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Your Money or Your Life: Strong Medicine for America's Health Care System
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Review
"Concise and persuasive...avoids most of the ideological shoals of the health care debate.... Cutler shows how the current system could be redesigned so that everyone is insured, the quality of care improves and the overall costs remain roughly the same."--Washington Post"This slender but important book...makes some exceedingly valuable points. Its passionate argument that modern medicine works is persuasive. It argues equally convincingly that there is both an economic and a moral case for medical spending. Perhaps most notable, it points out the manyperverse incentives in our current system of financing medical care, and it argues that we should correct the system by providing financial incentives for the medical treatments and the approaches we truly want. The book, in sum, represents a significant contribution to health-policy literature andideally, would be used to inform present and future discussions of health care in America."--St. Louis Post-Dispatch"It's also important for readers to understand the cost effectiveness behind developments in treating such conditions as cardiovascular disease, infant mortality and mental illness; chapters devoted to these are the best material in Cutler's book. His case studies are well researched and offera tremendous amount of information about medical history and its economic significance."--Los Angeles Times"When economics and medicine mix there is bound to be confusion unless someone like Harvard economics professor Cutler, who seems to effortlessly make a complex issue comprehensible, is doing the mixing.... An elegant investigation."--Booklist"Cutler has paved the way for a unique new understanding of health care in America: policy makers and providers should focus on increasing the value of dollars spent rather than rehashing the tired distinction between cutting costs and paying more. For everyone interested in improving healthcare in the United States, this is original and inspiring--actually, indispensable." --Bill Bradley"A thoughtful analysis of the problems afflicting our health care system. His creative proposals will interest every citizen concerned about improving American health care." --Edward M. Kennedy"This highly-readable volume explores all of the major issues that confront us as we attempt to improve America's health care system. David Cutler provides a clear and concise guide to how one should think about the costs and benefits of health care, the value of medical advances, and optionsfor reforming the health care system. This is the book to buy if you want to understand how we can improve health care in America." --Robert D. Reischauer, President, The Urban Institute"Cutler presents a refreshingly optimistic path for the future of America's health care system--promoting policies focused on increasing the value of medical services and improving health outcomes. He finds over and over that while health care expenditures are significant, we get a great dealmore in return. His work is a major contribution to what I believe will become an increasingly interesting and important debate--is more medical spending necessarily bad?" --Art Collins, Chairman and CEO, Medtronic, Inc."Flatly refutes the proposition that good economics has to be a difficult slog through arcane tables, charts, and mathematics. In 123 absorbing pages he shows readers why the gains from improved health care vastly exceed its formidable costs and how the gains could be larger still. In sodoing, he demonstrates that good economic analysis can contribute constructively to debate on public policy--and quote Euripides aptly at the same time!" --Henry J. Aaron, The Brookings Institution"Cutler's upbeat book delivers a welcome message to a public wearied by reports of medical errors, the rising number of uninsured, and the relentless growth in medical expenditures. Anyone with a serious interest in the U.S. health care system--and its future--should read this engaging andprovocative book by one of the most insightful health policy experts in the nation." --Alan Garber, Center for Health Policy, Stanford University
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About the Author
David M. Cutler is a professor of economics at Harvard University. He is a member of the Institute of Medicine and regular advisor to governments and corporations.
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Product details
Paperback: 176 pages
Publisher: Oxford University Press; 1 edition (February 10, 2005)
Language: English
ISBN-10: 0195181328
ISBN-13: 978-0195181326
Product Dimensions:
9.2 x 0.8 x 6 inches
Shipping Weight: 11.7 ounces (View shipping rates and policies)
Average Customer Review:
4.1 out of 5 stars
11 customer reviews
Amazon Best Sellers Rank:
#137,970 in Books (See Top 100 in Books)
Well researched and well documented with over 25 pages of endnotes, this book is a hybrid: wonderfully readable yet academically sound. As a health economist and member of the prestigious Institute of Medicine, Cutler offers a scintillating, objective economic analysis of our existing health care system, exposing the embarrassing inadequacies and problems while also highlighting its successes. He also offers sage guidance for a better health care future: increasing the value of our health care system primarily by aligning incentives with desirable outcomes. Many but not all of his ideas are reflected in the Accountable Care Act. If every policy maker had read this book with an open mind, we would have been spared much of the political drama surrounding the enactment of the Affordable Care Act, as well as the post-enactment machinations to undo it. To pick nits, Cutler's view that just about everyone believes that everyone should have health insurance is not supported by the facts. If that were the case, we would have had comprehensive health reform many decades ago and few if any would be trying to repeal, nullify, or starve the Accountable Care Act. Also, his lumping regulation along with litigation as necessarily punitive suggests a rather limited view of regulation. Overall, though, this book is superb, a "must read" for everyone who cares about health care and the health of their fellow Americans.
since nothing is perfect.Authoritative, clearly written, and quite interesting; I recommend to anyone -- professionals, academics, laypersons -- interested in these issues.Specifics:1) The first 5 chapters convincingly argue that the enormous increases in health care spending are first attributable to new technology and treatments, and well justified, benefits substantially exceed the costs. The arguments are based in substantial part on Cutler's own academic research. By themselves, these chapters are sufficient to justify the book. Cutler does a good job of explaining both the technical economic concepts and the medical issues, and I suspect anyone interested in the topic will find the chapters fascinating, eye-opening.He reaches a very important conclusion: we ought to spend MORE, not less.2) Subsequent chapters survey sources of waste and problems of distribution. I found these helpful in outlining some important problems, and well worth reading, but incomplete (see below). In part these explore the incentives created by different systems of paying for health care; this helps explain why some sorts of technologies and procedures are favored over others in any particular case.3) The concluding chapter contains his solution to the problems, a system of universal insurance (mostly private) coverage, subsidized and supervised by the federal gov't; worth reading, but inadequate. Cutler focuses on a subset of problems & proposes a solution, with little consideration for other problems or possible solutions.For example, he ignores 'public choice' issues: how would his proposal work in a world of self-interested government official, bureaucrats, insurers, medical professionals, patients, etc.? The system he proposes might work on paper, but is quite susceptible to "gaming." USDA crop insurance is a real world example, and its poor performance should make us hesitant to expand this approach to health care.Similarly, Cutler argues that gov't and insurers should develop a payment system that rewards providers for measurable health improvements. Cutler greatly underestimates the difficulty. Soviet planners wrestled this problem for 75 years and were unable to solve it, how to specify a set of desired production outcomes from above and then have them realized as one envisions. It's a very difficult problem, I think unsolvable. Cutler underestimates it, and devotes essentially no attention to possible solutions which would make the individual consumer directly responsible for payment, and evaluation, of health care services.4) Cutler provides a lengthy set of citations from the scholarly literature, excellent for further study. He also features, on his website, a technical appendix. It's clear he's trying to spread light, not heat, in the health care debate. Good on him!5) Despite any weaknesses, Cutler does a fine job of framing the issues. The book is accessible and a good read. OK, OK, 4.9 stars.C.N. Steele Ph.D.
Good book.
The best book to assist me in understanding my Economy of Health Care course.
Second read on this. He advised Obama originally but was overridden by mre ideological advisors. Read and weap about what should have been
First, a disclaimer: Professor Cutler was on my dissertation committee, so I am certainly biased in his favor.Your Money or Your Life does an outstanding job of taking important work from the economics literature and translating it for the intelligent lay audience. I have found it a very useful text for various health economics courses from the firstyear undergraduate level to the masters level.The book has two main strengths: (1) it lays out, succinctly and readably, how economists think about the value of health care, and uses those tools to evaluate health care advances. The first half of the book does a wonderful job of reframing health care reform away from "how can we keep costs down?" and into "how can we get value for our money?" (2) it discusses, again succinctly and readably, the role that incentives play in delivering health care. Cutler argues strongly that we get what we pay for--that is, if we pay doctors more for intensive care, what we get is more intensive care, which isn't identical to higher quality care.The book's strengths are thus in framing the health care discussion. Some reviewers are criticizing the book for not dealing with various other crucial issues in health care. The book's goal is not to serve as a comprehensive textbook on health economics; such books exist, but this isn't one of them.Readers who disagree with the short section on proposed solutions would still, I think, benefit from Professor Cutler's excellent discussion of the problems.
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