Your Money or Your Life: Strong Medicine for America's Health Care System

since nothing is perfect.Authoritative, clearly written, and quite interesting; I recommend to anyone -- professionals, academics, laypersons -- interested in these issues.Specifics:1) The first 5 chapters convincingly argue that the enormous increases in health care spending are first attributable to new technology and treatments, and well justified, benefits substantially exceed the costs. The arguments are based in substantial part on Cutler's own academic research. By themselves, these chapters are sufficient to justify the book. Cutler does a good job of explaining both the technical economic concepts and the medical issues, and I suspect anyone interested in the topic will find the chapters fascinating, eye-opening.He reaches a very important conclusion: we ought to spend MORE, not less.2) Subsequent chapters survey sources of waste and problems of distribution. I found these helpful in outlining some important problems, and well worth reading, but incomplete (see below). In part these explore the incentives created by different systems of paying for health care; this helps explain why some sorts of technologies and procedures are favored over others in any particular case.3) The concluding chapter contains his solution to the problems, a system of universal insurance (mostly private) coverage, subsidized and supervised by the federal gov't; worth reading, but inadequate. Cutler focuses on a subset of problems & proposes a solution, with little consideration for other problems or possible solutions.For example, he ignores 'public choice' issues: how would his proposal work in a world of self-interested government official, bureaucrats, insurers, medical professionals, patients, etc.? The system he proposes might work on paper, but is quite susceptible to "gaming." USDA crop insurance is a real world example, and its poor performance should make us hesitant to expand this approach to health care.Similarly, Cutler argues that gov't and insurers should develop a payment system that rewards providers for measurable health improvements. Cutler greatly underestimates the difficulty. Soviet planners wrestled this problem for 75 years and were unable to solve it, how to specify a set of desired production outcomes from above and then have them realized as one envisions. It's a very difficult problem, I think unsolvable. Cutler underestimates it, and devotes essentially no attention to possible solutions which would make the individual consumer directly responsible for payment, and evaluation, of health care services.4) Cutler provides a lengthy set of citations from the scholarly literature, excellent for further study. He also features, on his website, a technical appendix. It's clear he's trying to spread light, not heat, in the health care debate. Good on him!5) Despite any weaknesses, Cutler does a fine job of framing the issues. The book is accessible and a good read. OK, OK, 4.9 stars.C.N. Steele Ph.D.

Well researched and well documented with over 25 pages of endnotes, this book is a hybrid: wonderfully readable yet academically sound. As a health economist and member of the prestigious Institute of Medicine, Cutler offers a scintillating, objective economic analysis of our existing health care system, exposing the embarrassing inadequacies and problems while also highlighting its successes. He also offers sage guidance for a better health care future: increasing the value of our health care system primarily by aligning incentives with desirable outcomes. Many but not all of his ideas are reflected in the Accountable Care Act. If every policy maker had read this book with an open mind, we would have been spared much of the political drama surrounding the enactment of the Affordable Care Act, as well as the post-enactment machinations to undo it. To pick nits, Cutler's view that just about everyone believes that everyone should have health insurance is not supported by the facts. If that were the case, we would have had comprehensive health reform many decades ago and few if any would be trying to repeal, nullify, or starve the Accountable Care Act. Also, his lumping regulation along with litigation as necessarily punitive suggests a rather limited view of regulation. Overall, though, this book is superb, a "must read" for everyone who cares about health care and the health of their fellow Americans.

Good book.

Good condition for a used book

Second read on this. He advised Obama originally but was overridden by mre ideological advisors. Read and weap about what should have been

The best book to assist me in understanding my Economy of Health Care course.

The reader may find Cutler's work "Your money or Your Life" very interesting as well as provocative. The author touches upon multitude of dilemmas in the existing US health care system. One may see the health care system as a net in which interaction of players is subject to motivations, finances, laws, rules, regulations, and other variables. Finally, as an output, there is a health care system that does not work as it could. We have a system of health care where 20, 000 people die every year because they are uninsured. Really, what can be more precious than the life of a human being? Similarly, what is more important painting by Rembrandt or a cat in a burning building? Possibly, some would choose Rembrandts' painting instead of the cat, but that would be an individual choice. Our societal chains have to be re-linked. As humans we are capable of measuring up at the societal level; our health care system needs improvement! In his work, the author discusses history of the health care in the United States and presents the reader with real life situations and examples. The author attempts to weigh financial costs against human life value. The reader is presented with the dilemma: on one hand there is a system with intensive technologies, high costs, that is possibly beneficial to those who can afford it; on the other hand, we can have a system that works better, and is beneficial to everyone and in which prevention plays an important role. In authors view, it was a mistake by Bush administrations to make tax cuts benefiting very wealthy. If those tax cuts were applied to the population as a whole, we could have secured health coverage for everyone for several years without raising taxes.Healthcare services are underused or overused ("moral hazard"). The problem is not limited to the uninsured only. The author emphasizes that we need to eliminate overuse and underuse of care. Elimination of overuse saves money, and elimination of underuse saves costs. Truly, it costs much more to amputate foot of a diabetic patient than to prevent it through prevention strategies. Insurance companies do not pay for prevention, but almost all pay for amputation. In a case with uninsured population the situation is even worse. People go without prevention, and end up with amputated limbs, and bills mounted to six digits in thousands of dollars. In the authors' view, fundamentally, the problem is not of affordability, but of value. The health care reform needs to address the issue of value more than affordability. Having insurance does not guarantee good care. A common response to poor quality is to make it easier for people to sue insurers and providers. Would it improve the quality of care? The author states that this is not the solution to the issue. The threat of litigation creates a silo mentality when insurers are against physicians, and physicians are against each other. The author states that increased insurance coverage does require government action; and the only solution is to devote more resources to government medical care programs over time. The author thinks that the role of government shall be expanded in order to meet the burden of medical care. There are other alternatives for universal health coverage such as for example single payer system, but in the authors view, these alternatives are to a degree inferior. The common belief is that competition of private insurance system is superior to government provision. The author states that firms compete with each other seeking quality improvement and cost decrease. At the same time, it is debatable whether private insurance entities have quality improvement as one of the priorities. Competition does not guarantee quality of health care, but definitely, all insurance entities are seeking the ways that would allow minimization of costs. Also, private insurance involves higher administrative costs. The author thinks that payments can be adjusted basing on health risk of employees in order to reduce adverse selection. In my view, this is an unfair form of differentiation/discrimination basing on one's health status. It does not solve the issue of social injustice in the health care system. This type of reform will not generate better outcomes as the author states. Still, sick and poor will be lagging behind. Health care is a basic need. It is a basic right of every human being in the society. This is not the proper way of re-linking societal chains in the health care system. Medicare for all is needed for true health care reform! The recent passage of the healthcare law did not eliminate the problem. Millions of people still will have to buy commercial health insurance policies, which will cover roughly seventy percent of their medical expenses. People will still have to pay deductibles and co-pays. Millions of people will remain uninsured. Their access to care still will be limited and care delayed. While this is happening, health insurance companies will be making a profit from millions of people who will have to buy health insurance. The insurance companies will become even more influential financially and politically after they receive money from taxpayers. They will have more power to block future reforms. In order to eliminate the problem, we need one-payer system. We need Medicare for all. We need the system in which the government collects healthcare fees and pays out the costs. Under healthcare for all model, all citizens would be able to receive the healthcare they need. Healthcare shall be based on one's needs, and not an ability to pay!