Curing Our Sick Health Care System: A Solution to America's Healthcare Crisis, by Robert Gumbiner, MD. Bloomington, IN: AuthorHouse; 2006. 163 pages, softcover, $24.99.
Having just seen Michael Moore's film, Sicko, and reviewed HR 676, Conyers-Kucinich's bill for a universal, not-for-profit healthcare system, I was primed to read this book. The author, Robert Gumbiner, is a physician who graduated from medical school about 60 years ago, but appears to be a good deal more progressive than many of his medical brethren. Dr Gumbiner agrees with Moore, Conyers, and Kucinich: We need a universal healthcare system funded by the federal government.
This, of course, is a scary proposition for many Americans because the federal government has been berated by politicians for years. (This becomes a self-fulfilling prophecy when those who run the government are elected on a platform that government is bad.) Also, when the Clintons proposed a type of national healthcare plan in the early 1990s, the insurance companies ran many "Harry and Louise" television commercials that influenced viewers. This couple warned us that government healthcare will become rationed and we will no longer be able to choose our healthcare providers.
Yet everyone agrees that something radical needs to be done. Forty-five million Americans have no health insurance; millions more are underinsured because of high deductibles and copayments that discourage utilization; pre-existing conditions are invoked by insurers to resist payment; we spend 2 to 3 times more per capita on healthcare than other countries yet our health and life expectancy outcomes are not as good; and healthcare inflation continues to increase at more than twice the rate of overall inflation. Clearly, this is a dreadful, not to mention unsustainable, healthcare system.
As Gumbiner notes, our country has a vested interest in providing the most healthcare to the most people at the lowest cost. Privatization does not accomplish these goals, and when it is applied to Medicare, it makes that system worse. In 2007, for instance, Medicare Advantage, the privatized Medicare plan created by the insurance industry is rerouting $75 billion in government subsidy to the insurance industry rather than to the medical care of Medicare beneficiaries. Ironically, after pocketing this subsidy, the private plans often impose higher cost-sharing requirements on beneficiaries than does the traditional Medicare plan.
The American healthcare industry wastes money on advertising, marketing, profits for third-party insurance companies, and personnel to process insurance claims from multiple companies with differing policies and procedures. The lack of Certificate of Need programs in many states results in wasteful duplication of equipment and services. The $100+ million dollar lobbying effort by the drug companies led to legislation that barred the government from negotiating reasonable medication prices.
Gumbiner argues that fee-for-service medicine is wasteful and antiquated. Healthcare should be viewed as a public utility-regulated with regard to price and quality, and made available to everyone.
Gumbiner's prose, however, is uneven, and sometimes a hindrance to attracting converts to his position. The most annoying of his flaws is the repetition of information. Dozens of ideas are repeated almost verbatim several times throughout the book. And, some of his ideas-maybe not the same ones for everyone-will rankle the reader. I am not a fan of his notion, for instance, that medical malpractice lawsuits can be eliminated by identifying and weeding out bad doctors.
Nonetheless, this is a timely and provocative book by a healthcare pioneer with many decades of experience to draw upon.
David Haber, PhD
John and Janice Fisher Distinguished Professor of Wellness and Gerontology Fisher Institute for Wellness and Gerontology, Ball State University Muncie, Ind