Product Description
A world-renowned physician traces the rise of the medical-industrial complex that has made a disaster of our healthcare system--and tells us incisively what we need to do to change it. The U.S. healthcare system is failing. It is run like a business, increasingly focused on generating income for insurers and providers rather than providing care for patients. It is supported by investors and private markets seeking to grow revenue and resist regulation, thus contributing to higher costs and lessened public accountability. Meanwhile, forty-six million Americans are without insurance. Health care expenditures are rising at a rate of 7 percent a year, three times the rate of inflation. Dr. Arnold Relman is one of the most respected physicians and healthcare advocates in our country. This book, based on sixty years' experience in medicine, is a clarion call not just to politicans and patients but to the medical profession to evolve a new structure for healthcare, based on voluntary private contracts between individuals and not-for-profit, multi-specialty groups of physicians. Physicians would be paid mainly by salaries and would submit no bills for their services. All health care facilities would be not-for-profit. The savings from reduced administrative overhead and the elimination of billing fraud would be enormous. Healthcare may be our greatest national problem, but the provocative, sensible arguments in this book will provide a catalyst for change.

CUSTOMER REVIEWS (Average Customer Rating: 4.5 based on 12 reviews)

A physician perspective on the goals of health care reform by Christopher Grell (San Francisco, CA)

4 Stars
June 17, 2009
"A Second Opinion" takes another complementary viewpoint from the eyes of a physician. Dr. Arnold S. Relman is widely known as former editor of the New England Journal of Medicine and for his prescient 1980 article on the commercialization of medicine, and his phrase "the new medical-industrial complex". As many of his predictions have come true, he argues for a radical change in both ends of the current system to reduce waste and administrative overhead, improve quality, and provide coverage for all. Dr. Relman details the post World War II development of medical practice in the US, and the transition of role of the physician responsible for "care of the sick" to the varied roles they have today in the commercialized "health care industry". He describes the effects of commercialization as fragmenting the delivery of care at the expense of quality, encouraging overutilization of new technologies, and increasing inequity of care. In "A Second Opinion" he argues for a single payer system to eliminate administrative costs in the insurance industry and waste in the overutilization of treatment. In addition, he recommends a restructuring of the delivery of care to physician multi-specialty group practices (PGPs) that resemble the integrated health systems such as Kaiser, with reimbursements based on a fixed annual dollars per patient and doctors paid on a salaried rather than fee for service basis. In this way, physicians would return to their roots as a profession of primary caregivers, without regard to the level of compensation or financial incentives to practice medicine a certain way. In addition, like the PGPs, health care delivery facilities such as hospitals would be not-for-profit entities owned by the local community. By telling the history of how the practice for medicine has been commercialized and the effect of the growth of Medicare and the indemnity insurance industry, Dr. Relman is able to convey the ethic that has been lost in his profession that a systemic change could restore. In addition, he makes a detailed comparison with the Canadian system, recounting its history in parallel with ours. The result is that Canadians have 100% coverage and spend $3500 per person annually, or one-half the amount in the US (only 10% of GDP). He concludes with a open letter to his colleagues in the profession about the need for change and his vision of the practice of medicine in salaried not-for-profit multi-specialty group practices. Because of his perspective as a physician and manager of health care institutions, he doesn't approach the subject with any faith in market forces or technology to correct the current situation. In fact, he believes that the movement of consumer driven health care (CDHC) will fade with time just as HMO's did. The combination of catastrophic indemnity insurance and health savings accounts (HSAs) promoted as a solution to restore consumer decision making in the market will not change the fee for service orientation of the major expenditures such as hospitalization. Thus, it will fail to contain costs and at the same time will cause hardship in paying for physician office visits for low income individuals that may forego care to save the money in their HSAs. One issue with Dr. Relman's approach overall is that it freezes the current state of delivery of healthcare in place and makes adoption of innovation difficult, because there is no profit motive to compensate for risk taking and investment in service delivery. The rate of innovation in medical technology is increasing, not decreasing, and medical practice will need to keep up with the emergence of personalized medicine and telemedicine. But this structure would not preclude the medical device and pharmaceutical industries from remaining as for-profit suppliers to these non-profit delivery entities.

Proposed solution to fixing a sick system. by Tralfamidorian (Ohio)

3 Stars
March 31, 2009
At the beginning of my medical career, physicians feared inroads from socialized medicine. Three decades later we were pawns of capitalized medicine as insurers dictated what drugs to use, tests to order, and how long to keep a patient in the hospital. HMOs tout preventive care, and there are actually billing codes for this, but they are largely not reimbursed. During this time Dr. Relman held many prestigious positions that puts him near the top of the list of the most important physicians of our era. In this small book he succinctly outlines the history of patient care and the doctor-patient relationship over five decades. He reproves the entrepreneurial spirit that overtook physicians in the 1950s and how it created conflicts of interest. He describes how Medicare and Medicaid may have helped many patients, but almost destroyed the concept of a physician or surgeon giving free care to the poor. As insured health plans became more common in the 1970s and 80s, he castigates the unconscionable profit motive that effectively restricts health care to those who need it most. He outlines the socialized systems in Great Britain and Canada, good aspects and bad. Finally, he proposes a single payer plan for the United States. It's hard to disagree with Relman when the current system is in such a mess. Nevertheless I maintain that any new or revised system should not eliminate entrepreneurship. Socialism has already demonstrated that if you fail to reward excellence and ambition, you only reap mediocrity.

very well researched and very accurate insight by R. Booth (Huntington, WV)

4 Stars
March 30, 2009
The author has done his research and has accuratley articulated the major issues. This book should be read by all interested in the current health care and cost dilemma.

Health-care reform by Richard Whitlock (Nashville-area, Tennessee)

5 Stars
March 08, 2009
Dr. Relman was editor of New England Journal of Medicine for 14 years, a practicing physician, and on a variety of health care boards. His health care reform ideas offers the best or equal to the best plan for affordable, universal health care (at a basic level of care). He recommends single payer system, that physicians work in non-profit multi-speciality clinics for better comprehensive care of patients, that physicians receive bonus for going above a standard level of patient load.

A Second Opinion, Arnold Relman MD by Wells Shoemaker (California)

5 Stars
February 25, 2008
Superb "tough love" analysis of the way commercialization of healthcare has driven behavior predictably towards financial rewards while perpetuating disparities in access and quality of care and severely eroding the primary care workforce necessary for rational care for our next generation. Dr. Relman candidly acknowledges that correction of these patterns will cause some financial hurt to entrepreneurial physicians and physicians in highly remunerative procedural niches, as well as the familiar bogeymen of the for-profit commercial insurance companies and profit-driven hospitals. If physicians fail to take active, participatory leadership in the necessary corrections, a blunt and clumsy governmental change process will likely be necessary.

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