Healthcare, Guaranteed: A Simple, Secure Solution for America

by Ezekiel J. Emanuel

Book Overview

America spends more than any other developed nation on healthcare -- 2.1 trillion in 2007 alone. But 47 million Americans remain uninsured, and of those Americans who are insured, many suffer from poor health. In his ground-breaking proposal, Dr. Ezekiel Emanuel offers up a plan to comprehensively restructure the delivery and quality of our healthcare. By eliminating employer-healthcare and establishing an independent program to evaluate healthcare...

• Format: Paperback
• Language: English
• ISBN: 1586486624
• ISBN13: 9781586486624
• Release Date: May 2008
• Publisher: PublicAffairs
• Length: 240 Pages
• Weight: 0.15 lbs.
• Dimensions: 0.7" x 5.5" x 8.2"

Customer Reviews

A well thought out proposal

Over the years, many authors have proposed solutions for "curing" US healthcare. One might think that the book "Healthcare Guaranteed" by Ezekiel J. Emanuel M.D., Ph.D. is just another in the long list. However, this book succeeds in providing a fresh perspective. And now that the author has become a senior advisor in the Obama administration and his brother, Rahm Emanuel, is Obama's chief of staff, this book takes on added relevance. After quickly reviewing well recognized problems in the US healthcare system, Emanuel prepares his readers for his proposal by listing seven criteria that he believes should be used to evaluate any proposed new plan. These criteria include: 1) Does the plan guarantee coverage for all Americans? 2) Does it make the health system more cost effective? 3) Does the plan promote high quality coordinated care? 4) Does the plan provide patients with choice? 5) Does the proposal have a fair financing mechanism? 6) Does the plan have reasonable mechanism for malpractice dispute resolution? 7) Does the plan help the economy by eliminating the burden of healthcare on businesses? One can argue about the relative priority or importance of the proposed goals, but clearly any plan that meets all or most of his stated goals would have to be considered impressive. Throughout the latter part of the book, Emanuel uses these criteria to judge his own proposal as well as other alternatives. The key to Emanuel's plan is a voucher system for all Americans. With this voucher, each American can choose a health plan from any insurance company as long as the plan meets a minimum standard. The insurance companies must accept every patient who seeks coverage and can only charge minimal additional fees such as standard co-payments. Although my bias prior to reading the book was against vouchers, I found Emanuel's logic compelling. Although funding for this system would be through the federal government, insurance companies would compete in a free market system to be chosen by patients who pay with vouchers. To prevent insurance companies from avoiding the sickest, costliest patients, the voucher system pays the insurance companies more for the sicker patients who are predicted to cost more. Doctors and hospitals are also private and are free to contract with the insurance companies as they wish. Patients are free to pay for services that are not covered by their insurances plans, but their payments would be with after tax dollars. This plan also includes a number of other features to manage the oversight and administration of the plan. Emanuel proposes a National Health Board modeled after the Federal Reserve with twelve regional boards. Each member would serve a long, staggered appointment; and therefore compared to congress, the board would be less prone to being overly affected by political processes or special interest groups. Each regional board would also have a Center for Patient Safety and

Read This Book, Back This Plan

Dr. Emanuel has a smart healthcare solution for what ails us! At the heart of his plan is the method of funding, which makes so much sense. Everyone wants healthcare insurance and everyone should be willing to pay for it. Using a dedicated Value Added Tax (VAT) to pay for vouchers would be progressive, as those with more means consume more. (Credits would be given to those below an income threshold.) The VAT would capture a fair share from the illegals who currently crowd our emergency rooms for free service; it would also capture significant revenue from the illegal drug trade. Democrats should want to back it - it is truly universal healthcare. Republicans should want to back it as the plan provides vouchers to afford consumers to choose, i.e., affords competition for efficiency. Companies should want to back it because it removes a huge direct cost and disincentive for employment; workers would benefit for the same reason. Importantly, the VAT is the tax system of the era of globalization, as it is border adjustable, i.e., subtracted from exports and added to imports. The U.S. alone among its trading partners in not taking advantage of the VAT, which is supported under GATT rules and used by 135 countries today, including all of our trading partners, which get a competitive advantage over U.S. goods and services because of it. (For example, the cost of healthcare for Ford Motor is more than the cost of steel. Imagine subtracting the cost of steel from an exported car, and adding that cost onto an imported car. We would increase U.S. market share!) I bought a copy of this book for my Congressman, and for a leader in healthcare. Spread the word.

Another excellent book on the healthcare system in the USA

Dr. Emanuel has been writing for some time on the subject of health care policy, usually in collaboration with Prof. Victor Fuchs, an eminent, but now-retired, health economist. Prof. Fuchs collaborated with Dr. Emanuel on this book, as Dr. Emanuel notes in it, but apparently the final version as published is mostly the work of Dr. Emanuel. This and two other books that I highly recommend on health care policy, A Second Opinion and Health Care Policy, are written by physicians who know the science and practice of medicine as well as the economics of medical services. Another, also very good, book, Health Care Half Truths, is co-authored by a physician. The book is fairly short, very well-written and well-organized. Dr. Emanuel spends the bulk of the book analyzing the current medical services delivery (and to a lesser extent the funding of the system), then at the end of the book makes cogent recommendations on reform. Although my personal opinion on the particular form that the financing of medical services should take (I strongly favor a single payer/insurer scheme) differs from Dr. Emanuel's view, Dr. Emanuel presents compelling evidence why a single payer/insurer scheme is inferior to his recommendation: a voucher system that is funded by a dedicated value-added tax. Dr. Emanuel recommends the continued existence of private health insurers, asserting that their presence furthers choice and potentially at least engenders competition. My perspective is that private insurance simply has no place in a medical services system. The forces that drive private health insurance companies are immutable. Private insurers inevitably increase the administrative cost of effecting payment for services. They also have no ethical role as deciders of what treatment should occur. In particular very expensive treatments with whatever probability of lengthening a patient's life should not be decided by an employee of a private company. They also will continue to seek to exclude the sick and try to enroll the healthy in their insurance plans. Those are unavoidable characteristics that, at least in my mind, argue for a single payer plan, regardless of the pitfalls that Dr. Emanuel correctly notes.

Healthcare Reform, Understood

If the United States hasn't passed the threshold of interest in health care reform, it must be darn close. Thus, now is the time for a clear and concise argument for any particular approach. Dr. Emanuel puts forward a specific proposal for health care reform that would address the seven goals he views as essential to success. His proposal has a strong appeal to common sense, and as such, it is one that will surely suffer the slings and arrows of outrageous ideologs. But, besides presenting his own distinct proposal for reform, Dr. Emanuel gives enough background on our present plight, along with a heuristic tool to equip us to evaluate the many different reforms out there already and the many yet to come. And, he does this without resorting to the use of extreme case histories, which have become the coin of the realm for authors of books on health care reform and which can have distorting effects on any objective analysis. Even members of Congress will not be able to get away saying they do not understand the concepts in this book. This is an important book at an important time, and one that invites everyone into the health care reform debate whether they agree with Dr. Emanuel's proposal or not (count me among those who do). But, alas, important as this work is, it would never get Dr. Emanuel tenure at a major research university; it's much too accessible. He'll have to keep his current job.

A realistic fix for health care!

Emanuel and Fuchs have provided us a readable and concise view of what ails our health care system and a practical and feasible plan to fix our broken health care system. Many alternative solutions fail to deal with cost controls. Importantly the Guaranteed HealthCare plan does change the cost drivers in the health system. If we don't stop health care inflation we don't have a fix and a health care system that is sustainable. This book supplies an important new fresh look at both the problems and solutions for our health care system. Congress and the new President are going to need some new ideas like this to find a solution the majority of Americans can get behind and support. After you are done reading this great book.........mail it to your Congressman!