Overhauling America's Healthcare Machine: Stop the Bleeding and Save Trillions

by Douglas A. Perednia

Dr. Doug Peredniareveals how government and insurance company-created complexity is tearing apart the U.S. healthcare system and presents a new model for healthcare reform that will actually work. Leading physician, healthcare expert, and entrepreneur Perednia identifies specific inefficiencies and worthless administrative overhead that is making healthcare inaccessible or unaffordable for millions, driving providers from practice, and adding over half a trillion dollars annually to healthcare spending. Next, he shows how to design a far simpler system: one that delivers care to everyone by drawing on the best of both market efficiency and public "universality." Recent "health care reform" involved 2,000+ pages of complex, special interest-friendly legislation--including 168 new federal committees, program cuts, and higher taxpayer costs. Perednia offers a better way: a logical, comprehensive, and non-partisan and apolitical approach that gives providers and their patients more medical and financial security, enhances competition, would save some $570 billion annually--and still gives individual patients real freedom. This plan isn't wishful thinking: Overhauling America's Healthcare Machine backs it up with detailed logic and objective calculations. Even after the recent endless debate about healthcare, the system is still broken--and unless it's fixed, it will break us all. Perednia shows how to finally fix it: once and for all.

Genres: Health Care, Nonfiction, Medical, Politics, Health

369 pages, Hardcover

First published November 29, 2010

Reviews

[Bob Sorrell]

This book approaches the practice of medicine in America in the same way as an industrial engineering problem. It details current processes and issues for Clinicians, Health Insurance Companies, Government and Patients and why they do what they do, how their actions effect people in each of the other groups. Right now I'm still working through what are the problems with the current system. It attempts to take an honest look at what drives each of the four groups and how each is affected by the actions of the others.

My software company looked into supporting software for handling medical records and managing day to day operations in clinics and doctors offices. At that time I was focused on the technical issues but this book is giving me a better understanding of what kind of help doctors were looking for and why. Huge amounts of money/time are consumed dealing with administrative issues involving insurance, bureaucracy, academia, regulations and lawyers that have little or nothing to do with enhancing patient care. He calls these the "sand in the machine".

I haven't reached his solutions yet and I refuse to jump ahead, but I hope he has some intelligent ideas.

[Stan Jesuit]

I enjoyed this book a great deal - much more than one would expect for such a potentially tedious and complex topic. The author is a doctor who was also trained in economics, and the approach he takes is to first divide the health care system into its four active components: patients, physicians/providers, government and insurers. He then explores, from an economic perspective, why each of these entities acts as they do and what that implies with respect to their subsequent behaviors, incentives and disincentives. One of the important points made is that virtually everyone and everything associated with healthcare is, in the end, driven by money. You can argue that point or not, but it's pretty amazing how taking that approach explains what we see in the real world with great accuracy.

Once the motives of the players are established, the author then discusses how virtually all of the social, financial and political mechanisms currently built into the system work together to reduce economic efficiency, personal choice and the resources available for actual patient care. The terrible thing is how much money is just out-and-out wasted on paperwork, administrative costs and bureaucracy. It's about $1 out of every $3 spent - more than enough to provide healthcare coverage for everyone and still save billions of dollars each year. There are now almost 6 healthcare bureaucrats for every doctor, and most of the programs that are supposed to promote "quality" and "efficiency" do nothing of the sort. This is the sort of stuff that you would think that Congress and the President would be talking about all the time, but neither the Republicans nor the Democrats seem to even be aware of it.

The last third of the book deals with the authors recommended solutions, most of which seem like common sense once you've gone through the problems encountered in the first two-thirds of the book. One thing I find interesting is another reviewer's comment that most of the solutions seem to "left-leaning". I had exactly the opposite impression: that many of them would appeal to conservatives as much or more than liberals. Examples include the extensive use of free markets and drastically simplified, transparent pricing to let patients buy exactly those types of medical goods and services that best meet their needs based upon their physician's laying out the options. He does advocate for universal healthcare coverage, but entirely on grounds of economic efficiency rather than some sort of social entitlement. Maybe having different observers see the book as both right- and left-leaning is the sine qua non of an apolitical, balanced approach?

According to the author, the most important thing that we can do is simply our approach to healthcare regulation and financing. When you read why, it makes a lot of sense.

So what's not to like? The only real criticism I have is that it would have been interesting to directly discuss the provisions of the new health care reform law given the economic and behavioral principles discussed in the book. On the other hand I can understand why that might have been left out deliberately. For one thing it's not even clear if the new health care reform law will even be around in a year. For another it might well have made the book too long. As it is the book is about 350 pages, but it's so well written that it reads much shorter. However by the time I finished I'm not sure that I could have absorbed much more information without taking a break from the topic.

If you've ever wanted to learn more about this topic without the politics, biases and partisan hype, this is the best effort I've found thus far.

[Nancy]

In Overhauling America's Healthcare System, Richard Perednia, MD, makes a great many valid points about problems in the delivery of medical treatment in the US . He also has many suggestions about how to fix it. He talks about “the grit in the gears” of our system in great detail. He looks at the role of government regulation, insurance companies, and malpractice suits in raising the cost and complexity of practicing medicine at every level. He points out how doctors’ being paid per service rather than an hourly wage leads to unnecessary “care” and surgeries. He explores how converting medical records to an overly complex electronic records system can make a doctor’s office lose months of patient care time.

There are two major flaws in Perednia’s book. One is that he believes that doctors and only doctors can see the big picture in healthcare. It is clear that doctors will make major contributions to any successful overhaul of our healthcare system. But, for the most part, their focus has been helping those already ill or injured. Public policy experts must play an important role in making wellness rather than illness a major focus. Decisions about how medical research, medical education, and healthcare itself should all be funded are not necessarily best made by doctors. And many doctors still seem to have difficulty recognizing when it is time to stop encouraging patients to accept more treatment and allow them to come to peace with a death made as comfortable as possible.

The second flaw is that the book is not very good reading. A crisp, pointed critique making the same points Perednia did would have been interesting reading. Instead, he went on for 210 often plodding and repetitive pages about what makes healthcare so expensive, inefficient and difficult for patients, doctors and staff today. I wondered if he didn't credit his readers with the ability to comprehend what he was saying, so he kept on saying it in even more elaborate detail.

This is an important book. I believe everyone should read it or something like it. It is ironic that it suffered from inefficiency that felt like grit in the gears of my mind.

[Tony Canas]

Dr. Douglas A. Perednia goes in depth (with lots of facts, figures and cites from actual studies) to show why and how our health system is so broken. This first half of the book is very interesting and makes it very clear, exactly what the problem is. I recommend this first half of the book to anyone concerned about our health system who is looking for a better in-depth understanding of what's wrong and how we got to the point we are at.

The second half of the book is his proposed solution which is interesting although at times too complex for my taste. I do think there is a lot that can be grabbed from his suggested system that would seriously improve the existing system which truly stands in shambles.

[Zhifei Ge]

A very detailed critique of the America's healthcare systems. Well organized evidence to demonstrate authors' points. For the last section on recommended policies, the author didn't touch upon how to address the job losses.

[Kris]

This should be required reading for congress and medical students/residents alike.

Was it fun? Absolutely not. Did I need this? You bet

[Pilar]

Not new info and not presented well.