Corporatizing American Health Care: How We Lost Our Health Care System

by Robert W. Derlet

Tracking the evolution of medical care from an individualized small cottage profession to a giant impersonal corporate industry costing Americans over $3 trillion each year. Over the past three decades, the once-efficient American health care system has evolved into a complex maze of monopolies and a racket of bureaucratic checks, approvals, denials, roadblocks, and detours. This shift has created a massive and at times redundant workforce that frustrates patients, as well as physicians, nurses, and administrative staff. Health care costs the United States over $3 trillion each year and consumes over 18% of the country's gross domestic product. That's more than $11,000 for each person in the country each year―more than double what it costs in most Western European countries to deliver equal or even better care. In Corporatizing American Health Care , Robert W. Derlet, MD, traces the progression of health care policy in the United States. How, he asks, has US health care transformed from bedside medicine―a model of small practices and patient-focused care―into corporate medicine, which prioritizes profit and deals with both patient care and outcomes as billing codes? Arguing that the US Congress is the root of the problem, he describes how Congress has failed to enact legislation to prevent corporate monopolies in the health care industry. Instead, corrupted by large campaign donations and corporate lobbyists, Congress has crafted loopholes benefiting corporations and harming people. Drawing on his decades as a practicing physician caring for thousands of patients, as well as his university and medical school teaching experience, Derlet follows changes to both policy and practice across many sectors of health care. Scrutinizing how hospitals work, he also takes a hard look at high prescription drug prices, unresponsive insurance companies, problems with the Affordable Care Act, the growing medical implant device industry, and even nursing homes. Finally, he explains why the dominance of corporations and their lobbyists over health policy means that we now pay more for our care and our medications but have less choice both in what doctors we see and in what drugs we take. Breaking down the complex ABCs of health care to reveal the unscrupulous practices of the health care industry, Corporatizing American Health Care is perfect for both students and general readers who want to understand the changes in our system from the perspective of an actual doctor.

216 pages, Paperback

Published February 2, 2021

Reviews

[Rod Pierce · Rating 3 out of 5]

Healthcare industrial complex largely driven by special interest groups and lobbying. Very good read but I think American Sickness was more thorough.

- Pharma: raises prices through gouging, rebrand & combine generics to get back patent pricing, pharmacies consolidated out of mom & pop operations, get insurance to cover & pass costs to customer through premiums, direct to consumer advertising. Fix by preventing companies from donating to PACs & need to enforce monopolization policies through congress.
- Hospitals: used to work for doctors, now doctors work for hospitals. Hospital consolidation allows application of market forces, higher charges, increase revenue, including at non-profits, religious, & academic medical centers. Hospital charge via Diagnosis related groups (DRGs) for bundled care services. Many regional and local hospitals have closed and shunt pts to main hospital. Observational status increases hospital expenses since they’re reimbursed by payers for outpatient service and costs may trickle down to patients depending on their insurance. Fix by reducing special interest groups and list upfront prices for services.
- Doctors: private practice dying, employed practice the norm now (sold as hospitals creating economies of scale to reduce prices which hasn’t happened). Physician fee (fee for doctor service) vs Facility fee (fee for hospital as place to do service) the former is how hospitals make money. Specialization often a means for money. Burden of emr. In network vs out of network and surprise billing when patient finds out a provider was out of network (he blames physicians and their practices for).
- Health plans: in US, most plans devote 80% of revenue to pt care (rest is kept in pockets) compared to 95% in Europe. Companies like United health are listed public companies in stock market and have made a lot of money not by denying care but “not paying for services”. Medicare (>65, 10 years of paying into system) - part A, B, C & D (D= drugs) also advantage plans. Medicaid (below certain poverty line) - bc they pay low, many physicians & hospitals don’t accept. HMO combine health insurance and medical service under one organization - biggest is Kaiser. Many health systems and insurance plans are merging for cost savings & efficiency but actually cornering market and up charging.
- Western Europe: in general, highly government regulated, prices are set for services, taxes are used to offset / cover costs, most have extensive basic services and if you want more you pay out of pocket / private insurance, insurance companies can profit max 3-5% (vs US 20-25%). Prices for drugs, medical services including ER and outpatient services highly regulated from top down.
- Federal laws: done via aggressive lobbying w corporation profits. Many iterations through years from development of CMS, to HMO, to HIPPA, HITEC and ACA. While these all started as good, blanket care for society, they’ve been molded through litigation, legislation from lobbyists to make profit for corporations.
- Devices: lax regulations, companies making bank, need legislative regulation through congress to change loop holes that allow devices to exploit and extract profits from people / insurance companies. Also reduce lobbying power with regulations.

[Tanner Smith · Rating 2 out of 5]

This book makes a solid attempt but falls very short of providing a comprehensive overview of the history and pitfalls of American healthcare. It's fairly well researched, but also makes some broad statements backed only by personal experience. In other cases, the author swings the opposite direction by supporting relatively uncontroversial claims with a seemingly endless and almost unreadable list of citations.

[Niklas Zenius Jespersen · Rating 3 out of 5]

God gennemgang og information om hvor ekstremt dyrt, ulige og ineffektivt sundhedsvæsenet i USA er blevet. Desværre er hans løsningsforslag præget af en romantisk søgen tilbage til tidligere tiders generalist og lavere teknologisk medicin, frem for at pege fremad mod et moderne offentligt sundhedsvæsen.

[Lee Radford · Rating 5 out of 5]

Good history of modern United States health care from the perspective of an emergency room physician who is angry at how capitalism and political influence have made health care expensive and unavailable.