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Some of Goodman’s and Musgrave’s premises seemed to be self-evident, although they are not usually included in the discussion of health care. For example, they reminded us that, in a market system, the pursuit of self-interest is usually consistent with social goals. With that statement considered, some of their other conclusions become a lot clearer: We cannot solve America’s health care crisis if 250 million Americans find it in their self-interest to act in ways that make the crisis worse. Therefore, the goal must be to make solving the health care crisis a matter of individual self-interest.

In the chapter entitled “Moving Toward the Idea,” the authors itemize fifteen policy proposals that emphasize opportunities to exercise individual choice and responsibility. The government’s role becomes one of helper, rather than its current role of hinderer. Tax reform and catastrophic insurance protection are included in the list.

The crux of the problem, according to Goodman and Musgrave, is that individuals seeking health care are spending someone else’s money. Therefore, the solution is a system in which they spend their own money.

This could be done through a Medical Savings Account in which an employer or individual deposits money for the individual, out of which the individual pays small claims. Large claims are paid out of a high deductible catastrophic insurance policy. The list of benefits includes lowering the cost of health care, lowering administrative costs, removing barriers to the purchase of health care, creating a method to pay insurance premiums while unemployed, restoring the doctor/patient relationship, giving insurance incentives for improved lifestyle, and expanding the health insurance options for the elderly and the poor.

As a health insurance executive, I was certainly aware of how state regulation and mandates–plus federal government rules and spending–are driving up the cost and utilization of health care. Yet to my further distress, the authors uncovered even higher government-generated health care costs that don’t show up in the 800 billion dollars this country is said to spend on health care annually. For example, the OSHA and EPA establish rules and requirements that employers must enact to prevent certain diseases. The EPA’s cost-is-no-object approach, of course, is made possible with our money–in the form of higher prices for products we buy and lower wages to offset the costs of implementing these regulations. The authors point out far better uses of such money to improve the health care of the general population in this country.

In the chapter on  “Meeting the Needs of Under-served Populations,” the authors list 20 problems, the current non-solutions of cost-plus proponents, and the solutions of an ideal health care system. This is the book’s second useful, concise, and accurate list. The first problem discussed is rising health care costs, which Goodman and Musgrave say is caused by the consumer spending someone else’s money. This same consumer would be shocked to learn that approximately twenty percent of his income is actually taken by health care through lower wages and taxes before any service is provided.

Emphasizing patient autonomy, the authors explain that what a medical test is worth should depend on patient preferences and the patient’s attitude toward risk. They do not debunk outcomes-research and other results-oriented studies, but rather put them in their proper perspective.

Frequently, politicians confuse access to health care with access to health insurance. The authors clearly point out that there is access to medical care, even for those who cannot pay for it: In forty-seven states the law guarantees it. In addition, federal law requires all hospitals treating Medicare patients to accept patients regardless of ability to pay. The problem of access, according to Musgrave and Goodman, is created by public sector health care rationing. Since access to medical care is in fact guaranteed to Americans, they point out that health insurance should revert to addressing its primary purpose–the protection of financial assets.

Patient Power also looks at international health policy. Most other systems, in one way or another, have failed and are moving to privatization. The most successful system is the one used in Singapore, where the government requires each individual to put a certain percentage of their salary into a savings account to be used for health care. The people of Singapore then pay for most of their own and their families’ medical expenses with their own money.

The authors are to be congratulated for successfully and clearly describing problems of and solutions to America’s health care crisis.

My approach to reading Patient Power was to begin with chapter three, “Moving Toward the Idea: An Agenda for Change,” through chapter four, “Using the Agenda to Solve Problems,” then to jump to chapter twenty, “Meeting the Needs of Under-served Populations,” and to conclude by reading the rest of the chapters in numerical order. This allowed me to read the book with a better understanding of where the authors were leading me, and although it was a bit like reading the last chapter of a good novel first, it helped bring the rest of the book into focus. The detail and knowledge portrayed in Patient Power has not come close to being matched by anything else I’ve read on the subject.

The only real solution to our health care problem is not more bureaucracy, but patient empowerment and more individual responsibility. Patient Power should be required reading for anyone who wishes to discuss America’s health care crisis intelligently.

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