Book recommendation: Fixing American Healthcare

On my way to Singapore this summer I reviewed a pre-publication copy of Dr. Richard N. Fogoros’s book, Fixing American Healthcare; Wonkonians, Gekkonians and the Grand Unification Theory of Healthcare. There’s a blurb from me on the opening pages of the finished product:

Dr. Fogoros has hit the nail on the head with a bold, insightful critique of the U.S. health care system and a plan for radical reform that just might work. Fixing American Healthcare is a much-needed antidote to the fruitless incrementalism that dominates contemporary debate.

I meant what I wrote. Unlike others who dance around the topic or try to have it both ways, Fogoros doesn’t shy away from embracing bold, unpopular ideas as cornerstones of his solution. Here’s a taste from early on in the book:

[R]ationing of healthcare is a central theme in this book… I am not talking about something bland or benign… There is nothing pretty about rationing healthcare. Rationing is bad, and if we’re going to do it we should at least be willing to acknowledge exactly what we are doing. So here’s the definition I like: To ration healthcare is to withhold medical services from individuals who would probably benefit from them because we have decided not to buy those services for everybody who needs them.

I like this definition because it’s straightforward. Also, it puts the onus on us… instead of those nasty “scarce resources” themselves. That makes it harder for us to dance around the real issue, which is: if we’re going to ration healthcare then we ought to do it in the least harmful way possible.

Fogoros makes a compelling case that the problem with our current health care system is covert rationing, which has profound corrosive effects. Once the problem is laid out, Fogoros proposes a solution that encompasses open rationing and is characterized by six key principles. Among other things he wants to see competition between health care and other services provided by society, and rationing decisions left to individual patients to the extent possible.

Fogoros also insists on universal health care coverage as a key principle. Presidential candidates who advocate the same thing should study Fogoros’s book to see how it might actually be done.

September 24, 2007

4 thoughts on “Book recommendation: Fixing American Healthcare”

  1. I’m not sure I follow the reasoning here, and maybe it might become more clear if I read Dr. Fogoros’ book, but based on what’s highlighted here, and the link to Fogoros’ blog, I can’t sort out the contradictions, and see some dangerous manipulation of the discussion at work.

    On the one hand “rationing is bad,” he says. I hope this was meant as hyperbole or sarcasm because I have never believed that rationing is either inherently good or bad. It is simply what must be done. It is, in a word, rational.

    Healthcare is not tap water. We are not entitled to every bit of it that we want, nor everything that the provider-enablers want to sell us in their quest for revenue.

    And if, as Fogoros’ definition blithely tries to slip by us, our system denies “services for people who need them,” that is not rationing. That is malpractice, which we already have laws against.

    To put it in economic terms healthcare is not in infinite supply, so it must be rationed by some method. Dr. Fogoros is being disingenuous and inflammatory when he uses the term “scarce resources.” There’s nothing scarce about something our country spends $2 trillion a year on. What it is is a “finite resource.”

    But then comes the contradiction. “Rationing is bad,” but it is something we must do more openly to improve the situation. Huh?!?!

    I guess what I’m trying to say here is that I don’t necessarily disagree with Dr. Fogoros’ conclusions and prescriptions. Transparent rationing is a good thing, yes. But I have a big issue with his incendiary wordplay to make a point. For Mr. Williams to call this “bold” and “much-needed” only makes things worse.

    The debate over healthcare reform already has too much demagoguery. Adding one more demagogue (a doctor, what a shock!) to the mix is not helpful. I’d much rather see some cooler heads come together for appropriate solutions.

  2. Rick,

    As I read back over my post I can understand where you’re coming from. I was trying to convey the flavor of the book: its willingness to state things clearly, its commitment to addressing hard issues head on, and so forth. I didn’t attempt to summarize Dr. Fogoros’ arguments.

    When I started to read the book I thought I might find it demagogic, but I really didn’t. The assessment is well laid out and the conclusions are logical, pragmatic, and ethical, at least from this reader’s perspective.


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