Still Broken: Understanding the U.S. Health Care System

By McGrath, Robert J. | Inquiry, Summer 2011 | Go to article overview

Still Broken: Understanding the U.S. Health Care System


McGrath, Robert J., Inquiry


Still Broken: Understanding the U.S. Health Care System. By Stephen M. Davidson. Stanford, Calif.: Stanford University Press. 2010. 304 pp. $27.95.

In Still Broken, Stephen Davidson takes on the formidable task of attempting to explain the complexities and dysfunction of the U.S. health care delivery system and proposes a series of steps toward reform. Some are well founded in the health policy literature, others are slightly novel, and many are now familiar to most attuned readers of health reform within the context of the Patient Protection and Affordable Care Act of 2010 (ACA). The book, published prior to passage of the ACA, considers both the nature of potential political options for reform, and then proposes broad political strategies to enact those changes. These are not, however, moot points, as Congress this year has begun extended debate of revision, or perhaps even repeal of the ACA in the coming term.

The book essentially can be divided into two parts. The first is a well-researched description of the U.S. health care delivery system through Davidson's lens as an economist. Here he discusses both the inherent shortcomings and exceptional promise of our care system. In the first chapters, Davidson outlines the many advances and contributions of modern medicine to the quality of American lives. He then summarizes the exorbitant and unsustainable costs of the system, both per capita and comparative, and makes the often-heard case that from a population perspective, we in America spend the most and, by all accounts, get the least. From here, Davidson delves deeply into the obvious problems of the system: the uninsured and underinsured, diverse quality of outcomes, inappropriate utilization, inefficiencies created by payment incentives, lack of investment in information technology, and others. Throughout this section, he expertly culls the exhaustive literature and data on a myriad of complex but interrelated issues present within the delivery system. From this discussion follows an outline of the goals for reform.

It is in Chapter 6 where Davidson arguably provides his most important contribution to the ongoing debate, especially for the health policy newcomer, by offering a contextual explanation for how the problems of the health system evolved and why they persist. Here, he also makes his primary point: that rational actors will make irrational decisions if the incentives are so aligned. This is obviously not a new argument and it is one rooted in economic theory, and familiar to scholars of health policy. What Davidson does is make the arguments clear to a broader audience. His explanations are sound, and provide a reasoned lens from which to posit solutions.

The text then turns to examining the primary vehicles for policy change--regulation and the market. He explores fully the nature of competition, where markets work and fail, and under what assumptions and constructs. He explores the nature of prices, how they impact both competition and utilization, and asks key questions about the role of both the provider and patient in health care decision making. He argues that providers, not patients, are best incentivized to promote quality, and that promoting price competition among providers leads to suboptimal outcomes. The discussion culminates with the suggestion that insurance reform is necessary, but is only one component of the change needed to address existing incentive problems; for change to be effective, he writes, it must be systemwide.

Davidson next directs his attention toward reform options that address each incentive shortfall he has identified. As has been true with so many reform prescriptions, his ideas likely will find both support and question. By his own admission, he leaves many of the details of any specific plan to be determined, and focuses instead on broadly defined plan elements. Those attentive to health policy will recognize previously vetted proposals, many of which were included in the ACA legislation in some form; others, including a public insurance option, continue to be debated.

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Still Broken: Understanding the U.S. Health Care System
Settings

Settings

Typeface
Text size Smaller Larger
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.