AMERICA'S HEALTH IN THE BALANCE: Choice or Chance? by Howard H. Hiatt

AMERICA'S HEALTH IN THE BALANCE: Choice or Chance?

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KIRKUS REVIEW

An eminent doctor (Hiatt is currently Senior Physician at two Massachusetts hospitals and teaches at Harvard, where, until recently, he was dean of the School of Public Health) diagnoses the US health-care system, finds it afflicted with serious dysfunctions and proposes a cure."" We are,"" he says, ""the only industrialized country in the world to lack medical insurance for all."" Yet, we pay more per capita for a chaotic medical delivery system that grossly shortchanges the poor and even makes it complicated for the wealthy to get the right diagnosis and treatment. Unnecessary operations (tonsilectomies and hysterectomies) and tests (frequently for malpractice strategy) proliferate while the poor die for lack of treatment and a whole generation of poor pregnant mothers and children are breeding future societal problems such as retardation, chronic illnesses, etc. Hiatt's prescription draws on the experience of Britain's centrally funded National Health Service and Canada's universal health insurance, which is supervised on the provincial level and funded 50-50 by the central government and the provinces. Hiatt's health delivery system would also retain private insurance funds, which would join those of Federal, state and local governments in a series of ""regional health corporations."" These would fund doctors, hospitals, nursing homes, ambulatory care centers in regions comprising roughly 800,000 to 3.5 million people. Everyone would be provided with necessary health care at no direct cost. These regional centers would also commit 2 percent of total receipts to research (seriously underfunded today, says Hiatt) and would strengthen community services such as home nursing care, housekeeping services and so on. Medical malpractice costs would be curtailed by no-fault legislation, and other costs would be controlled through less duplication of costly equipment and better use of existing hospital beds and other services. Hiatt may be tacking against prevailing political winds, which have veered strongly toward less government involvement in social needs. However, by making his health delivery system regional and implying--but never quite spelling out--that it would cost no more than our present chaotic system, he may have overcome some fiscal and political objections. He also has the happy--and all too rare--facility for illuminating and clarifying a complicated and controversial subject. This makes for a book that should be read carefully by physicians, politicians and present and potential patients--in other words, all of us.

Pub Date: March 4th, 1987
Publisher: Harper & Row