Book Review: Who Killed Healthcare?
Professor Regina Herzlinger’s book “Who Killed Healthcare?” is a call to arms to transform our healthcare system with a consumer-driven cure. It is the latest work from economist and respected healthcare analyst Herzlinger, whose 2004 textbook-sized “Consumer-Driven Health Care – Implications for Providers, Payers, and Policy Makers” is credited with coining the term Consumer Driven Health Care. As detailed in her new book, Herzlinger believes that by returning our healthcare delivery system to the principles of competition and innovation, it will thrive as have other sectors of our economy.
The first portion of her book is a review of the past 50 years of our healthcare history; from post-WWII employer plans, indemnity, HMOs, managed care, preferred provider networks, and the resulting consolidation of hospital networks up through today’s advent of mega general hospitals and insurers transformed into healthcare organizations. She casts a very large net when answering her title question, “Who killed healthcare?”, and the list of suspects includes everyone from insurance companies, the government, and hospitals (whose profit-making or political motives affect their decisions) to Human Resource professionals, employers, brokers, and academics. In fact, Herzlinger identifies only two groups who are not at fault: patients (people who are sick) and private practice physicians (who are not financially aligned with the aforementioned hospitals).
Herzlinger explains that allowing consumers to make their own decisions on how much and what kind of insurance to buy, and giving them performance evaluations of doctors and hospitals, would produce “a more equitable, less costly and better system.” However, information and choice remain in short supply – which is the primary reason our system is in such trouble.
Throughout the book, Herzlinger draws parallels between healthcare and car ownership. She points out that we, as U.S. consumers, have much more readily available information regarding the purchase of a car than the purchase of our healthcare. To further demonstrate the irony, she notes that we as consumers would never dream of purchasing a vehicle without knowing the price and performance history of both vehicle and manufacturer; however, we will walk into a hospital knowing neither.
Herzlinger describes the government’s End Stage Renal Disease program in detail to demonstrate the inevitable outcome of a single payer system. The resulting one-size-fits-all care model, the preferential treatment for prescription drug manufacturers (with resulting mega profits), and the actual declining efficacy of the program, make the reader wonder how anyone could survive if all healthcare was delivered in this manner. Herzlinger’s solution is a consumer-oriented, market-driven system in which users (not providers) make decisions about the healthcare they want. For her, the solution is simple:
- Smaller, disease-focused medical facilities that provide complete care to patients
- A national system of medical records that provides privacy with confidential access by approved practitioners
- Mandatory performance evaluations of all hospitals and all other medical organizations
- Mandatory health insurance with subsidies for those who cannot afford it.
“Who Killed Healthcare?” is refreshingly informal and non-academic in its presentation, yet well-referenced throughout. Professor Herzlinger has successfully taken on one of our nation’s most challenging and complex issues and shown a path toward change.
For more information on Regina Herzlinger, click here, or to order a copy of the book, please click here.
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April 25, 2008
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