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THE AMERICAN HEALTH CARE PARADOX

WHY SPENDING MORE IS GETTING US LESS

Bradley (Public Health/Yale Univ.) and Harvard presidential scholar Taylor examine why Americans are less healthy than others around the world, even though the United States spends more on health.

The authors show that comparisons between health expenditures and outcomes are misleading since they count different things. The U.S. for example, outspends other advanced sector countries in gross national product terms, but measures of life expectancy, infant mortality and maternal survival are worse. Deconstructing numbers and interviewing professionals has led Bradley and Taylor to conclude that social welfare expenditures ought to be included with health care numbers to bring about a more realistic ranking. The United States is currently in the middle of the pack. To emphasize their point, the authors compare the social welfare spending of the U.S. to that in Scandinavian countries. For example, they demonstrate that helping a diabetic with $50 for new shoes can help to avoid the expenditure of $30,000 for the surgery that follows a visit to the emergency room. They insist that medical costs increase due to a lack of attention to the prevention and early treatment of many easily managed conditions, and they point to the public health benefits of programs for child support, income maintenance, and housing and employment support. The authors pair their comparison with a historical review of U.S. health care policy, showing how the present hospital-dominated arrangements developed out of compromises over repeated efforts to implement health programs. They also review the opposition to public health from the American Medical Association since the New Deal. Accused of advocating for poverty programs, Bradley and Taylor insist that their objective is to improve the effectiveness of spending by broadening access. An important attempt to shift the discussion on health in the United States.

 

Pub Date: Nov. 5, 2013

ISBN: 978-1-61039-209-9

Page Count: 288

Publisher: PublicAffairs

Review Posted Online: Sept. 3, 2013

Kirkus Reviews Issue: Oct. 1, 2013

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WHEN BREATH BECOMES AIR

A moving meditation on mortality by a gifted writer whose dual perspectives of physician and patient provide a singular...

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A neurosurgeon with a passion for literature tragically finds his perfect subject after his diagnosis of terminal lung cancer.

Writing isn’t brain surgery, but it’s rare when someone adept at the latter is also so accomplished at the former. Searching for meaning and purpose in his life, Kalanithi pursued a doctorate in literature and had felt certain that he wouldn’t enter the field of medicine, in which his father and other members of his family excelled. “But I couldn’t let go of the question,” he writes, after realizing that his goals “didn’t quite fit in an English department.” “Where did biology, morality, literature and philosophy intersect?” So he decided to set aside his doctoral dissertation and belatedly prepare for medical school, which “would allow me a chance to find answers that are not in books, to find a different sort of sublime, to forge relationships with the suffering, and to keep following the question of what makes human life meaningful, even in the face of death and decay.” The author’s empathy undoubtedly made him an exceptional doctor, and the precision of his prose—as well as the moral purpose underscoring it—suggests that he could have written a good book on any subject he chose. Part of what makes this book so essential is the fact that it was written under a death sentence following the diagnosis that upended his life, just as he was preparing to end his residency and attract offers at the top of his profession. Kalanithi learned he might have 10 years to live or perhaps five. Should he return to neurosurgery (he could and did), or should he write (he also did)? Should he and his wife have a baby? They did, eight months before he died, which was less than two years after the original diagnosis. “The fact of death is unsettling,” he understates. “Yet there is no other way to live.”

A moving meditation on mortality by a gifted writer whose dual perspectives of physician and patient provide a singular clarity.

Pub Date: Jan. 19, 2016

ISBN: 978-0-8129-8840-6

Page Count: 248

Publisher: Random House

Review Posted Online: Sept. 29, 2015

Kirkus Reviews Issue: Oct. 15, 2015

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GOOD ECONOMICS FOR HARD TIMES

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

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