The Buck Stops Nowhere Chapter Outline

Chapter 1. The Health Care Game and Blame War zone

Health care oozes intrigue and shifting alliances. The saying “the enemy of my enemy is my friend” is the best way to understand the system. It has birthed adversaries instead of allies, has made monsters out of otherwise decent people, and it has forced providers, insurance companies, pharmaceutical companies, government employers and patients to demonize each other for their own economic survival.

From the employers who are the emperors of the system, to the merchant pharmaceutical companies and insurance Inquisitors, this chapter covers the players, their interests and the stakes.

Chapter 2. Costs: Shoddy Returns on Big Investment

Our hostile health care environment may not be the only reason our health care costs are so high, but it certainly is a major factor. We pour more money into health care than any other country, but with the worst results. We spend over $1 trillion per year on health care services and products—as much as we spend on the federal budget.

In return, we are rated 37th internationally by the World Health Organization in terms of over performance and outcomes of our health care system.

A look here at our ranking compared with the other 37 nations.

Chapter 3. The Big Lie: Health Care is Undergoing Rapid Change

Health care is said to be in a frenzy of change, what with rising costs, the demise of managed care and the fragile financial base of Medicare. These are only symptoms of a larger problem. Not much has changed in 70 years, except rates and payment structures, which are simply new window dressings on the same old mannequin.

A look here at the report of the Committee on the Cost of Medical Care from 1932, which identified the 4 core reasons American health care costs so much: 1) Too many medical specialists; 2) a disease based system of care rather than prevention; 3) too many infectious diseases and 4) no community-based focus of health care. It also examines how things have and have not changed and the incentives that drive our system.

Chapter 4. Where We Went Wrong: Health Care as Greed, Creed and Compensation

The battle over national health insurance and health care reform in this country has been going on since the early 1900s in various forms. We ran amuck on several fronts.

We made four major mistakes: First, we made the debate ideological. Second, we made it a manner of money and independence from government control. Third, healthcare became an employee benefit as part of employee compensation and “terms and conditions” of employment. And finally, we never tied the public health system to the commercial/employer based insurance system. This means we left those who are not in employer-based insurance programs without any reliable and consistent safety net or affordable alternatives. We are the only country that does.

A look at the impact of compensation and ideology on changes and proposed changes in the health care system, who has fought what changes and what they spent and why.

Chapter 5: Health Policy: Rates, Regulations and Body Parts

Because we have no goal or vision for our healthcare system, our health care policy, by default, is just rates, regulations and body parts. Whatever changes we make are tinkers at the edge of a fatally flawed system. And any tinkering we do in one part only increase costs in the other parts.

A look here at the impact of this approach on health care cost containment and policies, whether it is Medicare, Medicaid or commercial insurance.

Chapter 6: Not In My Risk Pool You Don’t: Insurance, how it works, who gets it, who doesn’t and why

Like Medieval walled cities, insurance risk pools are designed to exclude the dangerous and protect those inside. They assume those inside are familiar and safe and that outsiders, if taken in, will either contaminate them and/or use up the resources and drain the treasury.

Every nation that offers health insurance assumes the community is the model and does not base premium costs on age, gender, occupation, health status or geographic location. Only we do.

A look here on what this has created and the different views and assumptions about insurance as well as what other countries do and how they pay for it and a look at the tides of the uninsured.

Chapter 7: Where to From Here? Let’s Talk

The United States is the world’s richest economy, yet we are the only nation that forces its residents to:

  • Face medical bankruptcy—600,000 people each year, nearly the size of Seattle
  • Live in fear of being unable to afford health care services or prescription drugs
  • Have health care benefits depend on where they work
  • Have health care premiums tied to their age, sex or health history.

A look here at why the system is no longer sustainable and what we must do to change it.

Chapter 8: A Challenge to Build the Best

I dedicated this book to my son, who I said is as much a voice as I am in this book. So, I offer a special challenge to the colleges and universities of America and will dedicate a scholarship in his name.

The terms and conditions of the challenge are outlined in this chapter.

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