Oxymorons: The Myth of a U.S. Health Care System

Oxymorons: The Myth of a U.S. Health Care System

Oxymorons: The Myth of a U.S. Health Care System

Oxymorons: The Myth of a U.S. Health Care System


In this impassioned and often vitriolic book _ a follow-up to the author's bestselling Bleeding Edge: The Business of Health Care in the New Century _ U.S. health care industry expert J.D. Kleinke offers an unflinching look at our broken health care system. Throughout the book, Kleinke-who was once a vocal advocate of the managed health care system-explains what went wrong and attempts to answer such perplexing questions as Who's in charge of the American health care system? How does managed care work . . . or not work? Why have hospitals become so complex? What are the prospects for reform? Does the Internet change anything? Can we solve the growing problem of the uninsured?


I contradict myself? So then,

I contradict myself.

Walt Whitman

One of the strengths of the Internet is also one of its great cruelties: it remembers everything. the Web site for The Newshour with Jim Lehrer on pbs includes a transcript of my effusive commentary, dated April 2, 1996, on the $8.8 billion merger between Aetna and U.S. Healthcare into a massive health insurer with 23 million members.

“The managed care revolution has brought to health care a much more organized, rational way of delivering health care, ” I told the cameras. “HMOs and other kinds of managed care companies seek to improve your health status and prevent disease progression, while steering you toward physicians who have better demonstrated quality.”

I was a true believer in the managed care revolution, and I could scarcely contain my enthusiasm about what this merger meant for those 23 million people. I believed in the promise of managed care and expressed that belief openly and passionately on national tv, in the editorial pages of the Wall Street Journal and jama, and in my 1998 book Bleeding Edge: the Business of Health Care in the New Century (Kleinke, 1998a). I argued that the economic and organizational disciplines unleashed by HMOs like U.S. Healthcare were harsh but necessary medicine for the systemic illnesses that have afflicted the financing and delivery of health care in the United States since the emergence of modern medicine. I was convinced (and occasionally . . .

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