Your Money or Your Life: Strong Medicine for America's Health Care System

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The problems of medical care confront us daily: a bureaucracy that makes a trip to the doctor worse than a trip to the dentist, doctors who can't practice medicine the way they choose, more than 40 million people without health insurance. "Medical care is in crisis," we are repeatedly told, and so it is. Barely one in five Americans thinks the medical system works well.
Enter David M. Cutler, a Harvard economist who served on President Clinton's health care task force and later advised presidential candidate Bill Bradley. One of the nation's leading experts on the subject, Cutler argues in Your Money or Your Life that health care has in fact improved exponentially over the last fifty years, and that the successes of our system suggest ways in which we might improve care, make the system easier to deal with, and extend coverage to all Americans. Cutler applies an economic analysis to show that our spending on medicine is well worth it—and that we could do even better by spending more. Further, millions of people with easily manageable diseases, from hypertension to depression to diabetes, receive either too much or too little care because of inefficiencies in the way we reimburse care, resulting in poor health and in some cases premature death.
The key to improving the system, Cutler argues, is to change the way we organize health care. Everyone must be insured for the medical system to perform well, and payments should be based on the quality of services provided not just on the amount of cutting and poking performed.
Lively and compelling, Your Money or Your Life offers a realistic yet rigorous economic approach to reforming health care—one that promises to break through the stalemate of failed reform.

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Editorial Reviews

Publishers Weekly
Not to be confused with the bestselling personal finance volume (by Joe Dominguez and Vicki Robin), this work examines the health care crisis in America. Many people readily admit they're unhappy with both the cost and the care they receive from their doctors and are very frustrated with the health-care system. However, according to Cutler, an economics professor at Harvard and health-care adviser in the Clinton administration, the advances made in health care over the past 50 years have been quite positive and have contributed to longer and more productive lives. But people have a hard time understanding their choices-paying more for medicine that will keep them alive or choosing costly surgery that may not guarantee a better quality of life. Cutler offers numerous examples of medical progress along with economic reasoning to persuade readers that more and more medical advances should be sought, along with better medical coverage for everyone. "For medical care to be effective, people must be able to afford it. The issue of affordability is clearly a concern of the uninsured. The uninsured rely on the largesse of the medical system as a whole." Cutler's discussion of managed care and how doctors are reimbursed for certain procedures but discouraged from other practices is especially clear. Cutler's position-health insurance for all and doctor reimbursement by quality, not simply service-is clear and compelling. This book will be of most interest to government officials, doctors and others in the health-care industry. (Feb.) Copyright 2003 Reed Business Information.
Library Journal
While there is general agreement that the healthcare system in the United States needs reform, debate continues over what form it should take. Cutler (economics, Harvard) proposes a universal care system that rests somewhere between a single-payer model and one that is based solely on employer payments. He briefly traces the history of healthcare in the United States and then explains how in his research he arrived at specific dollar figures for the value of such things as a year of human life. That serves as the basis for three chapters describing studies in which he participated: newborn health, mental health, and the care of cardiovascular disease. Discussing the costs, benefits, and trade-offs in each example, he then offers his own vision. George Halvorson and George Isham suggest a similar approach in Epidemic of Care, which discusses HealthPartners in Minneapolis, an HMO mentioned favorably by Cutler. Recommended for academic, medical, and large public librarises.-Dick Maxwell, Penrose-St. Francis Health Svcs., Colorado Springs Copyright 2004 Reed Business Information.
From the Publisher
"This slender but important book...makes some exceedingly valuable points. Its passionate argument that modern medicine works is persuasive. It argues equally convincingly that there is both an economic and a moral case for medical spending. Perhaps most notable, it points out the many perverse incentives in our current system of financing medical care, and it argues that we should correct the system by providing financial incentives for the medical treatments and the approaches we truly want. The book, in sum, represents a significant contribution to health-policy literature and ideally, would be used to inform present and future discussions of health care in America."—St. Louis Post-Dispatch

"Concise and persuasive...avoids most of the ideological shoals of the health care debate.... Cutler shows how the current system could be redesigned so that everyone is insured, the quality of care improves and the overall costs remain roughly the same."—Washington Post

"Cutler has paved the way for a unique new understanding of health care in America: policy makers and providers should focus on increasing the value of dollars spent rather than rehashing the tired distinction between cutting costs and paying more. For everyone interested in improving health care in the United States, this is original and inspiring—actually, indispensable." —Bill Bradley

"A thoughtful analysis of the problems afflicting our health care system. His creative proposals will interest every citizen concerned about improving American health care." —Edward M. Kennedy

"This highly-readable volume explores all of the major issues that confront us as we attempt to improve America's health care system. David Cutler provides a clear and concise guide to how one should think about the costs and benefits of health care, the value of medical advances, and options for reforming the health care system. This is the book to buy if you want to understand how we can improve health care in America." —Robert D. Reischauer, President, The Urban Institute

"Cutler presents a refreshingly optimistic path for the future of America's health care system—promoting policies focused on increasing the value of medical services and improving health outcomes. He finds over and over that while health care expenditures are significant, we get a great deal more in return. His work is a major contribution to what I believe will become an increasingly interesting and important debate—is more medical spending necessarily bad?" —Art Collins, Chairman and CEO, Medtronic, Inc.

"Cutler's upbeat book delivers a welcome message to a public wearied by reports of medical errors, the rising number of uninsured, and the relentless growth in medical expenditures. Anyone with a serious interest in the U.S. health care system—and its future—should read this engaging and provocative book by one of the most insightful health policy experts in the nation." —Alan Garber, Center for Health Policy, Stanford University

"When economics and medicine mix there is bound to be confusion unless someone like Harvard economics professor Cutler, who seems to effortlessly make a complex issue comprehensible, is doing the mixing.... An elegant investigation."—Booklist

"It's also important for readers to understand the cost effectiveness behind developments in treating such conditions as cardiovascular disease, infant mortality and mental illness; chapters devoted to these are the best material in Cutler's book. His case studies are well researched and offer a tremendous amount of information about medical history and its economic significance."—Los Angeles Times

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Product Details

  • ISBN-13: 9780195181326
  • Publisher: Oxford University Press
  • Publication date: 2/1/2005
  • Pages: 176
  • Sales rank: 1,283,331
  • Product dimensions: 14.30 (w) x 21.60 (h) x 0.50 (d)

Meet the Author

David M. Cutler is a professor of economics at Harvard University. He is a member of the Institute of Medicine and regular advisor to governments and corporations.

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Table of Contents

Introduction: Crisis by Design
1 The Health of the Nation: A History 1
2 Pricing the Priceless 10
3 Success and Failure at the Beginning of Life 22
4 The Power of the Pill: Prozac and the Revolution in Mental Health Care 32
5 The Heart of the Matter 47
6 Medical Care: Of What Value? 61
7 You Get What You Pay For 76
8 The Managed Care Debacle 86
9 Paying for Health 100
10 Universal Benefits 114
Notes 125
Acknowledgements 153
Index 155
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  • Anonymous

    Posted January 28, 2004


    Forty million Americans lack health care insurance and costs leap three and four times the inflation rate yet few Americans feel the system provides adequate care. Harvard economics professor and health-care expert Dr. David M. Cutler believes that the problem lies with the inability for most people to understand opportunity costs based on choices that may not lead to an improved life quality. The government and medical leadership exacerbate the problem with saving money as their solution, ignoring effectiveness. He makes a strong case on how much health care has dramatically improved over the past five decades as dramatized by longer productive life spans. Dr. Cutler believes that more money should be spent on further medical advances and that universal coverage for all needs should be implemented so that the present day uninsured can afford care rather than drain at a more costly rate the system. The key is to change from a system that economically encourages doctors to choose techniques that are not always the best for the patient factoring in cost and life quality to a system that reimburses doctors for quality service (not as hard as it first sounds)............................... Though at times the medical supply and demand is difficult to grasp, YOUR MONEY OR YOUR LIFE makes a powerful well written argument to reengineer a system in which political band aids fail everyone. The case for quality and the explanation of choices are well done and surprisingly easy to follow while offering a seemingly radical but compellingly logical approach to fixing the broken American health system................................ Harriet Klausner

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