Healthcare, Guaranteed: A Simple, Secure Solution for America,   ISBN:9781586486624

Customer Rating: 

A well written thesis, containing many bits of useful information that taught me a lot about our healthcare system. Clearly reform is needed. Is his answer the right one? I cannot know after readingt his book alone, but it sure is a good introduction to the topic, and a plain English common sense proposal.

Customer Rating: 

Very detailed--good comparisons of various options.
Zeke makes a compelling argument for ending fee-for-service
health care as well as the need for more evaluation of treatment
options--i.e. determining what is most effective and when.

The format makes comparing different options easy. All the "single payer"
people should read this. I used to be one of them but am now a proponent
of universal healthcare (which is often used to mean single payer).

Customer Rating: 

First of all, it is an outright lie that 47m Americanas are without health care. Those who want government to control Americans' life and death include 20 millions illegals in that number---so 1) they are not Americans; 2) they are not entitled to benefits paid for by hardworking Americans.

They also include in that number people who are uninsured for even a month or two--as those who are switching jobs or those in the 18-34 range who choose not to purchase insurance. (Note, most of these people get health insurance when they change jobs or get married and have children.)

No one goes without treatment because they don't have insurance--hospitals are REQUIRED BY LAW to treat people. Many hospitals have gone bankrupt because of all the illegals coming across the border and getting treated and/or coming over and having their babies here. Look at NYC---over a million illegals. BTW, many NYC high schools have health clinics with doctors, right in the school Call the main number for De Witt Cllinton HS--(718) 543-1000---you will hear the option for the Montefiore clinic right on the first menu.


Govt health care means bureaucrats make life and death decisions about your treatment and your very life. This is EVIL, this is Nazism. They have no God-given right to interefere with these decisions which belong to individuals, their families and their doctors. This is a denial of our right to life, liberty and the pursuit of happines.

See the bill for yourself and stop it


Health Care Bill in Bullet Form

No matter what political Party you are affiliated with.....This IS about Your Life.....

Page numbers refer to the current HR3200 bill available online---watch for changes, they will try to sneak this by you.

* Page 22: Mandates audits of all employers that self-insure!
* Page 29: Admission: your health care will be rationed!
* Page 30: A government committee will decide what treatments and benefits you get (and, unlike an insurer, there will be no appeals process)
* Page 42: The "Health Choices Commissioner" will decide health benefits for you. You will have no choice. None.
* Page 50: All non-US citizens, illegal or not, will be provided with free healthcare services.
* Page 58: Every person will be issued a National ID Healthcard.
* Page 59: The federal government will have direct, real-time access to all individual bank accounts for electronic funds transfer.
* Page 65: Taxpayers will subsidize all union retiree and community organizer health plans (read: SEIU, UAW and ACORN)
* Page 72: All private healthcare plans must conform to government rules to participate in a Healthcare Exchange.
* Page 84: All private healthcare plans must participate in the Healthcare Exchange (i.e., total government control of private plans)
* Page 91: Government mandates linguistic infrastructure for services; translation: illegal aliens
* Page 95: The Government will pay ACORN and Americorps to sign up individuals for Government-run Health Care plan.
* Page 102: Those eligible for Medicaid will be automatically enrolled: you have no choice in the matter.
* Page 124: No company can sue the government for price-fixing. No "judicial review" is permitted against the government monopoly.
Put simply, private insurers will be crushed by government bureaucrats.
* Page 127: The AMA sold doctors out: the government will set wages.
* Page 145: An employer MUST auto-enroll employees into the government-run public plan. No alternatives.
* Page 126: Employers MUST pay healthcare bills for part-time employees AND their families.
* Page 149: Any employer with a payroll of $400K or more, who does not offer the public option, pays an 8% tax on payroll
* Page 150: Any employer with a payroll of $250K-400K or more, who does not offer the public option, pays a 2 to 6% tax on payroll
* Page 167: Any individual who doesn't have acceptable healthcare (according to the government) will be taxed 2.5% of income.
* Page 170: Any NON-RESIDENT alien is exempt from individual taxes (Americans will pay for them).
* Page 195: Officers and employees of Government Healthcare Bureaucracy will have access to ALL American financial and personal records.
* Page 203: "The tax imposed under this section shall not be treated as tax." Yes, it really says that.
* Page 239: Bill will reduce physician services for Medicaid. Seniors and the poor most affected."
* Page 241: Doctors: no matter what specialty you have, you'll all be paid the same (thanks, AMA!)
* Page 253: Government sets value of doctors' time, their professional judgment, etc.
* Page 265: Government mandates and controls productivity for private healthcare industries.
* Page 268: Government regulates rental and purchase of power-driven wheelchairs.
* Page 272: Cancer patients: welcome to the wonderful world of rationing!
* Page 280: Hospitals will be penalized for what the government deems preventable re-admissions.
* Page 298: Doctors: if you treat a patient during an initial admission that results in a readmission, you will be penalized by the government.
* Page 317: Doctors: you are now prohibited for owning and investing in healthcare companies!
* Page 318: Prohibition on hospital expansion. Hospitals cannot expand without government approval.
* Page 321: Hospital expansion hinges on "community" input: in other words, yet another payoff for ACORN.
* Page 335: Government mandates establishment of outcome-based measures: i.e., rationing.
* Page 341: Government has authority to disqualify Medicare Advantage Plans, HMOs, etc.
* Page 354: Government will restrict enrollment of SPECIAL NEEDS individuals.
* Page 379: More bureaucracy: Telehealth Advisory Committee (healthcare by phone).
* Page 425: More bureaucracy: Advance Care Planning Consult: Senior Citizens, assisted suicide, euthanasia?
* Page 425: Government will instruct and consult regarding living wills, durable powers of attorney, etc.
Mandatory. Appears to lock in estate taxes ahead of time.
* Page 425: Government provides approved list of end-of-life resources, guiding you in death.
* Page 427: Government mandates program that orders end-of-life treatment; government dictates how your life ends.
* Page 429: Advance Care Planning Consult will be used to dictate treatment as patient's health deteriorates. This can include an ORDER for end-of-life
plans. An ORDER from the GOVERNMENT.
* Page 430: Government will decide what level of treatments you may have at end-of-life.
* Page 469: Community-based Home Medical Services: more payoffs for ACORN.
* Page 472: Payments to Community-based organizations: more payoffs for ACORN.
* Page 489: Government will cover marriage and family therapy. Government intervenes in your marriage.
* Page 494: Government will cover mental health services: defining, creating and rationing those services.

Complete bill go here: http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:h3200ih.pdf


STEALTH DEATH PLAN

The Democrat Congress is fast-tracking "America's Affordable Health Choices Act of 2009") to radically change not only health care, but also the role of the government in our lives. As written, the 1,018 page Bill*will:

* Eliminate employer and private insurance plans beginning in 2013.
* Create a new government-run agency on par with the Social Security Administration. $$$$$$$$$$$$
* Restrict care for the elderly, regulate hospice and control end-of-life decisions. Nazicare. Right to life, choice?
* Penalize with fines any citizens who do not participate; increase taxes on citizens and businesses. Right to life, liberty, pursuit of happiness?
* Add to health care costs and the deficit.
* Empower the new Health Care Administration to monitor all medical records and personal information.
* Impose political oversight and involvement at every level through a non-elected Health Benefits Advisory Committee.
* Control education of nurses and medical staff with new Public Health Workforce Corps.
* Limit physicians' control over patient care and medications.
* Give preference to certain identity groups with an Office of Minority Health.
* Force states into programs, adding more costs to states.

What can you do?

* Phone, write, e-mail your Congressman, or go to his district office, tell him you will not vote to re-elect him if he votes for HR 3200; you will campaign for and contribute to his opponent.
* Tell your employer you like your health insurance plan and want it to continue.
* Contact your insurer & your primary care physician and tell them you do not want government-run health care.
* Cancel your membership in AARP and any other organization that supports the Bill.
* Boycott companies such as Wal-Mart that support the Bill.
* Go to www.freeourhealthcarenow.com & www.savequalityhealthcare.org and sign the petitions.
* Circulate this page to everyone you know.


Stop Nazicrat Death Plan

Customer Rating: 

Dr. Emanuel has written an excellent analysis of the current state of the U.S. healthcare system. His suggestions for a complete revamping of our way of funding and delivering healthcare are the most comprehensive and meaningful I've seen. Dr. Emanuel recognizes the importance of not addressing our heathcare woes in a piece-meal manner. He advocates a complete and comprehensive overhaul of our current way of doing business. Furthermore, he presents his ideas in a manner in which there are mostly "winners" and very few "losers" as a result of the changes he suggests. To his critics, Dr. Emanuel consistently offers the reminder that our current situation is not sustainable. Something needs to change, and needs to change dramatically. Sitting idly by and doing nothing is no longer a reasonable option.

Everyone interested in improving our healthcare system should read this book. It is well written, thoughtful, comprehensive, and inspiring.

Customer Rating: 

Over the years, many authors have proposed solutions for "curing" US healthcare. One might think that the book "Healthcare Guaranteed" by Ezekiel J. Emanuel M.D., Ph.D. is just another in the long list. However, this book succeeds in providing a fresh perspective. And now that the author has become a senior advisor in the Obama administration and his brother, Rahm Emanuel, is Obama's chief of staff, this book takes on added relevance.

After quickly reviewing well recognized problems in the US healthcare system, Emanuel prepares his readers for his proposal by listing seven criteria that he believes should be used to evaluate any proposed new plan. These criteria include: 1) Does the plan guarantee coverage for all Americans? 2) Does it make the health system more cost effective? 3) Does the plan promote high quality coordinated care? 4) Does the plan provide patients with choice? 5) Does the proposal have a fair financing mechanism? 6) Does the plan have reasonable mechanism for malpractice dispute resolution? 7) Does the plan help the economy by eliminating the burden of healthcare on businesses?

One can argue about the relative priority or importance of the proposed goals, but clearly any plan that meets all or most of his stated goals would have to be considered impressive. Throughout the latter part of the book, Emanuel uses these criteria to judge his own proposal as well as other alternatives.

The key to Emanuel's plan is a voucher system for all Americans. With this voucher, each American can choose a health plan from any insurance company as long as the plan meets a minimum standard. The insurance companies must accept every patient who seeks coverage and can only charge minimal additional fees such as standard co-payments. Although my bias prior to reading the book was against vouchers, I found Emanuel's logic compelling. Although funding for this system would be through the federal government, insurance companies would compete in a free market system to be chosen by patients who pay with vouchers. To prevent insurance companies from avoiding the sickest, costliest patients, the voucher system pays the insurance companies more for the sicker patients who are predicted to cost more. Doctors and hospitals are also private and are free to contract with the insurance companies as they wish. Patients are free to pay for services that are not covered by their insurances plans, but their payments would be with after tax dollars.

This plan also includes a number of other features to manage the oversight and administration of the plan. Emanuel proposes a National Health Board modeled after the Federal Reserve with twelve regional boards. Each member would serve a long, staggered appointment; and therefore compared to congress, the board would be less prone to being overly affected by political processes or special interest groups. Each regional board would also have a Center for Patient Safety and Dispute Resolution that is authorized to evaluate incidents of patient harm and potentially to provide compensation for the patient. To better understand the relative merits of the different treatments, the plan proposes an Institute of Technology and Outcome Assessment that funds studies comparing the relative effectiveness of different treatments.
To fund the new system, the author proposes a new dedicated value-added tax. At first the new tax appears to be large, but the author makes a convincing case that the current system is already costing Americans more through taxes to support Medicare and Medicaid and through lost wages to support employee-based private insurance. The new system would allow American businesses to focus on their core business rather than health benefits, and employees would no longer fear losing their health coverage if they switched jobs.

Emanuel's proposal is intended to lead to a more rational, cost effective system. Patients will be the ultimate driver of quality by choosing plans that best meet their needs. The national health board will help in providing standardized quality metrics that consumers can use in choosing their plans. Patients will also no longer be limited to the one or two plans their employer has chosen. All of the funds for the system will come from the value-added tax, so voters will have to balance their desire for more benefits with their aversion to increased taxes.

Although Emanuel's proposal is comprehensive, the proposal does not address all of the problems with today's healthcare system. For example, primary care medicine is failing, the adoption of electronic medical records has been very slow, and monopolistic practices hinder competition in many local regions. Perhaps the markets and incentives in "Healthcare Guaranteed" will fix these problems, but I am not convinced. On the other hand, as a short quick read, the book addresses a great deal. To address more might have made the book less approachable.

In the latter part of the book, the author criticizes alternative plans using the seven criteria he used to evaluate his own proposal. Although using the same seven criteria as a way to evaluate all plans was a good way to demonstrate the weaknesses of the other alternatives, Emanuel's evaluation of the other plans seems a little unfair. The presentation of the author's proposal includes the voucher system and other supporting ideas. The book does not present the alternative proposals as comprehensively, and consequently, these ideas seem weaker by comparison. In addition, other authors might have interpreted these alternative proposals somewhat differently.

I also question the book's appraisal of incremental reform. Emanuel advocates a major change and downplays the benefits of any incremental changes. "Regardless, incremental reform is just another way of doing business as usual." The US health care system is so large, I wonder if smaller changes could indeed be effective. For example, the recent national stimulus bill provides funding for comparative effectiveness research and former Speaker of the House Tom Daschle's book advocates for a National Health Board modeled on the Federal Reserve Board. Both concepts are beneficial and can be implemented independently of each other.

The Obama administration's healthcare policy differs from Emanuel's proposal. For example, the administration favors an employer-based system instead of a voucher system. It will be interesting to see the influence Emanuel has on the Obama administration and the effect that being in the new administration has on him. Whatever happens, "Healthcare Guaranteed" is a worthwhile book, and I hope Emanuel's position in the White House helps make the ideas presented in his book more than just an academic exercise.