Austin gave you his thoughts on the preface, though more from him on that section are coming on Friday. I’d like to add some of my own. I’ve been travelling for the past few days, but I wanted to get things down here.
First of all, I will be honest and admit that as I read the first few pages, I felt myself getting defensive. John begins with the ususal complaints which I’ve discussed here before. He argues that by removing skin in the game, health care is over-used (I disagree). He also argues that making health insurance more affordable makes it more expensive, I don’t think that has to be the case, as many, many other countries make health insurance quite affordable without racking up our prices.
But then he went and surprised me.
John supports value based insurance. We’ve discussed that many times on this blog. I imagine we’d implement it differently, but I also have been a supporter of this idea.
John also notes that by identifying outliers (like Jeffrey Brenner did), we can reduce costs. I agree. So does Atul Gawande, who wrote about the same thing.
John ends though, by citing the fact that some physicians have had success with EMRs or figuring out more efficient practices without outside help, therefore all should. I’d counter that it’s totally likely that out of the 800,000 practicing physicians, some have been able to succeed. Anecdotes are not, however, evidence of widespread trends.
So far, I’m encouraged. While I never expected to agree with everything that’s in the book, I was not as put off as I feared I might be. I look forward to chapter 1.