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The health care mess we are in is an American problem. It should have an American solution. The Canadian health care system is good for Canada, the British system is good for England, and the Cuban system is good for Cuba. European health care systems are good for their countries. We can and we should learn from them. But adopting one or more will not solve our problem.
America's personality, and its perspective is different. So is its psyche. An inherent desire for innovation and cutting-edge technology is an essential ingredient of that personality. Impatience to have it now and get it right is part of the psyche. Freedom of choice is part of both--the personality and the psyche. The treatment plan for our sick health care system must ensure preservation of those characteristics. Otherwise, it may not work. (page ix)..
Physicians: My special request to each physician is to buy the book immediately and read it fully if you have the time. If not, read just the last two chapters. If you largely agree with the recommendations, buy four more copies and send one to the President of the United States, one each to the senators of your state, and one to the congressperson of your district. Their names and addresses are given in an appendix at the end. Believe me, this will be the best investment you will ever make. Returns will be phenomenal, especially in terms of saving a nation from looming disaster, and an ailing health care system from total collapse. (page xi)..
High school, college, and university students: The future belongs to you. So does the nation. You must reclaim it from Washington politicians who have been dumping an ever increasing burden of debt on you and your children--yet to be borne. Just read the chapter "Conference of Uncles" and you will get the idea. Read the whole book, you will get many more ideas, I hope all useful. (page xiii)..
The health care system in the U.S. ranks first in the world in cost and 35th in overall efficiency, according to the World Health Organization surveys. In 2001 national health care expenditure totaled $1.4 trillion and accounted for 14.1% of gross domestic product (GDP). In Switzerland it accounted for 10.9% of GDP, in Germany 10.4%, in Canada 9.3%, in Australia 8.4%, in New Zealand 7.6%, and in the U.K. 6.7%. In all these countries, the infant mortality rate is lower than in the U.S. and life expectancy higher. In Japan, where life expectancy is highest among the developed countries of the world, health care expenditure is one- half as a percentage of GDP compared with the United States. (page 59-60)..
In 2011, the first batch of baby boomers (people born between 1946 and 1964) will reach age sixty-five and become eligible for Medicare. A year or so after that, they will also qualify for full Social Security benefits, although many would have exercised the option of early retirement at age sixty-two and started receiving their Social Security checks. According to the trustees of Social Security and Medicare, the federal government will need an additional $155 billion in 2010 to pay for the expected benefits for these programs. In 2020, when a little over half of baby boomers will have joined these programs, the deficit will be $780 billion. In 2030, with all baby boomers on board, Medicare and Social Security will run a shortfall of over $2 trillion. The problem of Medicare is complex and will take some years to solve, but Social Security is not a difficult problem. In fact, for decades it has been taking more money in than its share of expenditure. The U.S. government, instead of safekeeping it, has been spending it every year, leaving an IOU for the amount taken. These IOUs are being stored in filing cabinets in Parkersberg, West Virginia. Their paper value in 2005 was $1.6 trillion, which would be more than enough to carry this program into the imaginable future without any difficulty. The sad fact, however, is that these IOUs have no dollar value. It is therefore absolutely imperative to do something now. Here is what I recommend: (page 134-135)..
One more thing which will make everyone feel better and also make the nation stronger is the fiscal responsibility of the U.S. government. I have devised a simple formula to measure this and would like to call it the Fiscal Responsibility Index. (page 170)..
The physicians' medical liability or malpractice insurance system even at its inception was not a purely benign or benevolent phenomenon. But now, nearly one hundred years later, it has become totally ignominious and is perhaps the most important single cause of the high and rising cost of health care in this country. (page 177)..
The action on the part of the federal government is very simple and easy. Congress needs to pass a law incorporating ingredients of the Medical Injury Compensation Reform Act (MICRA) of 1975 and Proposition 103 of 1988, both of which have successfully addressed the problem of medical liability insurance in California. This is one state where physicians did not have to close their practices or move to other areas because of the escalating and unaffordable cost of malpractice insurance. As a result, patients in California have been served well over the years. Patients in other parts of the country deserve no less. (page 179)..
Corporate executives should be the next ones to adopt an oath of conscience, incorporating a mission whereby they will keep the interest of shareholders and employees ahead of their own. The stockholders are their real employers, and employees contribute to their success just as much as they themselves. (page 227)..