Shannon Brownlee

This book is an eye-opener. Author Shannon Brownlee has a master's degree in biology and writes on medical and health care topics. On page 9, Brownlee says her book "is an exploration of three simple questions. What drives unnecessary health care? Why should we worry about it? And once we understand how pervasive it is in American medicine, how can we use that knowledge to create a better system?"

Brownlee shows how doctors, hospitals, and drug and device manufacturers are rewarded (mostly show more by health insurance systems) for how much care they deliver rather than how effective it is. Coupled with most Americans' tendency to want SOME kind of treatment when they go to a doctor, either medication or tests, even when unneeded, Brownlee shows how costs are driven up while quality of care usually does not improve.

Brownlee uses numerous (often scary) examples throughout the book to illustrate her points, and concludes with a chapter that recommends some changes in current health care practices - but not socialized medicine. She gives the Veterans Administration hospitals as an example of a system to model - which surprised me, simply because I did not know they were that good. She also recommends electronic medical records, something that I am surprised is so slow to be adopted in the medical field.

The book is easy to read and understand - EXCEPT for the horrible end notes! She doesn't use standard footnotes, nor any numbering at all in her end notes, and it is difficult to find the sources for some of her statements. And some of those you can find don't make sense. For example, when she states on page 204 that "vascular surgeons performed about eighty-eight thousand unnecessary carotid endarterectomies in 2002, thereby causing an unknown number of strokes," the end note references personal communication with a British neurologist, and a published study that compares the outcomes of endarterectomies with another procedure, stenting. It's not at all clear what, if anything, supports her 88,000 figure - and that, in my opinion, is the biggest weakness of this book, and the reason it only gets 3.5 stars . I would certainly recommend reading it, but keep this weakness in mind. show less

Shannon Brownlee knows why healthcare costs so much: poor top-down public policy that provides all the wrong incentives to everyone involved in dispensing it. She also knows the solution: top-down public policy that will force everyone to do the right thing. She gives great examples of over-treatment: fancy equipment and tests that really don’t help long-term survival rates, expensive procedures that upon closer examination don’t work, and of course the relentless pursuit of profit among show more Big Pharma and other Evil Capitalists. She promotes as a model healthcare system, the Veterans Administration, which scored well on all the metrics she promoted when this book was written (2007) but of course was later turned upside down when it emerged that the top officials were lying.

This is an example of a book that does not withstand the test of time. Sure, as a lesson for what happens when top-down policy makers run an entire industry like healthcare, this is an sobering case study, but don’t look here hoping for creative solutions. Brownlee’s only solution seems to be “more of the same, only be smarter about it.” show less

Conglomeration of thoughts:

Perhaps socialized medicine, not "Medicare for all," but medicine, care, insurance strictly regulated might be the answer. Her arguments for the VA system seem to be solid. But they, the VA, do seem to have some drawbacks.

This book was published before Obamacare/ACA was created, put into being, etc. I wonder what, if anything, the writer would change with that law in place.

If the problems with American Healthcare were visualized, it would be as follows:
Physicians, show more Insurance, Patients, Hospitals, Laws & Lawyers, Pharmaceutical Companies... all pointing fingers at each other but, in reality, all responsible for a portion of the issue (and some of them very well-meaning).

Intermountain Healthcare was touted as one of the better companies/hospitals. If that is true either a) something has changed in the last eight or so years or b) other hospitals are pretty terrible. show less

I don't disagree with everything Brownlee says, and certain points are valid. However, I dislike her writing. I find it over-sensationalized, and I can't even get through the first few chapters. Maybe it gets better, but right now, I just don't have the patience for it. This is quite pathetic given that the book is only 300 pages. I think I would have preferred to read this in an academic journal with more substance.