Who Shall Live? Health, Economics, and Social Choice (Expanded Edition)

In an effort to get up to speed on healthcare economics, I purchase Victor Fuchs' _Who Shall Live?_ and Arnold Kling's _Crisis of Abundance: Rethinking How We Pay for Health Care_ together in hopes of obtaining a balanced view of the subject. I was not disappointed in either book. Fuchs' book was originally published in 1975, but now contains new material added in the wake of the Clinton era attempt at creating universal health care. Regardless, the original material is just as valid now as then. Fuchs outlines the roles of patients, doctors, hospitals, drugs, and financing in contributing to the costs of health care. It is written by an accomplished health care economist, but for the laymen, so mathematics does not show up frequently. In clear terms, Fuchs goes through a number of standard arguments, providing data to back up the arguments that show that some standard arguments are correct and some are wrong. After reading this, the most rabid pro-universal health care enthusiast should have their expectations tempered. I don't know if the most rabid enthusiast against universal health care will be won over by his arguments in favor of some type of system. Yes, he is in favor of something; though it is not clear that he would support any of the current proposals, it seems very clear that he is against some of the arguments used to support those proposals. Kling's book was written much more recently. Kling's approach requires a great deal more understanding by his audience of some of the mathematical and economic arguments offered. Kling offers more specifics in the way of policy proposals, but I'm not sure how realistic they are. One thing that both men seem to agree on is that the current system is far to prone to apply too much expensive technology for too little return. We are nearly to the point where doctors will order an MRI scan for a hangnail on the basis that we don't want to overlook something (and besides, "someone else" is paying for it). Insurance against catastrophic, unexpected, high expenses has given way to a system in which everyone wants insurance to pay for band-aids for their boo-boos. Doctors are unusually resistant to scientific management (including standard practices and checklists) and more likely to "go with their gut", follow tradition, or make moral cases for heroic efforts for every case no matter how slight the effect on outcome. Because of this, there is as much variation in costs and life expectancy between regions in the US as there is between the US and European countries (and there is as much difference in infant mortality and life expectancy between income groups in Great Britain as in the US). So both seem skeptical about the influence of finance or maintaining a commitment to insulating the average person from cost, both seem to emphasize that we should concentrate more on helping the very poor and very sick, and both seem to think that a health care plan should include some commitment to a research bod

On reading this book I kept experiencing the urge to wave it in the face of my well-meaning friends and wider acquaintance and force them to read it under duress. Quite simply, it makes perfect sense. Content-wise, I think the review under the hardback edition will fill you in more objectively than I could hope to.What I do want to do is recommend this book to any med students struggling to cope with their seemingly-freakish interest in health economics and policy. The med school fare is almost totally devoid of any discussion of such issues, which I may consider criminal considering doctors work as part of a system and not in isolation, but is hardly surprising given the near-universal lack of interest amongst the students. Stop trying to bully your friends into arguing with you and put the energy into getting your library to buy a copy of this book. Then consider selling off your anatomy textbook to pay for your own.