Health Care Will Not Reform Itself: A User's Guide to Refocusing and Reforming American Health Care,   ISBN:9781439816141

Customer Rating: 

This is a very concise (less than 150 pages), punchy, little book by the head of Kaiser Permanente on what is wrong with American healthcare and how to fix it. Halvorsen's analysis of what is wrong with the system is the best that I have yet read. We spend vast amounts on healthcare, and we get exactly what we pay for. We pay for a lot of procedures, one at a time. We do not pay for results, and we do not pay for coordination. We thus get a huge number of procedures, we get results that are not as good as they might be and we get close to zero coordination between healthcare providers. The system is astonishingly inefficient, because there is literally no one keeping track of a patient's overall condition and coordinating all of his or her treatments. With the very sick -- who produce most of the costs of the system -- this is both inefficient and dangerous.

What to do? Halvorsen is the head of Kaiser Permanente, and, not surprisingly, the solution he advocates is to have the whole country's system look alot like Kaiser. Every person should be required to buy insurance, he says, with the poor being subsidized. Every insurance company should be required to sell to anyone who applies. This would bring down costs per person by spreading risk. Further, everyone should have a permanent electronic medical record, which can be accessed by any medical provider. Above all, national health care policy should be set consciously. We should set goals, like reducing diabetes by one half, and we should then have a national plan for meeting the goal. Halvorsen is very big on plans, agendas and and goals.

Halvorsen, however, has a curiously limited perspective. He knows a lot about health care. He knows a lot about Kaiser. He seems not to know much about Medicare or Medicaid. He seems totally ignorant of the Veteran's Administration. (A particularly glaring lack, given his focus on electronic medical records; he literally never mentions VistaA, the VA's remarkable system of electronic records.) He also never discusses the politics of any of this.

As a result, his ideas are curiously disembodied. He says that "we" should set a national goal of reducing asthnma, and he sets out how this might be done. Who is the "we?" The insurance companies? The employers? Medicare? Medicaid? The President? The Surgeon General? Halvorsen seems to have absolutely no idea that we need institutions to carry out policies. We already have a huge number of very large, very complicated institutions in the health care field, both public and private. No one is in the position to just issue orders to this non-system. If you want to issue orders, like Halvorsen, suggests you would need a very total change in the structure of our institutions. How to achieve that re-structure? Halvorsen's ideas on that are so vague as to be close to useless.

So, a good diagnosis, some interesting ideas on pieces of the cure but no overall vision on how to plausibly get there from here.

Customer Rating: 

This book is probably the best explanation I've read on why we have the health care mess that we do in the United States. We read a lot about health care in the papers and hear stories on the news but few articles get into the real reason for the problems and even fewer into what would be a really good solution. I learned far more from this book than I have from all the other sources put together. It was interesting in the way it discussed the health system in this country compared to that of some of the other countries in a manner that was easy to understand with many examples.

I didn't realize until I finished the book that George Halverson is the CEO of Kaiser Permanente, the largest not-for-profit health plan and care system in America with over eight and a half million members. My sister worked for a company that was insured by Kaiser and she was very impressed by the electronic medical record system at Kaiser. She was able to see all of her medical test results as soon as they came back from the lab just by logging onto a password protected website and was able to see comments from any doctors or specialists she had seen in the system. She was also able to make doctor's appointments online and email her doctors. They in turn could see any medications prescribed by any of the other doctors and any comments on any condition. Halverson talks about such a system for everyone in the country and mandating that everyone be insured which would help to slow down the increases in the cost of healthcare.

According to Halverson, at least 50% of the visits to an emergency room for asthma attacks don't need to happen. Treatment for the condition varies so much from doctor to doctor and the outcomes can be very different. But hospitals and doctors in our system don't make as much money by preventing an attack as they do with a visit to the emergency room. Our system makes big money on procedures after a crisis rather than preventing them from happening in the first place. That's one of the shortcomings of the system we have. Using Kaiser an example, Halverson shows how changing how we treat just four or five conditions could save huge amounts of money that we spend now on healthcare.

Probably one of the things that surprised me the most is how many mistakes and bad outcomes we now have in hospitals in this country. What I thought was a fairly consistent system turns out to actually be very haphazard in many ways. Most medical records are now kept on paper, in files, in each doctor's office and aren't shared with any other doctor who might be treating the patient. The results of treatments also aren't shared among other doctors in most cases, so we don't always have a consistent way of treating conditions. Electronic records of outcomes with different treatments would help to establish new and better ways of treating specific conditions because doctors would have a larger sample of outcomes to compare.

I didn't find this book to be political or partisan, but rather some very good ideas of how to change our current system and make it better for everyone involved. I hope a lot more people read this book.

Customer Rating: 

This is a really thought provoking book with some excellent points.

Was a tad puzzled why Chapter 9 was only a handful of pages long and discussed issues like Americans being unhealthy, obese, lazy, and a few issues like food labeling etc., but nothing about Americans who love their constitutional rights and freedoms, which are written down on paper beginning with the founding fathers. Rights few other countries have as law. Rights that allow for a person to do what they want to their own bodies. Thus how do we change poor choices? How do we get the drug user,sexually promiscuous person,smoker,junk food eater, couch potato, beer drinker, poor lifestyle choices person to STOP?

We have had health warnings on cigarettes for decades and warnings about drinking and driving. For decades now we have had expense ad campaigns and a plethora of books that make up whole sections of book stores, that warn of the effects of poor choices. How will a national healthcare plan change poor choices? Have dozens of physician and nurse practictoner friends who talk about the waste of time it is to try and help clients make better choices. They get met with excuses as long as a small dictionary.

So with a government mandated healthcare law, all I see is insurance companies getting out of the healthcare insurance business, doctors going cash or credit card only, or leaving the practice all together. And we already have a doctor shortage, with even fewer medical students in medical schools. Its often said when discussing abortion that the government cannot legislate morality. Yet this is exactly what the United States seems to want to do. Make me have the medical coverage they demand even if I don't want or need it. And lets not forget the wealthy will always have an out, since they will buy a meager mandated plan and then use their wealth to get the best medical care they want.


United States Declaration of Independence:We hold these Truths to be self-evident, that all Men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.

Customer Rating: 

See my other reviews for Halvorson. These are all great books if you want to learn about HC reform from the inside out. Objective, and no BS.

Customer Rating: 

George Halvorson is on to something here. You're never going to reduce health care costs until you improve health care quality. Providing better, proactive or preventive care reduces the severity of disease, complications, hospital stays, etc. When you provide quality care to a patient, his or her lifetime medical costs go down. When you provide poor quality care, the costs go up because the patient is sicker and needs more care. It is pretty simple when you think about it, but the current U.S. health care system does not provide incentives for doctors and hospitals to provide quality care, it only provides incentives (in the form of payments) for the volume of care they deliver.

If health care providers care about reducing costs now, there are actually steps they can take today, as Halvorson describes in chapter 3, "Set Goals and Improve Care." There are a handful of preventable medical events that are enormously expensive because of the hospital stays and expensive treatments that go with them. Picking three examples, Halvorson says we can reduce by 50 percent the number of kidney failures, asthma crises and heart attacks. With rare exceptions, no one in America should end up in an emergency room with an asthma crisis, because it is preventable through education and preventive care. At a local level, health care providers can start planning today and setting goals to reduce these incidents.

But as much as I like George's book and approach, I fear that the majority of our nation's health care providers are more concerned about their bottom line than patients like you and me.