• Goodman’s book now available for free

    Sorry folks. Though John thought he and I could make the PDF available for free, the publisher thought otherwise. We had to pull it. You can buy a copy here.

    If you haven’t yet bought John Goodman’s book for the TIE book club, you don’t need to. John made it available by PDF. (If that link doesn’t work try this.) This is the first book I own in three formats: hard copy, Kindle, and now PDF. If only it were available as an audiobook or major motion picture …


    • I know Austin hasn’t had his first go yet, but I saw the following paragraph in the introduction to Priceless and immediately had problems; wondering if some of you wonks out there could help me out.

      “The solution to this problem is not to outlaw insurance for pre-existing conditions, but to legalize it. In an unfettered market, you would be able to insure against the possibility of developing a pre-existing condition that results in above average premiums, should you need to change health plans. When you enter a new health plan, you and your previous insurer would pay a premium that fully reflects the expected costs you bring to that plan. In such a market, the sick would be just as desirable as the healthy to an insurance company. And there would be an active, entrepreneurial market to find low-cost ways to solve your health problems—in order to lower costs both for you and your insurer.”

      The sercond sentence asserts that one could expect (in an unfettered market) to insure against the possibility of developing a pre-existing condition. I understand that new insurance provides protection against future uncertain events, but isn’t a pre-existing condition a certain event that has already occurred? Moreover in this unfettered market (apparently unregulated) your previous carrier seems to be willing to pay to get rid of you – but isn’t the reason they want to get rid of you is so they don’t have to pay the actuarial value of the (future) pre-existing condition.

      Can someone help me with this?

      • The system John suggests isn’t much more than standard risk adjustment financed by surcharges on plans. I.e., every plan pays a certain sum into a pot. Plans that end up enrolling high risks get a cut. It’s just a transfer from plans with low risks to those with high risks.

        However, since plans are liable for the risk of consumers that leave them, they would be more willing to invest in care to keep them healthier.

    • Ok, so there is a “fetter” or two, after all.Thanks.

    • This is nothing but “political agenda” in a book’s clothing.. no wonder it was made free… and many arguments made in the book are just not correct. Like this one on page 263
      ” Moreover, the business model of the ACO requires that patients see only the doctors that the ACO employs. If you are getting care from an ACO, therefore, your insurance may not pay for you to see doctors outside the ACO. Also, part of the ACO vision is that all doctors and nurses will practice medicine in the same way. This means that when you visit an ACO clinic, you will not necessarily see the same doctor you saw on your last visit. ACOs will probably be given a lot of freedom to limit the terms and circumstances under which you can see doctors.
      Nationwide, Medicare started paying fees to ACOs in 2012. Eventually, the Obama administration would like to see everyone in an ACO. But if no one had any previous interest in forming ACOs, let alone joining them, what is going to cause them all to change our minds? Money. Insurers won’t be able to get premium increases unless they adopt ACO plans”

      Here are corrections:
      1. Even though a medicare patient is assigned to an ACO he is not “bound” to the ACO. He is free to see any doctor he likes, even those outside of the ACO. This is the main difference between an ACO and HMO.
      2. Medicare ACOs, as per law, cannot be coupled with managed care. They are stand-alone FFS programs and hence there is no question of not paying to see a doctor outside of an ACO. (Future ACOs may get capitated.. but the basic principle holds good under capitated model as well .. patients are free to see any doctor they choose!)
      3. Also the program is completely voluntary, doctors will get paid the same rate whether they are within an ACO or outside of an ACO.
      4. The argument about forcing private insurers to offer ACO plans by not increasing their rates too didnot make any sense to me.

      I am disappointed. I am deleting the PDF I downloaded!

      • Thank you. As I (or we) will not be able to comment on every issue, we invite readers like you to flag issues in the comments.

      • IMO the key to the reduction of health care expenditures will involve the reduction of beneficial health care, marginal or otherwise. Thus incentives are of primary importance. If ACO’s succeed in their primary task (saving money) then the incentives will have forced the ACO to act in a fashion that is virtually the same as the HMO.

        It appears government is trying to create a regulatory body that can control human nature. It can’t.

    • As a practicing Internist of 36 years, I have been searching many years for the right stuff to apply to our dilemma of ever rising health care costs. There is definitely some good material in this book. But also a bunch of head slappers!

      I knew by page 9 I was in for a treat when the author brought up the pricing of cosmetic and Lasik surgery.

      And on page 24. The old “one-visit-one-condition policy”!
      Why is it in all my years I’ve never thought of or even heard of doing such nonsense?

      I’m now re-reading and taking more notes…

    • BTW, the link to the PDF did not work for me. I’ll check again tomorrow.

    • Not that I have an entitlement to free books, but the pdf link appears broken.

    • The PDF link is now 404. Anyone have an updated link for the PDF?

    • Page 65:

      “This is why it is easier to see a primary care physician in Britain than it is in the United States but harder to see a specialist and much harder to access expensive technology.”

      Speaking as an practicing internist since the ’70’s, it was around the early ’80’s that the U.S. began to diverge from primary to specialty centered medical care. For good and/or bad. But definitely more expensive. And I’ve seen graphs that show this very time when our health care costs started its obvious upward divergence from the rest of the developed world.


    • The iron law of irony insists that no book entitled “Priceless” shall in fact be…priceless.