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Rating: 
Summary: Health Care Financing
Review: Anybody that is concerned about the rising costs of health care in America should read this book. As a physician, I am disappointed at the lack of leadership in medicine as well as among the politicians.
We are sending the current bills for health care to our children. Gov Lamm's book provides great insight into the fiscal problems we are facing and provides some good suggestions on how we might go about addressing the problem.
Rating:
Summary: Facing up to difficult decisions
Review: Former Colorado Governor Lamm is a Democrat, but this book should be required reading for everybody, no matter where you fall on the political spectrum. It is, fortunately, a really easy read. My major problem was stopping to write down quotable lines; just about everything in this book is quotable. Did you know, for instance, that many of our problems began when Otto von Bismark declared that workers should retire at 65, an age which we are still reluctant to change? It can't have been much of an issue in 1880, when life expectancy was 47 years; but a child born today can anticipate 80 years of life. When Social Security was introduced there were perhaps 30 workers for each retired person; now there are about 3, and when the Baby Boomers begin to retire in droves at the end of this decade, we will be in real trouble, because taxes on current earners go directly to support current retirees, and it is certain that Social Security (and Medicare) will be bankrupt unless we completely reform the system; a fact cautiously alluded to recently by Alan Greenspan (and greeted by the inevitable outcries from politicians and others in support of the status quo).Lamm's theme is initially unpalatable but completely rational. He points out that our health care system is often compared favorably to Canada's: "We have the best, they come to the US for treatment." But the truth is, at its best ours may be the best, but on average, it's far from that; the World Health Organization says we're 37th out of 191 countries in terms of efficiency, what a health-care dollar buys. Canadians may have to wait longer for treatment compared to Americans, but all Canadians have coverage, and 43 million people in the US have no coverage at all. Gov. Lamm asks the hard question: Should older people (he includes himself) have the most expensive procedures, paid for by others, when there are, for example, thousands of pregnant women without access to antenatal health care? He tells the story of Oregon, where the issue of "rationing" has, uniquely, been faced. It is a far cry from the situation in the rest of the country. Our problem, in effect, is that with hot-button politics and term limits, it is too easy for us to kick our fiscal issues forward and let our children and grandchildren worry about them. In 2008, when the first Baby Boomers start watching the mail for the Social Security checks, our chickens will start coming home to roost. The book, published in paperback by the admirable Fulcrum Press of Golden, CO, is a pleasure to read, with a decent amount of ink on the page. I would have liked an index but at 128 pages it's not really necessary.
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Summary: Reality of US healthcare exposed
Review: Hard choices face the American people in their thirst for more and better health care. Gov. Lamm reveals these choices and the reality of health care financing in a passionate, yet erudite fashion, supporting his arguments with appropriate data. Gov. Lamm describes the inevitable conflict between medical ethics, with its focus on the individual; and social policy, which must focus on the good of all citizens. He outlines how we arrived at our current situation of 43+ million uninsured in a system that is technologically the most advanced in the world. Since the US currently funds about 50% of all health care cost, these are issues that should concern us all. The clear message is that Americans must both understand the drivers of increased health care cost and understand that the health of the nation is not necessarily improved by more health care. The message is of particular importance to baby boomers, who will be faced with the financial reality of a shrinking working population to support their appetite for health care. This is a provocative and challenging book that should be read by anyone interested in health care and public policy.
Rating: 
Summary: Frustrated with the current world of health care? Read on..
Review: Health policy is often very intimidating to people without specific expertise. This is a shame because it affects each and every one of us. Former Colorado Governor Richard Lamm has written a concise, easy-to-read book that every thoughtful American should read - and then act upon. Lamm takes his readers on journey through the American health care system. With the clarity of vision available to a former politician, Lamm takes on many of the myths of our health care system: 1) that it is not the best health care system in the world, by almost any measuring device ("a nation may have brilliant medicine but have a poor or inadequate health care system"); 2) that Social Security and Medicare have a ponzi scheme quality to them that will bankrupt future generations; 3) that the physician-patient relationship should not determine the course of health care in this country. Lamm argues passionately for a more rational public policy with respect to health care - one that seeks to maximize the health of the public rather than maximize the health of each and every individual. Public policy must stand up for the collective good, even if at the expense of additional marginal health care provided to any given individual. He presses his readers to recognize that the question should be "how does a society produce health?" and that the answer is that the health care delivery system is only a part of the health agenda. The quest for a healthier society may be "best achieved in areas of social policy other than health care." The solution lies in explicitly recognizing the role that rationing must play in a more effective and equitable health care system. A central component of this is recognizing that health care should not be viewed as a right. Lamm reminds us "no matter how we organize health care and no matter how we fund health care, we will find that our ability to discover medical miracles has outpaced our ability to pay for them." A "right" trumps all other categories of social spending - including housing and education and will lead us into an ever enlarging black hole of health care spending. Better to provide basic health care to all Americans and let "rights" refer to the freedom of those with more resources to pay for marginal, but expensive care. Although Lamm's discussion of what ails the system and the need to change its fundamental dynamics are the most well reasoned and articulate aspects of the book, he does spend some time focusing on the details of how to fix the system on a more practical level. Lamm argues that fixing the system will require removing the obstacles that keep market dynamics from working. This means "structuring incentives for both the providers and purchasers to improve productivity." Rather than rely on government controls, the government should focus on market reform a la managed competition. Lamm also proposes some fundamental changes to Medicare and Social Security, as well as malpractice reform and medical personnel changes. The book reminds us just how broken our public policy is with respect to health care, but also sheds important light on what we must be willing to do to realign our public policy to create a more equitable, sustainable American health care system. This book should be required reading for every person who has ever griped about our health care system, worried about our health care system, been bankrupted by our health care system, or, in fact, used our health care system.
Rating: 
Summary: Darwinism in action
Review: I give Governor Lamm two stars for trying to devise a solution to one of the most difficult public policy issues of our time. But his solution is horrific. He advocates a health care rationing plan in which, in effect, those who are sickest will be jettisoned in favor of those who are somewhat sick or not sick at all. It's not just social Darwinism, which deems poverty to be proof that those who are poor are inherently defective, that is, unfit to survive and therefore beyond help. This is Darwnism at its purest: the unhealthy are by definition unworthy of society's limited resources. Call it the life-raft approach. "Let's throw off the raft those we deem less likely to survive in order to improve the chances of those we believe more likely to survive." As Scrooge might put it, those who are in danger of dying "had better do it, and decrease the surplus population." It's not unlike the day when lepers were segregated into colonies. Merely a short step away is killing the unhealthy to prevent them from consuming any more of our limited health care dollars. Unthinkable? Germans didn't think that making Jews wear yellow stars would lead to their deliberate slaughter. Many people don't know that Hitler deemed the disabled as unfit for German society as Jews and slaughtered millions of disabled people as well. As you might imagine, I fall among the disabled. Through no fault of mine, multiple sclerosis has ravaged my middle-aged body. And it chills me to think that, under Lamm's "divert resources toward the fit" rationing, a healthy young serial murderer would get a liver transplant before I would. Moreover, researchers would have no incentive to find ways to reverse existing damage; when resources are explicitly diverted toward preserving health and preventing illness, doctors would be idiots to work toward treatments that fall far down on the list of health care priorities. Lamm correctly points out that we implicitly ration health care today. Those with insurance get more care than those without. But at least those without insurance can hope to get it someday. Nothing in the world will make a disabled person fit to compete against the young and healthy for health care. Lamm has framed the problem well. We do need an explicit method of rationing health care. But we need a lot more debate on the ethics of such a plan before we deem one segment of society irredeemably beyond its pale.
Rating:
Summary: Darwinism in action
Review: I give Governor Lamm two stars for trying to devise a solution to one of the most difficult public policy issues of our time. But his solution is horrific. He advocates a health care rationing plan in which, in effect, those who are sickest will be jettisoned in favor of those who are somewhat sick or not sick at all. It's not just social Darwinism, which deems poverty to be proof that those who are poor are inherently defective, that is, unfit to survive and therefore beyond help. This is Darwnism at its purest: the unhealthy are by definition unworthy of society's limited resources. Call it the life-raft approach. "Let's throw off the raft those we deem less likely to survive in order to improve the chances of those we believe more likely to survive." As Scrooge might put it, those who are in danger of dying "had better do it, and decrease the surplus population." It's not unlike the day when lepers were segregated into colonies. Merely a short step away is killing the unhealthy to prevent them from consuming any more of our limited health care dollars. Unthinkable? Germans didn't think that making Jews wear yellow stars would lead to their deliberate slaughter. Many people don't know that Hitler deemed the disabled as unfit for German society as Jews and slaughtered millions of disabled people as well. As you might imagine, I fall among the disabled. Through no fault of mine, multiple sclerosis has ravaged my middle-aged body. And it chills me to think that, under Lamm's "divert resources toward the fit" rationing, a healthy young serial murderer would get a liver transplant before I would. Moreover, researchers would have no incentive to find ways to reverse existing damage; when resources are explicitly diverted toward preserving health and preventing illness, doctors would be idiots to work toward treatments that fall far down on the list of health care priorities. Lamm correctly points out that we implicitly ration health care today. Those with insurance get more care than those without. But at least those without insurance can hope to get it someday. Nothing in the world will make a disabled person fit to compete against the young and healthy for health care. Lamm has framed the problem well. We do need an explicit method of rationing health care. But we need a lot more debate on the ethics of such a plan before we deem one segment of society irredeemably beyond its pale.
Rating:
Summary: Ethics and Economics - an American Challenge
Review: Lamm clearly shows that the US health care system puts priority higher on the ethics of personal medical practice than it does on the overall health of the US population. Our (US) system is provider driven, which results in defensive medicine and over treatments. "Long shot" medical practice costs us: 27 percent of costs are for the sickest 1 percent. US spends about 50 percent more per person than other developed countries spend. Why? Says Lamm: "We fund too much marginal medicine and fail to fund enough basic health care. We spend too much on high technology medicine and not enough on prevention." This amounts to spending the budget to save a few trees while the forest gets weak and sick. The need exists to set limits on treatments, so that more people are more healthy and costs can be maintained, as European countries have done. This book does not claim to have all of the answers, but does challenge Americans to begin an honest debate of ethics vs costs. We should listen to his challenge. Buy this book now, before your medical costs get too high for you to afford it.
Rating:
Summary: Political science & public policy blend in serious discourse
Review: Political science and public policy blend in a serious discourse by former Colorado Governor Richard Lamm, who takes a fresh look at the current state of the American health care system in Brave New World Of Health Care. Problems in policy, professional circle, and in public attitudes and expectations alike are deftly surveyed in an engagingly thoughtful discussion of how reforms and changes may be enacted.
Rating:
Summary: Endorsement for: THE BRAVE NEW WORLD OF HEALTH CARE
Review: What health care nightmare has your name on it? The United States is $7 trillion in debt. Consumer debt exceeds $2 trillion. The average American credit card carries an $8,000.00 balance. As baby boomers eat and age their way into a health care pile up in the next 10 years, our health care industry recoils against horrific odds in providing for millions of Americans. Not withstanding, millions of legal and illegal immigrants have not and did not pay into a system they use today. Millions of uninsured Americans suffer. Governor Lamm, once again, identifies what is happening across the United States. He offers solutions that, if ignored, all Americans stand to suffer in the long term.
Rating:
Summary: Endorsement for: THE BRAVE NEW WORLD OF HEALTH CARE
Review: What health care nightmare has your name on it? The United States is $7 trillion in debt. Consumer debt exceeds $2 trillion. The average American credit card carries an $8,000.00 balance. As baby boomers eat and age their way into a health care pile up in the next 10 years, our health care industry recoils against horrific odds in providing for millions of Americans. Not withstanding, millions of legal and illegal immigrants have not and did not pay into a system they use today. Millions of uninsured Americans suffer. Governor Lamm, once again, identifies what is happening across the United States. He offers solutions that, if ignored, all Americans stand to suffer in the long term.
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