THE HOSPITAL THAT ATE CHICAGO: Distortions Imposed on the Medical System by Its Financing by

THE HOSPITAL THAT ATE CHICAGO: Distortions Imposed on the Medical System by Its Financing

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KIRKUS REVIEW

Dr. Fisher has two very separate things here: a clear explanation of medical insurance and how it finances the hospital system; and a diatribe against all insurance except for catastrophic illness. Fisher does actually manage to untangle the financial maneuvering by which hospitals operate; and he makes plain the roles of Medicaid/Medicare, Blue Cross/Blue Shield and other insurance companies, and the non-insured patient. The trouble begins with his analysis of where it has all gone wrong. To Fisher, the present method of reimbursement is the root of all evil in the health-care system--and that evil he identifies with high cost, not poor services. His solution: ""to restore the market mechanism"" by having each person pay for his own health care, except in cases of catastrophic illness. This, Fisher contends, would bring down the price of medical care--a debatable point insofar as he overlooks both advances in medical technology and the increasing age of the populace. More important, of course, he says nothing about what pay-as-you-go (or stay away?) would do to people's health. Other recommendations include continued funding of scientific research so that ""the one-time cost of eliminating a disease can replace the endless process of curing it."" There is not a word here of prevention--of improving health by education, better nutrition, better living conditions, measures which drastically reduced the incidence of tuberculosis long before a drug treatment was found. But there's an insidious balance-sheet mentality in evidence throughout. ""We need to be able to determine the ultimate longevity of people treated in some defined manner,"" Fisher writes, ""and this needs to be compared with the retrospective cost and characteristics of the provider. . . determining in retrospect what good it all was, and how much longevity we got for what cost."" What begins as a careful look at how hospitals are financed ends in a flurry of warnings against socialism, and an almost total disregard of the human problem.

Pub Date: March 17th, 1980
Publisher: Saunders Press--dist. by Holt, Rinehart & Winston