Crisis of Abundance: Rethinking How We Pay for Health Care
	Author: Arnold Kling Published: 2008-05-25
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Customer comments on this selection. Presents a very good framework for thinking about health care I have read several books on the US health care "crisis" in the last six months. Crisis of Abundance is by far the most valuable. The book is a quick read, but lays out a very useful framework for thinking about how we got to the current situation and the tradeoffs to consider in changing health care finance. The insight that private health insurance is not really insurance is particularly informative. Anyone who is interested in the health care debate should read this. Best Book on Health Care I've Seen This is the best source for understanding the health care I have come across. The book does a great job exploring the complexities of the health care problem and the inevitable trade off we will face in making changes to the current system. Kling explains how basically there are 3 conflicting goals for health care finance: affordability for society as a whole, unfettered access for individuals, and insulation of individuals from the cost of their health care. It is impossible to achieve all three goals at once, as many schemes promise to do. Kling believes the best solution is to abandon the 3rd goal, insulating consumers from direct costs. Kling offers some models of long term, high deductible insurance policies which would be capable of insuring most people at reasonable costs. However, such a system would require significant regulatory and tax policy changes, and would probably be politically unpopular. The book contains some great analysis I have not seen anywhere else. I was surprised to learn that in many universal systems people consumers actually pay slightly more direct health care expenses than in the United States. Kling points to this insulation from costs as a major reason regular market forces cannot operate and health care spending continues to grow unchecked. I would recommend this book to anyone vaguely interested in the health care debate. It's just under 100 pages but packs in an incredible amount of learning. Fresh policy proposals In an effort to get up to speed on healthcare economics, I purchase Victor Fuchs' Who Shall Live?: Health, Economics, and Social Choice (Economic Ideas Leading to the 21st Century , Vol 3) and Arnold Kling's _Crisis of Abundance_ together in hopes of obtaining a balanced view of the subject. I was not disappointed in either book. Fuchs' book was originally published in 1975, but now contains new material added in the wake of the Clinton era attempt at creating universal health care. Regardless, the original material is just as valid now as then. Fuchs outlines the roles of patients, doctors, hospitals, drugs, and financing in contributing to the costs of health care. It is written by an accomplished health care economist, but for the laymen, so mathematics does not show up frequently. In clear terms, Fuchs goes through a number of standard arguments, providing data to back up the arguments that show that some standard arguments are correct and some are wrong. After reading this, the most rabid pro-universal health care enthusiast should have their expectations tempered. I don't know if the most rabid enthusiast against universal health care will be won over by his arguments in favor of some type of system. Yes, he is in favor of something; though it is not clear that he would support any of the current proposals, it seems very clear that he is against some of the arguments used to support those proposals. Kling's book was written much more recently. Kling's approach requires a great deal more understanding by his audience of some of the mathematical and economic arguments offered. Kling offers more specifics in the way of policy proposals, but I'm not sure how realistic they are. One thing that both men seem to agree on is that the current system is far to prone to apply too much expensive technology for too little return. We are nearly to the point where doctors will order an MRI scan for a hangnail on the basis that we don't want to overlook something (and besides, "someone else" is paying for it). Insurance against catastrophic, unexpected, high expenses has given way to a system in which everyone wants insurance to pay for band-aids for their boo-boos. Doctors are unusually resistant to scientific management (including standard practices and checklists) and more likely to "go with their gut", follow tradition, or make moral cases for heroic efforts for every case no matter how slight the effect on outcome. Because of this, there is as much variation in costs and life expectancy between regions in the US as there is between the US and European countries (and there is as much difference in infant mortality and life expectancy between income groups in Great Britain as in the US). So both seem skeptical about the influence of finance or maintaining a commitment to insulating the average person from cost, both seem to emphasize that we should concentrate more on helping the very poor and very sick, and both seem to think that a health care plan should include some commitment to a research body that endorses (not mandates) standard approaches to diagnosis. I was surprised that neither put any emphasis on tort reform. I enjoyed both books and found something to think about in each, but if I had to pick one to recommend to people to come up to speed on the issue, it would be the Fuchs book. Excellent Having been chasing the Health care debate for 15 years, and participating almost as long, I have to say that I was basically underinformed in the past. Roughly, if you haven't read this book, you're not informed enough to participate in the health care debate. Fabulous book. Short, concise, explains the actual problem. Reading it on the Kindle I'm reading this book on the Kindle (and writing this review from the Kindle, also). The content is well-presented and mostly understandable to a noneconomist. The author presents various econommic considerations to deal with the issues with good examples. The only drawback with reading the book on the Kindle is that the publisher did not hyperlink the notes and references from within the body, making it difficult to move around from text to reference and back.
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