As Dr. Lebow points out, in the health insurance industry, competition among health insurers has led to less efficiency rather than more efficiency. 10 different credentialing applications, 12 different contract types, no standardization whatsoever and an administrative mess for any doctor who doesn't have the luxury of a seasoned healthcare administrator in his office. Add to that the eligibility trouble. Multiple phone calls for every patient to check eligibility for every appointment. Worst of all, the current health insurance system provides no incentive to managed care to pay for preventive care.

These are the issues that single-payer would fix for the insured population, saving billions of dollars. Dr. Lebow is right on, though I wish he spent as much time on eligibility and insurance company hassles as he did on preventive care. He also does great work in presenting the myths of healthcare today. Many of them can't be repeated enough (like the corporate welfare given to prescription drug companies).

But I have several issues as well.

My biggest complaint is that his solution only delays the inevitable a little longer. He deals only with the healthcare funding system and has little to say about the healthcare delivery system. "Market Driven Healthcare" by Regina Herzlinger and "From Chaos to Care" by David Lawrence offer real long-term solutions to the healthcare delivery problems we face in our current environment. Unless those market principles are imposed on healthcare, single payor will only delay the final implosion of medical care. Once the financial gains from single-payor healthcare are realized and exhausted, the costs will continue to spiral out of control.

Another issue is that he gives few details in the "how" of his solutions. Focusing on prevention and public health is a good and obvious point. Everybody agrees on it, but I don't think simply saying "it will happen once a grassroots movement demands it" is sufficiently descriptive of how he sees prevention and public health becoming the standard. Who will implement it? How?

Because of these problems, Dr. Lebow does not make a convincing case to those in power that change is good for them. He persuades the persuaded brilliantly, but I can't imagine why someone who opposes single-payer would change his mind after reading this book. And those in power are whose minds must be changed if change is to come.

The way I see it, healthcare as we know it is a very young industry. Only 16 years ago, managed care was almost an unkown in the healthcare world. Now, it dominates. Unfortunately, that insurance model grew so quickly there was no way anyone could have planned it properly. Imagine how the computer industry would have destroyed itself if it weren't entirely made up of systems thinkers known for their planning ability. ISO-9000 was brilliant, as is settling on the PC as the standard. Healthcare needs, and is getting, more of that now. HIPAA and state-mandated credentialing applications perfectly demonstrate the government's role in fixing healthcare. It should be a regulator, an agent for the lowly to make sure the big guys play fair, and a standard-setter to make commercial insurance more efficient. But it's entirely too early to declare the market dead and single payer as the only way out of this mess.


Health Care Meltdown by Dr. Lebow MD   February 27, 2004
 1 out of 2 found this review helpful

The work points to many of the negations in the current health
care delivery systems in the USA. It spends too much money and
the paperwork is burdensome, generally uninformative and
inefficient. The system needs a separation between the doctor
and the pharmaceutical industry because the needs of the general
public demand an independent attitude on the part of physicians.
Emergency rooms are utilized instead of patient clinics.
This contributes to bloated costs. The HMO co-pay can be burdensome for patients. In addition, there is a slow migration
toward the universal health care coverage in order to correct
some of these inefficiencies and distribute the resource to
persons uncovered or undercovered by the present protocols
and medical delivery systems.


American Health Care Dissected: Engaging and Informative   November 3, 2003
 13 out of 15 found this review helpful

In more than 20 years teaching a course focusing on analysis of American health care history and policy, I have yet to discover a more persuasive diagnosis of our health care delivery system's ills or a more convincing case for how to cure them. Dr. Lebow brings to this examination direct experience as a practicing physician from which he draws numerous stirring personal accounts. To his clinical perspective, he adds an extraordinary command of the broader economic and political issues essential for understanding the context and causes of America's current health care crisis epitomized by the alarming number of our country's uninsured--now about 44 million and growing. The book is honest, engaging, and sure to stimulate discussion with its clear prescription for change. With lively prose and strategically placed humor, he makes complex matters understandable. His humanity and passion are the earmarks of a brilliant teacher. Regardless of how deeply you presently understand America's health care system, you can learn from this book. And regardless of your political inclinations in respect to his advocacy of a single-payer solution, you can't ignore his meticulous presentation of the facts or the relentless logic of his conclusions from them.


Should be mandatory reading for health care providers   October 8, 2003
 3 out of 3 found this review helpful

Health Care Meltdown: Confronting The Myths And Fixing Our Failing System by Robert H. LeBow (former Medical Director of an Idaho community health center for more than 25 years and who was paralyzed in a cycling accident shortly after completing this book) is a clarion wake up call focused upon the medical care system's rampant excesses, over billings, neglects, and quagmires that floods the American health care system to near incapacitation. Over 40,000,000 Americans have no health insurance. This places an unsupportable burden on Emergency Room Care (one the most expensive health care provider resources), and while money is in unnecessary and wasteful bureaucratic and law-suit avoidance oriented testing, far to many people simply go without the medical service they desperately need. A sharply worded criticism that also offers models for reform and improvement, Health Care Meltdown should be mandatory reading for health care providers, citizen health care activists, anyone charged with the responsibility of developing policies and guidelines for managing health care services.