Book Review  |   November 2010
Healthcare Solved—Real Answers, No Politics
Author Affiliations
  • Donald W. Brown, Jr, DO
    Muskegon, Michigan
Article Information
Book Review   |   November 2010
Healthcare Solved—Real Answers, No Politics
The Journal of the American Osteopathic Association, November 2010, Vol. 110, 680-681. doi:
The Journal of the American Osteopathic Association, November 2010, Vol. 110, 680-681. doi:
Healthcare Solved—Real Answers, No Politics covers several important aspects of the healthcare system, including costs, electronic medical records, liability issues, and the roles of pharmaceutical companies, insurers, and government. Writing for the “citizen consumer, healthcare professional, and employer,” Debra A. Smith, DO, provides an insightful and clarifying discussion regarding a matter that is often muddied with uninformed and inaccurate commentary. 
Healthcare reform is an issue that deserves honest, straightforward dialogue. Dr Smith provides that discourse by meticulously dissecting components of healthcare, with an emphasis on cost containment and the need to provide quality care. All points in this book's 13 chapters have been thoroughly researched and heavily documented. Dr Smith uses her medical and business backgrounds to navigate the reader through the complex reality of healthcare, and she does so in terms that everyone can understand. She is an osteopathic physician and economist who has worked in clinical medicine, medical administration, and insurance underwriting. She brings an international perspective to the text with her experience as a consultant in healthcare financing and public health for the World Bank and United Nations. 
As with anything in life, it is best to—as chapter 3 is titled—”follow the money.” Dr Smith explains why medical costs have spiraled out of control. Part of this explanation is as follows: 

Less than 1% of the population accounts for 30% of the total medical costs, most of which are cancer patients. Another 11% of the population accounts for 43% of the costs, most of these are patients with chronic diseases at advanced or end stages.... The money goes to treating the end results of these chronic diseases that often take decades to develop. That's why it takes so long to reap the benefits of prevention. As a clinician, I believe prevention is necessary, as is adequate continuing medical management. But, it's not the most effective way to impact healthcare expenditures now.

Dr Smith points out that health insurers are operating with an average profit margin of approximately 2%, and more and more insurers are losing money. Insurers derive their wealth from underwriting, investment income, and interest rates. If private insurance companies are struggling, can we realistically expect the government to do better? 
The author explains very eloquently that more healthcare does not equal better healthcare. For example, she notes the following: 

If there is no impact on patient management as a result of the screening tests, there is no point in doing it.... Doctors need to know the costs of the tests they order and understand when the evidence base supports ordering a given test for a given patient. Physicians must understand the power of one test vs. another to get the biggest bang for our healthcare dollars. Otherwise our good intentions will cost the system more money and our patients more worry, both unnecessarily.

Issues related to demographics are discussed extensively. Dr Smith clarifies how factors associated with aging and ill consumers when weighed against young and healthy consumers affect insurance premiums and the purchase of insurance. 
Dr Smith notes that Medicare, founded in 1965, has become a catastrophic unfunded liability as a result of changes in demographics from the time of its founding to the present. Medicare has never been indexed to increase the eligibility age and reflect the increase in life expectancy. Thus, a substantial cut in discretionary spending and an increase in tax revenue are now required to correct this problem. However, this is a self-perpetuating problem because the public repeatedly elects politicians who do not address the issue but kick it down the road. 
The text goes on to explain how research into cost analysis and cost effectiveness in medicine is in its infancy. There are no standards for economic review because there is a lack of physicians with business and economic skills to properly evaluate studies. In addition, there are no agreements on national standards for basic treatments and diagnostic tests for various conditions. Dr Smith recommends that we look at catastrophic diseases—the diseases on which insurance companies spend large funds—and analyze the effectiveness of treatments, diagnoses, and prevention as they relate to cost. 
Electronic medical records can be part of the solution. However, as the book points out, a single electronic medical record does not work for everyone. With proper use of medical records, a substantial amount of funds will be saved. 
Healthcare Solved—Real Answers, No Politics methodically and meticulously explains healthcare issues so that everyone can learn by reading the book. A number of tables and figures aid the explanations by highlighting key concepts. The author does not shy away from a truthful discussion of the issues, and she is willing to evaluate holistic and foreign sources of information as aspects of a viable solution to a complex problem. I applaud Dr Smith for a job well done. 
 By Debra A. Smith, DO. 216 pp. $14.55 (soft-cover), $31.50 (hardcover). ISBN: 978-0-557-09032-7. Indianapolis, IN: Global Health Press; 2009.