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Tuesday, December 9, 2008

Book Review

Not too long ago, I ordered a copy of "Critical: What we can do about the Health-Care Crisis", by Senator Tom Daschle (President-Elect Obama's choice for Secretary of HHS) with Scott Greenberger and Jeanne Lambrew. The book was sold out in my local bookstores, so I ordered it online. It arrived yesterday, and I've just finished reading it today.

The book itself is fairly short, about 200 pages. Organized into five parts, the book first introduces the crisis in healthcare, talks about what's been done to reform healthcare in the last century, and describes why these efforts failed. Next it describes the Sentator's ideas for solving the problem. He closes by calling for change in the healthcare system that sticks. I found the first three parts of the book to be of little interest personally. However, I understand why they are included in the book.

The key focus of the book is the notion of a Federal Health Board, and independent body modeled after the Federal Reserve. The members of the board would be experts in healthcare appointed by the President, and approved by Congress. The board would set policy on how private insurers participate in Federal health programs. It would recommend coverage of proven drugs, procedures and therapies for the treatment of specific diseases. What makes the idea of the FHB march is the expansion of the Federal employee health benefits and Medicare programs to include plans that would allow members of the public to participate. It might also unify federal coverage so that members of the military, the Federal government, and those obtaining care under Medicare obtain similar benefits for similar costs.

Other key objectives of the FHB made in the book include:
  • Focusing on prevention
  • Ensuring universal coverage
  • Equity not just for general healthcare, but also dental and mental health coverage
In addition to these goals, the FHB would also continue existing programs to increase transparency into healthcare costs, improve and measure quality of care, and change the focus from payment for services to payment for performance.
Daschle speaks somewhat about the use of electronic health records in the book, but devotes only a handful of pages to the topic. He notes that the US is woefully behind the rest of the world in use of healthcare information technology, and that we could save as much as five percent of our total healthcare spending (some $1.66 trillion in 2003) by implementation of a fully electronic healthcare system. He suggests tax breaks, loans or loan-guarantees to health-care institutions to enable them to upgrade their health IT systems.
This isn't a great book, but it does have some interesting insights. If you will be dealing with healthcare policy issues in the US, I'd recommend reading it.


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