A hard look at how for-profit health management organizations have come to be the force they are in our health care system and how their emphasis on the bottom line threatens quality medical care. Wall Street Journal reporter Anders (Merchants of Debt, 1992) reveals how corporations in the 1980s turned to managed care as a way to hold down the mushrooming costs of employee health plans by taking power away from doctors, hospitals, and patients and putting it in the hands of businessmen. Over 55 million Americans are now covered by HMOs, and their numbers are growing at the rate of 100,000 a week. The entrepreneurs who led the way in this astonishing revolution in our health care system come in for some sharp scrutiny (Anders seems to enjoy deploring their greed and flashy lifestyles), but the main focus is on how HMOs function. Anders examines their impact on hospitals, doctors, the pharmaceutical industry, and of course consumers. Hair-raising stories about the refusal to treat seriously ill patients are featured prominently in his discusion of how cost-conscious HMOs handle heart disease and breast cancer, emergency medicine, mental health, and care of the elderly and the poor. The picture that emerges is disheartening, even alarming, but not hopeless. Anders shows how consumers, doctors, employers, and regulators have been able in specific instances to challenge stingy treatment guidelines, negotiate for better access to specialists, change the rules about use of emergency rooms, and help set better standards of coverage. He concludes by summarizing various courses of action these groups can take to improve the medical care provided by HMOs and by warning HMOs that as society develops a cost-effective medical system, they may find themselves expendable. Highly readable and downright essential for anyone—patient or doctor—in an HMO or considering joining one. (Author tour)
Pub Date: Nov. 13, 1996
ISBN: 0-395-82283-1
Page Count: 288
Publisher: Houghton Mifflin
Review Posted Online: May 19, 2010
Kirkus Reviews Issue: Sept. 1, 1996
Occasionally wonky but overall a good case for how the dismal science can make the world less—well, dismal.
“Quality of life means more than just consumption”: Two MIT economists urge that a smarter, more politically aware economics be brought to bear on social issues.
It’s no secret, write Banerjee and Duflo (co-authors: Poor Economics: A Radical Rethinking of the Way To Fight Global Poverty, 2011), that “we seem to have fallen on hard times.” Immigration, trade, inequality, and taxation problems present themselves daily, and they seem to be intractable. Economics can be put to use in figuring out these big-issue questions. Data can be adduced, for example, to answer the question of whether immigration tends to suppress wages. The answer: “There is no evidence low-skilled migration to rich countries drives wage and employment down for the natives.” In fact, it opens up opportunities for those natives by freeing them to look for better work. The problem becomes thornier when it comes to the matter of free trade; as the authors observe, “left-behind people live in left-behind places,” which explains why regional poverty descended on Appalachia when so many manufacturing jobs left for China in the age of globalism, leaving behind not just left-behind people but also people ripe for exploitation by nationalist politicians. The authors add, interestingly, that the same thing occurred in parts of Germany, Spain, and Norway that fell victim to the “China shock.” In what they call a “slightly technical aside,” they build a case for addressing trade issues not with trade wars but with consumption taxes: “It makes no sense to ask agricultural workers to lose their jobs just so steelworkers can keep theirs, which is what tariffs accomplish.” Policymakers might want to consider such counsel, especially when it is coupled with the observation that free trade benefits workers in poor countries but punishes workers in rich ones.
Occasionally wonky but overall a good case for how the dismal science can make the world less—well, dismal.Pub Date: Nov. 12, 2019
ISBN: 978-1-61039-950-0
Page Count: 432
Publisher: PublicAffairs
Review Posted Online: Aug. 28, 2019
Kirkus Reviews Issue: Sept. 15, 2019
SEEN & HEARD
An absorbing, wide-ranging story of humans’ relationship with the water.
A study of swimming as sport, survival method, basis for community, and route to physical and mental well-being.
For Bay Area writer Tsui (American Chinatown: A People's History of Five Neighborhoods, 2009), swimming is in her blood. As she recounts, her parents met in a Hong Kong swimming pool, and she often visited the beach as a child and competed on a swim team in high school. Midway through the engaging narrative, the author explains how she rejoined the team at age 40, just as her 6-year-old was signing up for the first time. Chronicling her interviews with scientists and swimmers alike, Tsui notes the many health benefits of swimming, some of which are mental. Swimmers often achieve the “flow” state and get their best ideas while in the water. Her travels took her from the California coast, where she dove for abalone and swam from Alcatraz back to San Francisco, to Tokyo, where she heard about the “samurai swimming” martial arts tradition. In Iceland, she met Guðlaugur Friðþórsson, a local celebrity who, in 1984, survived six hours in a winter sea after his fishing vessel capsized, earning him the nickname “the human seal.” Although humans are generally adapted to life on land, the author discovered that some have extra advantages in the water. The Bajau people of Indonesia, for instance, can do 10-minute free dives while hunting because their spleens are 50% larger than average. For most, though, it’s simply a matter of practice. Tsui discussed swimming with Dara Torres, who became the oldest Olympic swimmer at age 41, and swam with Kim Chambers, one of the few people to complete the daunting Oceans Seven marathon swim challenge. Drawing on personal experience, history, biology, and social science, the author conveys the appeal of “an unflinching giving-over to an element” and makes a convincing case for broader access to swimming education (372,000 people still drown annually).
An absorbing, wide-ranging story of humans’ relationship with the water.Pub Date: April 14, 2020
ISBN: 978-1-61620-786-1
Page Count: 288
Publisher: Algonquin
Review Posted Online: Jan. 4, 2020
Kirkus Reviews Issue: Feb. 1, 2020
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