Is It Time For A Government-Run Health Care System?

Abstract

Over the past forty years, national health policy has moved through successive eras that have differed markedly in reform initiatives. The 1960s and 1970s saw government policies that focused on hospital and physician supply and a regulatory national health planning system; the 1980s brought a national system of Medicare hospital and physician payment regulations; and the 1990s brought an emphasis on managed care and markets. Critical Condition, by Donald Barlett and James Steele, Pulitzer Prize–winning investigative reporters, makes a strong case that much is wrong with our health system, despite (and, in part, because of) “Washington’s blind obsession with market-based health care.” For the most part, their recounting of failures will be familiar to the health policy community: the world’s highest health care spending but often poor health outcomes (for example, in longevity and infant mortality); more than forty-four million uninsured people; loss of insurance coverage with job loss; communities having to organize bake sales to help pay a child’s medical bills; egregious hospital overcharging and bill collection practices; overpriced prescription drugs (protected by government import restrictions); large-scale fraud by drug companies; emergency department closings and ambulance diversions; drive-through deliveries; medical errors as a leading cause of death; the revolving door of Washington health policy influentials departing for lucrative lobbying jobs; and health-sector spending of $734 million in 1997–2000 to lobby Congress and the executive branch. From this general indictment, Barlett and Steele move on to deal with the role of Wall Street and investors (HealthSouth, HMOs, Columbia/HCA, Tenet, physician practice management companies), MedPartners’ failure, new business bureaucracies (with their voice mail and call centers—some outsourced to India), and the Madison Avenue influence (direct-to-consumer advertising, fen-phen, and other drugs). The authors are particularly good at combining descriptions of national problems with personal case studies that show how innocent people are victimized. However, their indictments of governmental pro-business policies could even be stronger. For example, they could have added a chapter on the 1997 Medicare+Choice initiative, which saw more than two million elderly people dumped by their Medicare HMOs, and another chapter on the unsuccessful fight to give patients a right to sue managed care companies. The recent Medicare prescription drug legislation will offer more opportunity for investigative journalists. Although Critical Condition works well to make the authors’ points, it is not a full assessment of the benefits and costs of health care markets. For example, the move to managed care and market-negotiated hospital and physician payments (from traditional open-ended B o o k R e v i e w s