoken people in health care IT. His passion for driving innovation is changing the industry. The tale of disruption in his book offers lessons for us all.”
John D. Halamka, MD, chief information officer, Beth Israel Deaconess Medical Center

Meet the Author

JONATHAN BUSH is the CEO and cofounder of athenahealth, one of the fastestgrowing technology companies in the country. The nephew and cousin of two U.S. presidents, he has worked in health care for two decades. He has an MBA from Harvard and lives in Cambridge, Massachusetts.

STEPHEN BAKER is a former senior writer for BusinessWeek and author of The Numerati and Final Jeopardy.

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Where Does It Hurt?: An Entrepreneur's Guide to Fixing Health Care 5 out of 5 based on 0 ratings. 1 reviews.
Anonymous More than 1 year ago
My dad is reading this and he is like omg deanna this is da best book ever u like totally got to read this