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Health Care Revolt: How to Organize, Build a Health Care System, and Resuscitate Democracy―All at the Same Time
The U.S. does not have a health system. Instead we have market for health-related goods and services, a market in which the few profit from the public’s ill-health. Health Care Revolt looks around the world for examples of health care systems that are effective and affordable, pictures such a system for the U.S., and creates a practical playbook for a political revolution in health care that will allow the nation to protect health while strengthening democracy. Dr. Fine writes with the wisdom of a clinician, the savvy of a state public health commissioner, the precision of a scholar, and the energy and commitment of a community organizer.
192 pages, Paperback
Published September 1, 2018
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Displaying 1 - 14 of 14 reviews
October 9, 2018
“We have lots of people who make a living from health care- doctors, nurses , hospitals, health insurance companies..... Isn’t that a health care system ? No it’s a market” , an exploitable market.
The author does a great job of explaining all of the background machinery of the health care system ( correction health care market ) and how messed up it is. His emphasis being there is no health care system just a profit driven market. He explains everything from pharmaceutical companies to insurance who are all driven by profit or government who is directed by congress who is directed by lobbyists who is directed by , you guessed it, profit driven private companies.
His analysis of CMS , center Medicaid and Medicare , as bureaucrats who do nothing but write rules then fight among themselves about the rules, is hilarious and accurate.
The answer is a health care revolution that removes all the profit driven private entities. He describes a place where every community has community center that will accommodate all needs of every person in the area. The health care paradise he describes is very familiar and has been successful. He basically is describing Cuba ( health system). However , the author leaves out some major logistics
1) His health care utopia involves doctors knowing ever single person in the community, given doctors already are squeezed to 10-15 minute visits to accommodate about 40% of the population, he doesn’t describe how to get more offices to have more providers and staff , especially in the setting of a health care shortage.
2) He doesn’t address outside factors, such malpractice or non compliance.
3) He doesn’t describe that due to history of inequality and racism, not all communities will have same issues and some will need more resources, more staff ,
4) Finally, he forgets the big C , Capitalism, the system that led to stealing land from people, imposing forced labor and causes the US to eff with Cuba every 15 minutes. The author doesn’t recognize that all US systems, education, housing, criminal justice are equally screwed up due to the priority to privatize and allow excessive profit. This is in the US genetic makeup and an isolated health care revolution can’t occur without addressing the distorted ideas of capitalism.
I wish instead the book would have focused on smaller but major solutions
How do we put a cap on Medical executive salaries ?
Reduce insurance cost?
Close loopholes that allow pharmaceutical to raise prices by 500% ?
Or simply what can a regular doctor do in every day practice to change the system?
Overall the book did prove I’m not crazy and every frustrating thing I see is real but not convinced it will change soon .
The author does a great job of explaining all of the background machinery of the health care system ( correction health care market ) and how messed up it is. His emphasis being there is no health care system just a profit driven market. He explains everything from pharmaceutical companies to insurance who are all driven by profit or government who is directed by congress who is directed by lobbyists who is directed by , you guessed it, profit driven private companies.
His analysis of CMS , center Medicaid and Medicare , as bureaucrats who do nothing but write rules then fight among themselves about the rules, is hilarious and accurate.
The answer is a health care revolution that removes all the profit driven private entities. He describes a place where every community has community center that will accommodate all needs of every person in the area. The health care paradise he describes is very familiar and has been successful. He basically is describing Cuba ( health system). However , the author leaves out some major logistics
1) His health care utopia involves doctors knowing ever single person in the community, given doctors already are squeezed to 10-15 minute visits to accommodate about 40% of the population, he doesn’t describe how to get more offices to have more providers and staff , especially in the setting of a health care shortage.
2) He doesn’t address outside factors, such malpractice or non compliance.
3) He doesn’t describe that due to history of inequality and racism, not all communities will have same issues and some will need more resources, more staff ,
4) Finally, he forgets the big C , Capitalism, the system that led to stealing land from people, imposing forced labor and causes the US to eff with Cuba every 15 minutes. The author doesn’t recognize that all US systems, education, housing, criminal justice are equally screwed up due to the priority to privatize and allow excessive profit. This is in the US genetic makeup and an isolated health care revolution can’t occur without addressing the distorted ideas of capitalism.
I wish instead the book would have focused on smaller but major solutions
How do we put a cap on Medical executive salaries ?
Reduce insurance cost?
Close loopholes that allow pharmaceutical to raise prices by 500% ?
Or simply what can a regular doctor do in every day practice to change the system?
Overall the book did prove I’m not crazy and every frustrating thing I see is real but not convinced it will change soon .
January 24, 2025
this is my manifesto fr
November 29, 2019
Seeks to be a Thomas Paine's Common Sense for health care reform in the United States by giving examples of what has and hasn't worked in communities over the country and maintains that health care reform is not only necessary for the health of bodies but for the health of democracy. Some statistics were so shocking I actually did the legwork to check the sources and sadly found them true. A good guide and conversation starter for our health care market to become a system but it has this weird hang up on electric tooth brushes and I love my electric tooth brush and am not giving it up g-dangit!
June 29, 2019
This is the most sensible book I have read about health care in America. The author insists that we should never say "health care system", we should say "wealth extraction system," and he details how that system is taking public money (ie Medicare, Medicaid) and putting it into private companies (drug manufacturers, hospitals, insurers) instead of using it for public good (the health of the public). He explains that he was involved in the drafting of Obamacare, and that it simply wasn't possible politically to do any better than the Affordable Care Act because of entrenched interests. He argues that Obamacare, which was health insurance reform, not healthcare reform, had marginal short term benefit at enormous cost, and will probably have net negative effect because it is increasing income inequality.
He argues that what we need to change the system is grassroots-level activism, which he calls the Movement for Health Care in America. "We'll expose and educate. We'll mobilize health care workers. We'll organize small health care systems in every community." And we'll build a national political movement - a political revolution in health care - to pass enabling legislation at the state and local level." p122 He gives an example of changes that he helped make in Rhode Island to build a functioning medical system there.
Though sometimes I think the author goes a little far, such as asserting that international trade is being affected by our losses in health care, I think he makes a lot of sense. I was a little disappointed that there was no contact information for the "Movement for Health Care in America" that he describes. If he is going to lead a charge, it needs to be organized.
Some of his points:
"The design of a health care system that exists to strengthen democracy is easy. The politics that prevent us from getting there are incredibly complex. Too many people, making too much money, stand in the way of the United States creating a health care system that is personal, rational, equal, and just." p119
"Health insurance costs $11,000 per person per year. Other countries with better health outcomes pay $2500 to $4000 per year. [...] Insurance pays for products and services we don't really need and creates profits for the health care profiteers, who eat us out of house and home. We need to say that over and over again, until everyone understands." p123
"We'll say over and over again that it's the cost of health care and not illegal immigration that is stealing American jobs and constraining our prosperity. We'll remind people every chance we get that the health care profiteers steal from us in four different ways - once when they take actual money out of our actual pockets, a second time when the loss of buying power slows growth in the domestic economy, a third time when the loss of price competitiveness slows growth in international trade, and a fourth time when they divert the public money that should be going to education, housing, public transportation, and community development, instead of creating profit for themselves." p124
"Notice that there is no medical services counter-advertising, which is what we used to do to try to counteract cigarette company advertising. If we had it, medical services counter-advertising would be saying that lots of medicines are used unnecessarily, increasing the cost of health insurance, and that many medicines have side effects that become more meaningful when they aren't really needed, and those side effects contribute to the 250,000 deaths a year in the U.S. from medical accidents and misadventures. No one is putting pictures of people injured by medical misadventures on TV, or of obese people with diabetes and heart disease who ate the industrial food goop that the advertisers told them to buy." p128
"We need to be saying that we have twice the number of hospitals we need, and those hospitals costs us money, make executives and specialists rich, but contribute nothing to the public's health or to our common life, other than keeping a huge number of people employed. Then we need to be saying that the same people could be doing something productive for society, instead of working in a process that is destructive to democracy." p128
"Along the way, we need to help our fellow citizens learn about the $500 million a year the medical industrial complex spends on lobbying." p128
After he explains how we have the technology to stop HIV transmission but haven't because we don't have a health care system, and how much HIV transmission is costing us: "This $13.6 billion ends up in the coffers of pharmaceutical companies and other who profit when we fail to address a preventable disease, rather than being spent on education, housing, the environment, and public safety, which turn out to be what matters if we are going to improve the public's health." p41
"But the number and location of other [non-primary care] specialists are associated with shorter life expectancy and higher costs." p65 - That is disturbing, that having more of some types of doctors doesn't just not make people better, it actually makes people worse.
"Can I prove that taxing industrialized food products and using the money to subsidize local agriculture, build better public transportation, and making sure there is one community center for every community will reduce diabetes and save lives? Of course I can't. No well-standardized, double-blind crossover trial has ever been done to prove that, and none ever will be. Such a trial is too complex and too expensive. But no well-standardized, double-blind crossover trial has ever been done on our market-driven industrial food system either. In fact, our demand for evidence-based decision-making in all our public processes is helping to drive our market culture, because evidence is controlled by market actors who can afford to obtain it and know how to ask research questions that are inherently biased." p71
"People who are more educated live longer, have less infant mortality, and make more money. [...] Educated people have just learned to make healthier choices." p72 This is an oversimplification. Maybe educated people aren't stressed by being poor, so they have more resources to devote to their health? Maybe they are more likely to be white and better treated by the healthcare system?
"Spending on social programs (sometimes) helps make a more vibrant society if that spending is thoughtful and effective, and a vibrant society is more likely to make us healthier than will spending on medical care, particularly in our culture, where spending on medical care is more about some else's profit than it is about our common life." p77
"[Primary care clinicians] help their patient decide when to see a specialist, who to see, and they tell the specialists about the patient's problem. [Uh, really? I've always had to repeat my entire history for each new specialist]. The they help the patient understand and make sense of the specialist's advice [Uh, what? since when?], coordinating the array of medical services available in a marketplace that exists only to sell services and not to actually help individuals make the best choices." p87 I agree that PCPs refer patients to specialists, but I have never seen any of the rest of this description happening.
"Most primary care physicians have to bill thirty to forty different health insurers [30 to 40? what really? I thought most accepted around 10], each with its own set of rules, so 20 to 40 percent of what primary care physicians earn is devoted to paying for the billing process itself. But the cost of primary care is an entirely predictable expense. Like the cost of groceries or routine care repairs, it is small enough that most people could actually afford it themselves. We could fix most of what ails health care in America if we just started paying primary care physicians and practices a certain amount of money per person per month and spread these physicians across the nation, so that there was a primary care practice or community health center in every neighborhood and community." p89
"We also predicted that a health care system that provided primary care and health insurance to all Americans would generate between $59 billion and $371 billion a year in savings, not new costs, because deploying primary care keeps most of the population from overusing medical services." p 90
"The Affordable Care Act, in restucturing the health insurance marketplace, allowed already-rich insurance companies, pharmaceutical companies, hospital executives, and others to get richer, while health insurance premiums continued to climb faster than ever. Those increased expenditures took money out of the pockets of poor and working people despite the subsidies. The net financial effect of the Affordable Care Act is to transfer public funds away from public purposes and into the pockets of executives and stockholders of insurance companies, for-profit hospitals, and specialists." p91
"The law was clear. The only thing that matters in our jurisprudence is providing everyone with something to sell equal access to the marketplace. We have no jurisprudence of the common good." p107
"The states with the best health outcomes - Massachusetts and California - have cultures that focus, often to the level of obsession, on healthy behaviors and reflect those choices in law and regulation. [...] California has a health-oriented culture and achieves impressive outcomes, while being one of the lowest-spending states in the country, so likely deserves more public health attention than it gets. [...] So culture matters. Maybe it matters more than money. Certainly it matters more than medical care." p109 Huh. Go California. Can't help wondering if the beautiful weather is related somehow.
He argues that what we need to change the system is grassroots-level activism, which he calls the Movement for Health Care in America. "We'll expose and educate. We'll mobilize health care workers. We'll organize small health care systems in every community." And we'll build a national political movement - a political revolution in health care - to pass enabling legislation at the state and local level." p122 He gives an example of changes that he helped make in Rhode Island to build a functioning medical system there.
Though sometimes I think the author goes a little far, such as asserting that international trade is being affected by our losses in health care, I think he makes a lot of sense. I was a little disappointed that there was no contact information for the "Movement for Health Care in America" that he describes. If he is going to lead a charge, it needs to be organized.
Some of his points:
"The design of a health care system that exists to strengthen democracy is easy. The politics that prevent us from getting there are incredibly complex. Too many people, making too much money, stand in the way of the United States creating a health care system that is personal, rational, equal, and just." p119
"Health insurance costs $11,000 per person per year. Other countries with better health outcomes pay $2500 to $4000 per year. [...] Insurance pays for products and services we don't really need and creates profits for the health care profiteers, who eat us out of house and home. We need to say that over and over again, until everyone understands." p123
"We'll say over and over again that it's the cost of health care and not illegal immigration that is stealing American jobs and constraining our prosperity. We'll remind people every chance we get that the health care profiteers steal from us in four different ways - once when they take actual money out of our actual pockets, a second time when the loss of buying power slows growth in the domestic economy, a third time when the loss of price competitiveness slows growth in international trade, and a fourth time when they divert the public money that should be going to education, housing, public transportation, and community development, instead of creating profit for themselves." p124
"Notice that there is no medical services counter-advertising, which is what we used to do to try to counteract cigarette company advertising. If we had it, medical services counter-advertising would be saying that lots of medicines are used unnecessarily, increasing the cost of health insurance, and that many medicines have side effects that become more meaningful when they aren't really needed, and those side effects contribute to the 250,000 deaths a year in the U.S. from medical accidents and misadventures. No one is putting pictures of people injured by medical misadventures on TV, or of obese people with diabetes and heart disease who ate the industrial food goop that the advertisers told them to buy." p128
"We need to be saying that we have twice the number of hospitals we need, and those hospitals costs us money, make executives and specialists rich, but contribute nothing to the public's health or to our common life, other than keeping a huge number of people employed. Then we need to be saying that the same people could be doing something productive for society, instead of working in a process that is destructive to democracy." p128
"Along the way, we need to help our fellow citizens learn about the $500 million a year the medical industrial complex spends on lobbying." p128
After he explains how we have the technology to stop HIV transmission but haven't because we don't have a health care system, and how much HIV transmission is costing us: "This $13.6 billion ends up in the coffers of pharmaceutical companies and other who profit when we fail to address a preventable disease, rather than being spent on education, housing, the environment, and public safety, which turn out to be what matters if we are going to improve the public's health." p41
"But the number and location of other [non-primary care] specialists are associated with shorter life expectancy and higher costs." p65 - That is disturbing, that having more of some types of doctors doesn't just not make people better, it actually makes people worse.
"Can I prove that taxing industrialized food products and using the money to subsidize local agriculture, build better public transportation, and making sure there is one community center for every community will reduce diabetes and save lives? Of course I can't. No well-standardized, double-blind crossover trial has ever been done to prove that, and none ever will be. Such a trial is too complex and too expensive. But no well-standardized, double-blind crossover trial has ever been done on our market-driven industrial food system either. In fact, our demand for evidence-based decision-making in all our public processes is helping to drive our market culture, because evidence is controlled by market actors who can afford to obtain it and know how to ask research questions that are inherently biased." p71
"People who are more educated live longer, have less infant mortality, and make more money. [...] Educated people have just learned to make healthier choices." p72 This is an oversimplification. Maybe educated people aren't stressed by being poor, so they have more resources to devote to their health? Maybe they are more likely to be white and better treated by the healthcare system?
"Spending on social programs (sometimes) helps make a more vibrant society if that spending is thoughtful and effective, and a vibrant society is more likely to make us healthier than will spending on medical care, particularly in our culture, where spending on medical care is more about some else's profit than it is about our common life." p77
"[Primary care clinicians] help their patient decide when to see a specialist, who to see, and they tell the specialists about the patient's problem. [Uh, really? I've always had to repeat my entire history for each new specialist]. The they help the patient understand and make sense of the specialist's advice [Uh, what? since when?], coordinating the array of medical services available in a marketplace that exists only to sell services and not to actually help individuals make the best choices." p87 I agree that PCPs refer patients to specialists, but I have never seen any of the rest of this description happening.
"Most primary care physicians have to bill thirty to forty different health insurers [30 to 40? what really? I thought most accepted around 10], each with its own set of rules, so 20 to 40 percent of what primary care physicians earn is devoted to paying for the billing process itself. But the cost of primary care is an entirely predictable expense. Like the cost of groceries or routine care repairs, it is small enough that most people could actually afford it themselves. We could fix most of what ails health care in America if we just started paying primary care physicians and practices a certain amount of money per person per month and spread these physicians across the nation, so that there was a primary care practice or community health center in every neighborhood and community." p89
"We also predicted that a health care system that provided primary care and health insurance to all Americans would generate between $59 billion and $371 billion a year in savings, not new costs, because deploying primary care keeps most of the population from overusing medical services." p 90
"The Affordable Care Act, in restucturing the health insurance marketplace, allowed already-rich insurance companies, pharmaceutical companies, hospital executives, and others to get richer, while health insurance premiums continued to climb faster than ever. Those increased expenditures took money out of the pockets of poor and working people despite the subsidies. The net financial effect of the Affordable Care Act is to transfer public funds away from public purposes and into the pockets of executives and stockholders of insurance companies, for-profit hospitals, and specialists." p91
"The law was clear. The only thing that matters in our jurisprudence is providing everyone with something to sell equal access to the marketplace. We have no jurisprudence of the common good." p107
"The states with the best health outcomes - Massachusetts and California - have cultures that focus, often to the level of obsession, on healthy behaviors and reflect those choices in law and regulation. [...] California has a health-oriented culture and achieves impressive outcomes, while being one of the lowest-spending states in the country, so likely deserves more public health attention than it gets. [...] So culture matters. Maybe it matters more than money. Certainly it matters more than medical care." p109 Huh. Go California. Can't help wondering if the beautiful weather is related somehow.
October 27, 2018
Dr. Fine's experience as a family physician and as Director of Rhode Island Public Heath gives him the advantage of seeing policies in action at the grassroots and how policies have a population impact. He presents an understandable explanation of what is ailing healthcare and the health of the United States. We are not the healthiest country by almost every marker and he shows us why.
His core idea in the book its that we have a healthcare market, not a functional healthcare system. Profits are placed over patients by insurance companies, for-profit hospitals, and the pharmaceutical industry. He clearly shows that we have both wasteful high cost care while vulnerable populations don't have access to basic and preventive services.
However his message isn't one of doom and gloom, he shows what is possible by highlighting bright spots throughout the country and world of what is working and making measurable differences. His prescription is to put health and healthcare back in the community with his vision for community health stations that would focus on primary care, mental health and dental health. He also shows us that healthcare isn't even the biggest impact on our health. He calls on communities to focus attention on education, community centers, healthy nutrition, public safety, and housing to achieve better health for the individual and population. The Movement for Health Care in America is possible and Dr. Fine has given us the script that we have to fill together to stop being sick and instead be well as a nation.
His core idea in the book its that we have a healthcare market, not a functional healthcare system. Profits are placed over patients by insurance companies, for-profit hospitals, and the pharmaceutical industry. He clearly shows that we have both wasteful high cost care while vulnerable populations don't have access to basic and preventive services.
However his message isn't one of doom and gloom, he shows what is possible by highlighting bright spots throughout the country and world of what is working and making measurable differences. His prescription is to put health and healthcare back in the community with his vision for community health stations that would focus on primary care, mental health and dental health. He also shows us that healthcare isn't even the biggest impact on our health. He calls on communities to focus attention on education, community centers, healthy nutrition, public safety, and housing to achieve better health for the individual and population. The Movement for Health Care in America is possible and Dr. Fine has given us the script that we have to fill together to stop being sick and instead be well as a nation.
April 27, 2020
Summarizing the book along my reading:
1. what has gone wrong?
a. no one in the States is responsible for the overall physical well-being of the public
b. capitalism i.e. pursuit of profit distorts market players' incentive, causing waste/harmful practice
c. deregulation promoted by lobbyists
2. why market does not work?
a. common good, humanitarian approach, public provision to increase access & desired results (like education, law enforcement etc)
b. fundamental difference between profit-oriented and health-oriented
c. not justifiable that professors take public funded research to undertake commercial adventure
3. what matters?
a. better education, sanitation, social cohesion,
b. less income disparity, racism, industrialized food
Fine is getting verbose and repeating himself over and over...
1. what has gone wrong?
a. no one in the States is responsible for the overall physical well-being of the public
b. capitalism i.e. pursuit of profit distorts market players' incentive, causing waste/harmful practice
c. deregulation promoted by lobbyists
2. why market does not work?
a. common good, humanitarian approach, public provision to increase access & desired results (like education, law enforcement etc)
b. fundamental difference between profit-oriented and health-oriented
c. not justifiable that professors take public funded research to undertake commercial adventure
3. what matters?
a. better education, sanitation, social cohesion,
b. less income disparity, racism, industrialized food
Fine is getting verbose and repeating himself over and over...
December 4, 2018
I was kind of trudging through the last few chapters wishing that Dr. Fine was less prescriptive about his model for health care systems reform when he went and namedropped Don Berwick so maybe he has ideas about participatory design that he didn't go into.
This is a good primer on how fucked up the system is, but maybe not quite as in depth as I hoped/expected. This is for folks without a public health background for sure.
This is a good primer on how fucked up the system is, but maybe not quite as in depth as I hoped/expected. This is for folks without a public health background for sure.
March 24, 2020
In Health Care Revolt, Michael Fine lays out a vision for a healthcare system that works for the American people, not for the profit of the few. Read this book and take action to fix the broken healthcare system!
May 2, 2023
When literature is engaging with its prose but accessible to any educational level, the topics & themes ring familiar & relevant to every single person, and the conclusion/call-to-action so clear & compelling, you get books like these. Read & be immediately ready to fight back.
January 27, 2024
Eye opening! We urgently need change in our health care “market” and this book shows why and how “we can create a health care system that cares for everyone in America and do it for less with better health outcomes”! It also shows how our health is connected with our democracy. Let’s do it!
December 13, 2024
Polemical, shoddy; deteriorating in quality, building narcissism, and expanding in grandiosity as it neared the end.
Not a good first book to read on my post UNH reading journey to learn more about the health care system.
Not a good first book to read on my post UNH reading journey to learn more about the health care system.
December 12, 2018
A firm, solid book that explains why healthcare is a nightmare in America. I could give this to my parents and they'd come out on the other side converted and understanding.
January 18, 2023
great book about flaws in us healthcare system - made me angry about things i didn’t even know i should be angry about
July 12, 2020
Evident from this book that Dr. Fine has no understanding of public health. Don't waste your time reading a book from yet another undeserving powerful, privileged man.
Displaying 1 - 14 of 14 reviews