A detailed and innovative blueprint for fixing what ails American medicine.
Time to radically revamp the American health care system in light of the flawed response to the Covid-19 pandemic and many other dysfunctions, argues this sweeping manifesto.
Kapur, a public policy professor at the University of Maryland College Park, and debut author Chalil, a physician and chairman of the Indo American Press Club, start by noting medical difficulties faced by the United States during the Covid-19 pandemic. These include shortages of masks, personal protective equipment, and ventilators; mass layoffs that caused people to lose their insurance; and bankruptcies among some hospitals that suspended elective procedures to make way for virus cases. They continue with a wide-ranging critique of American medicine, spotlighting its higher costs and poorer health outcomes compared to other developed countries; the lack of accessibility of needy and uninsured patients; shortages of hospitals, doctors, and nurses; and the pressure on providers to improve profits by cutting corners and to defend against malpractice suits with unnecessary tests. To remedy these problems, the authors propose a “Grand Plan To Restructure Healthcare in the U.S.” with a mix of public provisions and market-based competition. They envision a “SafetyNet” of public county hospitals providing basic care to all regardless of insurance or ability to pay. A second system of private hospitals, providers, and insurance, funded by “Enhanced Health Savings Accounts,” would run in parallel and compete in price and quality in a national and global market, with medical services advertised like groceries, complete with coupons. Other plan features include a unitary electronic medical record, caps on malpractice damages, a Comprehensive Consumer Healthcare Score that awards points for healthy lifestyles that could lower insurance rates, initiatives to train more health care professionals, a National Strategic Healthcare Reserve of emergency supplies, and new technologies, from online diagnosis to medical robots.
Kapur and Chalil present their case for far-reaching reforms of American health care in lucid prose that has an incisive bite. (“Calling it a healthcare system is a misnomer. It is a disease-care system, one that focuses on diagnosing and treating symptoms instead of taking on the job of educating individuals and families to take a proactive approach to their health.”) But the book suffers from a meandering, repetitive structure and an occasional lack of focus and rigor; it pursues tangents that some readers may consider dubious, like a brief for traditional Indian ayurvedic healing as an adjunct to Western medicine; and it sometimes gets facts wrong. (The 1918 Spanish flu did not kill “a third of the world’s population”—mortality was between 1% and 6%—and British Prime Minister Boris Johnson did not “support a herd immunity theory until he was hospitalized with the COVID-19 virus”; he imposed a national lockdown to prevent contagion on March 20, 2020, seven days before he tested positive.) The authors’ plan is something of a hodgepodge, with myriad moving parts to achieve many disparate goals, and it’s hazy on some important points, like the costs and funding mechanisms of the public SafetyNet hospitals. Still, Kapur and Chalil manage to steer clear of the dogmas of the right and left to offer a thoughtful, cogent analysis of the manifold problems in the U.S. health care establishment and a wealth of concrete proposals for dealing with them.
A detailed and innovative blueprint for fixing what ails American medicine.Pub Date: Oct. 5, 2020
ISBN: 978-1-7359048-0-1
Page Count: 276
Publisher: TheUNN Corporation
Review Posted Online: Feb. 8, 2021
Kirkus Reviews Issue: March 15, 2021
Review Program: Kirkus Indie
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
BOOK REVIEW
BOOK REVIEW
BOOK REVIEW
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
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