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The Managed Healthcare Industry -- A Market Failure, by Jack Charles Schoenholtz
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The Supreme Court has now planted the Affordable Care Act firmly among those needing healthcare coverage. Its 2015 decision in King v. Burwell begins with noting that Obamacare “grew out of a long history of failed health insurance reform,” and ends with the sweeping conclusion, “Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them.” So, why are the cost of healthcare in the United States and our infant mortality rate still higher than over 30 advanced nations? The book's second, expanded, edition offers a comprehensive overview of healthcare history, the factors, fictions, laws, and policies leading up to the Affordable Care Act. This indispensable resource by Professor Jack C. Schoenholtz offers page after eye-opening page information that explains the often overwhelming issue of the costly managed healthcare industry. This edition of The Managed Healthcare Insurance Industry--A Market Failure, intensifies its investigation of America’s healthcare. The book is written for the public who wish to understand the health and structure of the US healthcare system. It also reaches college-age youth, educators, and healthcare professionals--both providers and executives--and is excellent for legislators and regulators and their staff who attempt to reconcile problems that remain in healthcare delivery. It exposes the reasons for the remaining high cost of healthcare, and the byzantine way insurers have managed it and created the market failure that it is, costing society and patients more than it benefits them. By an analysis of historical and contemporary data, this revelatory and rigorously researched work brings facts from state and federal governments’ historical and judicial approaches to the public’s healthcare and the evolution of relevant statutes and regulations, together with the political economics and day-to-day medical and social issues surrounding the critically important doctor-patient relationship. The Managed Healthcare Insurance Industry examines the legislative and economic changes of the past forty years that resulted in the pre-Affordable Care Act’s millions of uninsured Americans. In Part I, the book highlights the onset of the healthcare “cost-containment” era, by way of the insurance-company friendly HMO Act, which led to the birth of managed-care insurance. Parts II and III helps unravel relevant federal antitrust law, particularly in terms of the power of federal “preemption,” and the 1974 enactment of ERISA, the “Employee Retirement Income Security Act,” so vital to pension benefit plans. Part IV illuminates the contributing factors that led insurers to “manage,” for profit, the delivery of healthcare by doctors and hospitals; and how by managing insurers' costs, left only a few giant insurance companies to control entire states’ healthcare systems. This section addresses whether insurers were legitimately cutting "costs of care," or care itself, by coercively manipulating prices in a predatory manner, and how patients, and their doctors, became reluctant participants in economically compromised care, and why this market failure became a deadweight loss for society. Parts V and VI demystify the business of insurance companies, and how formerly “risk insurance” policies became “noninsurance,” which exploits employers and their employees’ benefit plans alike by keeping their administrative costs artificially high. Parts VII, VIII, and IX explore managed healthcare as an economic market failure that results in a waste of resources. Parts X and XI discuss the legal attempts by the commercial insurance industry to dislodge congressional will in enacting Obamacare, bringing up-to-date the attempts by the industry to control the new Exchanges and Accountable Care Organizations so powerfully resolved by the Supreme Court.
- Sales Rank: #3148407 in Books
- Published on: 2012-02-18
- Original language: English
- Number of items: 1
- Dimensions: 9.00" h x 1.51" w x 6.00" l, 1.92 pounds
- Binding: Paperback
- 602 pages
About the Author
Dr. Schoenholtz is a Distinguished Life Fellow of the American Psychiatric Association, a Fellow of the American College of Psychiatrists, and a clinical professor of psychiatry and behavioral sciences at the New York Medical College, teaching medical students and supervising psychiatric residents for over thirty years. He served as chair of the New York State Association of Private Psychiatric Hospitals for over ten years, as a trustee of the National Association of Psychiatric Health Systems for six years, and was the founding medical director of the Rye (psychiatric) Hospital Center in New York. He also represented the American Psychiatric Association, as an early member of the Practicing Physicians Advisory Council of the NCQA, the National Committee for Quality Assurance, the insurance-company-founded accrediting organization. Trained in psychiatry at New York-Presbyterian Hospital/Weill Cornell Medical Center, in White Plains, NY, he was among the early researchers in the U.S. in the use of lithium for bi-polar illness. He has been active in state and federal regulatory matters and participated as consultant to committees and councils of the American Psychiatric Association and other professional groups. His numerous writings range from clinical to broad social issues published in newspapers, magazines, and professional journals. In The Wayne Law Review, he was senior author of the ‘Legal’ Abuse of Physicians in Deaths in the United States: The Erosion of Ethics and Morality in Medicine, with Drs. Alfred M. Freedman and Abraham L. Halpern; a discourse on physician-assisted suicide, doctors’ participation in competency examinations for executions, and the ethical dilemma of physicians embracing managed care. In this rigorous work he chronicles the history and political economy of healthcare insurance, and offers an extensive, research-based and up-to-date account of the complex present-day American healthcare system, Professor Schoenholtz diagnoses the systemic disease that eroded this country’s healthcare system before the Affordable Care Act. The expose of the managed healthcare system's market failure makes great strides toward curbing these inherent problems, as it highlights the path for ensuring adequate, affordable healthcare for everyone.
Most helpful customer reviews
0 of 0 people found the following review helpful.
A Must Read
By Amy Schoen
This work delves deeply into the history of how our healthcare system was deconstructed. Dr. Schoenholtz creates a clear path in understanding how "real" insurance was lost and managed care (really "managed cost") emerged, as Wall Street not Main Street became an operating force in dictating the direction of healthcare. This is a must read for legislators in this country who have the ability to effect a "cure" for the consumer. However, it is not just for lawmakers but providers, the business community and, most especially, those of us who are forced to utilize this broken system. This is a scholarly, research rich work and Dr. Schoenholtz should be saluted for his endeavor. I would enthusiastically encourage the reading of this book for anyone who cares about their health and healthcare.
0 of 0 people found the following review helpful.
THE MANAGED HEALTH CARE INDUSTRY; a patients perspective
By william becker
it has become increasingly time consuming and frustating to deal with the insurers responsible for my medical bills. to have claims indiscriminately denied and to argue interminably before finally giving up has become commonplace. more importantly, because of reduced payment levels, my doctors spend less time with me and i'm sure my quality of care has suffered.
THE MANAGED CARE INDUSTRY explains how we got to our present position and hopefully will start a legislative pushback at the outrageous domination of healthcare providers by the insurance industry. all of the aggrieved parties; patients, doctors and hospitals have a vested interest in fighting back.
william becker
0 of 0 people found the following review helpful.
The Managed Healthcare Industry
By D.Dyson
An in-depth explanation of how we ended up with less "Healthcare" and more "managed costs" for our increased insurance premiums.
Hopefully, understanding how we arrived here will enable us to pressure our Policymakers to get back to a place where our Insurance Premiums pay for "Medical Treatment" and not the Overhead and Profit of the "Healthcare" gatekeepers.
This is a must-read for all of us that have ever attempted to understand the "why" of a Denied Claim.
We still may not understand the "why" of but at least we will be able to understand the "how" of "how we got here".
A timely read.
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