American Health Care: Government, Market Processes, and the Public Interest

Transaction Publishers
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President Clinton's health care reform proposals of 1993 represented the most far-reaching program of social engineering attempted in the United States since the passage of Medicare and Medicaid in 1965. Under the guise of reforming the health care system, the Clinton plan would have herded almost all Americans under age sixty-five into large, government-sponsored health insurance purchasing alliances that would have contracted with insurers to offer a standard set of benefits at regulated prices. The plan came under fire from both Republicans and Democrats, including moderates from both parties, but it soon became apparent that what doomed it was a public unwilling to trust government to manage their health care. The critical literature has failed to offer a cogent analysis of why government control of health care does not work. American Health Care delivers that analysis. This volume examines why untoward consequences usually follow when government sets out to do good things. The contributors demonstrate how hospital rate regulation raises hospital prices, that "no-fault" medical malpractice increases the occurrence of faulty medicine, and that FDA regulation is a major cause for the escalating cost of new drugs. Part 1, trace the genesis of Medicare and its later developments and argue the consumer advantages of medical savings accounts and written health contracts. Part 2, explore the fallacies of antitrust policies that serve the interests of competitors, attack community rating for making health insurance unaffordable to large numbers of young workers. Part 3, contains a powerful critique of the FDA for withholding vital information on the health benefits of aspirin and shows how HMOs and other plans have caused pharmaceutical marketing to shift its focus from medical effectiveness to cost effectiveness. The final section explores how the private sector is improving in the areas of regulating physician and other health professional fees and the supply and quality of health professionals. American Health Care proposes reasonable balances between government and market options for in supply of health services. Without denying the need for some governmental action, the contributors show how far the market can go farther in performing critical functions in the health care industry. This volume will be important reading for health policymakers, economists, and health care professionals. Roger Feldman is professor at the Institute for Health Services Research, University of Minnesota. Mark V. Pauly is professor in the Department of Health Care Systems of the Wharton School, University of Pennsylvania.
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Additional Information

Publisher
Transaction Publishers
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Published on
Dec 31, 2000
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Pages
444
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ISBN
9781412816939
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Language
English
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Genres
Medical / Health Care Delivery
Political Science / Public Policy / Economic Policy
Social Science / Sociology / General
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Content Protection
This content is DRM protected.
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Available on Android devices
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Eligible for Family Library

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Sorrel King was a 32-year-old mother of four when her eighteen-month-old daughter, Josie, was horribly burned by water from a faulty water heater in the family’s new Baltimore home. She was taken to Johns Hopkins—renowned as one of the best hospitals in the world—and Sorrel stayed in the hospital with Josie day-in and day-out until she had almost completely recovered. Just before her discharge, however, Sorrel noticed something was wrong—Josie was looking pale, she appeared severely dehydrated, and her eyes were rolling back in her head. Sorrel pleaded with the doctors and nurses (many of whom she had become close to) that something was wrong, and they agreed to stop administering Josie methadone, the narcotic they were using to wean her off morphine. Josie had begun noticeably improving when a new nurse approached her with a syringe of methadone. When Sorrel tried to stop her from administering the drug, the nurse said that the orders had been changed again. Sorrel, against her better judgment, decided that Hopkins must know best, and stepped back. Almost as soon as the drug had been injected into Josie’s system, she went into cardiac arrest. The doctors raced to save her, but by the time they stabilized her, Josie was brain dead, her organs shutting down one by one. She passed away shortly thereafter, her family having made the choice to take her off life support.


In the days and months that followed, Sorrel went through the tumultuous processes of grieving. For a while, she thought she would not survive; suicide and alcohol both seemed like viable escape possibilities, and Sorrel toyed with both. But ultimately it was her rage that kept her alive—rage at the doctors, at Hopkins, and at the medical institution that had allowed this to happen. She wanted the doctors to feel the same pain she had caused them. She wanted to destroy Hopkins “brick by brick.” Dizzy with grief, she came close to ending her marriage, but slowly pulled herself and her life back together, for the sake of her family, and for the memory of Josie.


It was around this time that Sorrel learned a staggering fact—though indeed an error, Josie’s death wasn’t a fluke in the statistical sense of the word. About 98,000 American patients die a year as the result of medical error, making it the fourth most prevalent cause of death in the US. Armed with this fact, the money from her settlement with Hopkins, and a vague awareness that Josie’s death could have been prevented, Sorrel began to penetrate the healthcare industry. An appearance on Good Morning America and a long article in the Baltimore Sun raised the public profiles of her and her mission, while speaking requests began to pour in from hospitals and healthcare groups across the world. For the most part, medical errors had simply not been talked about; most doctors involved in them were paralyzed by remorse and fear of lawsuits, while the patients were dead or badly injured and their families crippled by grief. Sorrel was helping to pull back the curtain on an all-too-common killer, and the world of healthcare knew it. Despite some initial resistance, most in the industry came to welcome her message, and to look to her for answers. With the help of other patient safety advocates—many of them doctors, and some of them the very Hopkins officials who had defended the hospital after Josie’s death—Sorrel and The Josie King Foundation began to develop and implement in hospitals basic programs that emphasize communication, respect of the patient, and attentiveness to their concerns. Rapid Response Teams, for instance, can be called from the beside by patients or their families who feel they are experiencing a serious change in their condition that is not getting sufficient attention from hospital floor staff. A team made up of doctors, nurses and a patient relations coordinator responds quickly to evaluate the patient and develop a plan for care. This is just one example of a program that came out of Sorrel’s efforts, and it’s in place in hospitals across the country, and has saved countless lives.


Sorrel’s account of her unlikely path from grieving parent to nationally renowned advocate is interwoven with descriptions of her and her family’s slow but steady road to recovery, and ends with a deeply affecting description of a ski trip they took recently. The sun is shining, her children are healthy, and they are all profoundly happy—a condition that Sorrel has learned to appreciate all the more for Josie.

The book ends with a resource guide for patients, their families, and healthcare providers; it includes information about how to best manage a hospital stay and how to handle a medical error if one does occur. Two prominent characters from the story, Hopkins’ lawyer Rick Kidwell and Paul Bekman, the personal injury attorney who handled the case for the King family, have come together to contribute advice in a Q & A section, and Sorrel also provides lists of general advice, useful online resources, and essential books on the subject.
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