"Money-Driven Medicine"

I don't get to do a lot of book reviews, possibly because I don't have a lot of time to read whole books. However, I have just finished one book that may be of particular interest to people interested about threats to physicians' core values, especially from concentration and abuse of power.

Money-Driven Medicine by Maggie Mahar (New York: HarperCollins, 2006) takes a broad look at what has gone wrong in US health care. Especially good are its sections on:

• The History from the Beginning of Medicare Through the 1990s - Mahar briskly starts with the background of Medicare, providing some important insights along the way. Of particular interest was how the AMA was originally equally opposed to "socialized medicine," and "corporate medicine." The organization, however, used up most of its political capital fighting the former, and hence was unable to resist the latter. Another fascinating tale was how commercial managed care arose (or was perverted?) from the original not-for-profit model, perhaps inadvertantly fueled by the demise of federal money that only went to not-for-profit HMOs.
• For-Profit Hospitals: the National Medical Enterprises Case - Mahar gives a detailed history of the case of National Medical Enterprises, a large, for-profit hospital chain that specialized in psychiatric hospitals and substance abuse facilities in the 1990s. NME was charged not only with run of the mill offenses like over-billing, but more exotic ones like kidnapping patients. NME eventually settled with federal authorities in 1994 for $379 million, and plead guilty to a variety of charges. Of course, no one went to jail, and the CEO walked away with a golden parachute. Thus, this case looked like the perfect precursor to newer cases discussed on Health Care Renewal. More striking, and what I hadn't realized, was that NME did not disappear. It didn't either go out of business or get swallowed up by some larger company. It simply changed its name - to Tenet Health, a company which has not been featured positively on this blog, and which seemed to repeat, in a broad sense, all the mistakes it had made before under a different name.
• Medical Devices: the Johnson & Johnson Charite Spinal Disc Case - Mahar again demonstrated that those ignorant of history are doomed to repeat it by narrating the more recent case of J&Js Charite spinal disc prosthesis.

Other chapters deal with the cost of competition, the hazards of over- and under-treatment, and the issues of quality, all worth reading.
In my opinion, the book's biggest weakness is its failure to dig into the causes of what it repeatedly identified as a fundamental problem, the irrational reimbursement system. However, given all that the book does address, that is a quibble.
In summary, Money-Driven Medicine provides vital background, clearly narrated, and should provoke a lot of thought about how we got ourselves into this mess, and maybe about how to get out of it.

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