Crisp, clear analysis of health care—from the perspective of a businessman who applies a systems approach and focuses on the financial incentives that drive the system. Halvorson's credentials are impressive—president of a billion-dollar health-care organization (which remains unnamed here); developer of two HMOs; a former senior executive of Blue Cross—and his approach is direct and businesslike. As he sees it, perverse market incentives inadvertently have been built into our present system. We reward medical providers for volume and complexity and our insurers for risk avoidance; consequently, health care in America is wasteful, expensive, complex, and leaves millions without coverage. Halvorson believes that the solution lies in simple common sense and economic reality. If we change the incentives, he says, we can create a high-quality, highly efficient, and continually improving system. He analyzes how the key elements of the present health-care delivery and financing system work, discussing in turn doctors, hospitals, technology, drugs, insurers, HMOs, and—last but not least—the government. Halvorson also examines some of the options currently being proposed, assessing their strengths and weaknesses. Finally, he proposes 12 objectives for America's medical system (including a truly competitive marketplace, prepayment for care, quality standards for caregivers, and universal coverage), and explains in some detail how each objective can be met by changing the incentives that drive the system. One key to success, he contends, is enlightened medical leadership, with doctors being trained in political science and management—especially in the Deming approach to quality improvement, used so successfully by Japanese industry. Persuasive, straightforward, and worthy of attention in the ongoing national debate.
Pub Date: Oct. 1, 1993
ISBN: 0-679-42980-8
Page Count: 256
Publisher: Random House
Review Posted Online: May 19, 2010
Kirkus Reviews Issue: Aug. 15, 1993
A moving meditation on mortality by a gifted writer whose dual perspectives of physician and patient provide a singular...
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
PERSPECTIVES
For Howard Zinn, long-time civil rights and anti-war activist, history and ideology have a lot in common. Since he thinks that everything is in someone's interest, the historian—Zinn posits—has to figure out whose interests he or she is defining/defending/reconstructing (hence one of his previous books, The Politics of History). Zinn has no doubts about where he stands in this "people's history": "it is a history disrespectful of governments and respectful of people's movements of resistance." So what we get here, instead of the usual survey of wars, presidents, and institutions, is a survey of the usual rebellions, strikes, and protest movements. Zinn starts out by depicting the arrival of Columbus in North America from the standpoint of the Indians (which amounts to their standpoint as constructed from the observations of the Europeans); and, after easily establishing the cultural disharmony that ensued, he goes on to the importation of slaves into the colonies. Add the laborers and indentured servants that followed, plus women and later immigrants, and you have Zinn's amorphous constituency. To hear Zinn tell it, all anyone did in America at any time was to oppress or be oppressed; and so he obscures as much as his hated mainstream historical foes do—only in Zinn's case there is that absurd presumption that virtually everything that came to pass was the work of ruling-class planning: this amounts to one great indictment for conspiracy. Despite surface similarities, this is not a social history, since we get no sense of the fabric of life. Instead of negating the one-sided histories he detests, Zinn has merely reversed the image; the distortion remains.
Pub Date: Jan. 1, 1979
ISBN: 0061965588
Page Count: 772
Publisher: Harper & Row
Review Posted Online: May 26, 2012
Kirkus Reviews Issue: Jan. 1, 1979
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