WHERE DOES IT HURT?

With the assistance of former BusinessWeek senior writer Baker (Final Jeopardy: Man vs. Machine and the Quest to Know Everything, 2011, etc.), Bush, nephew of George H.W., offers an alternative to Obamacare based on his own experiences as CEO of athenahealth, Inc.

Despite the author’s family connections, this is by no means a vitriolic attack on the Affordable Care Act but rather an appraisal of why, in his opinion, it is not up to the necessary task of reforming the American health care system, since escalating costs (whether borne by individuals or government) are not sufficiently addressed. The author charges that the ACA has failed to address the “legions of powerful stakeholders” who profit from the system. At the top of his hit list are insurers and hospitals. He holds large hospitals accountable for providing many primary care services at inflated prices—“in hospitals we pay for a Ritz experience, but the service we get is below the YMCA.” Based on his experiences as a medic during the first Iraq war, he contends that the skills of highly trained specialists are being wasted on jobs that semiprofessionals could be trained to handle. After receiving a master’s degree from Harvard and serving as a consultant, Bush decided to launch a series of birthing clinics. In 1997, the venture failed, but he salvaged athenahealth, an online data-processing system for medical record-keeping that is now a $4 billion business. The author contends that the cost of medical treatment could be vastly reduced by the expansion of clinics staffed largely by semiprofessionals (perhaps attached to big-box stores such as Wal-Mart), which would treat minor injuries, colds and immunization. He advocates making medical records available to patients so that they can freely shop for affordable care from a pool of competing providers without the need of government intervention.

Likely to find its way onto the Republican platform but worthy of serious consideration on its own merits.