Still Broken

by Davidson, Stephen M.

• ISBN13: 9780804761963
• ISBN10: 0804761965
• Format: Hardcover
• Copyright: 2010-03-24
• Publisher: Stanford Business Books

Summary

Health care is, arguably, the most hotly debated topic since Barack Obama took over the presidency. Perspectives on the future of our system echo through the halls of Washington and in the living rooms of Americans. A must-read for engaged citizens and policymakers alike,Still Broken: Understanding the U.S. Health Care Systemtakes a close look at our problems, proposes how to solve them, and explains how to navigate our political system to effect positive change. Based on over 30 years of study, Stephen M. Davidson provides a thorough understanding of the forces that have produced the monumental problems that we face in health care today. Then, he makes a compelling case for overhauling our system, offering six elements that should be included in any plan for change. To begin, everyone must have insurance. Individuals and employers would pay a premium or tax earmarked for this purpose to a federal agency. Using the tax system is the simplest way to collect the money, and progressive rates are the fairest way for individuals and businesses to pay. Critically, the amounts that individuals and employers pay would be independent of health status. Insurers and health care plans must accept anyone who wants to enroll. But payments to them would be risk-adjusted to protect them against adverse selection. Finally, patients' out-of-pocket payments must be limited so they can really access the services they need, and providers can make decisions based only on what procedures are appropriate. Davidson charts potential compromises to these six elements and the effects of those concessions, outlining a realistic political strategy. Whatever compromises are accepted, the underlying goal of reform must be to change incentives for all players who participate in the system. This goal cannot be achieved if we rely solely on market-based solutions. Davidson's captivating and persuasive book argues that only a solution with a large public-sector role can lead us to real reform.

Author Biography

Stephen M. Davidson holds a Ph.D. in Health Policy from the University of Chicago and a M.S.W. in Community Organization from the University of Maryland. He is Professor of Strategy and Policy at Boston University's School of Management, and Faculty Director of the Health Care Management Research Center. He has co-authored two successful books: Remaking Medicaid: Managed Care for the Public Good and The Physician-Manager Alliance: Building the Healthy Health Care Organization.

Table of Contents

List of Tables and Figures	p. xi
Preface	p. xiii
Acknowledgments	p. xv
Problems with the U.S. Health Care System
The Promise and Disappointment of U.S. Medical Care	p. 3
How Much We Spend	p. 15
What We Get for What We Spend	p. 34
Trouble in the Delivery Subsystem	p. 49
Solutions
Why the Problems Need to Be Solved and the Goals of Reform	p. 71
What Caused These Problems, and How Can We Attack Them?	p. 94
Competition and the Market or the Public Sector?	p. 120
Elements of a Solution for Increasing Access to Health Care, Improving Quality of Care, and Containing Health Care Expenditures	p. 152
Politics!
A Short History of Health Care Reform Efforts	p. 181
The Politics of Reform: Elements of a Strategy to Break the Logjam	p. 206
Strategy and Compromise	p. 227
Notes	p. 253
Index	p. 281
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