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Elizabeth H. Bradley
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The American Health Care Paradox: Why Spending More is Getting Us Less 1st Edition, Kindle Edition

by Elizabeth Bradley (Author), Harvey V. Fineberg (Foreword) Format: Kindle Edition
4.6 out of 5 stars 193 ratings
Foreword by Harvey V. Fineberg, President of the Institute of Medicine

For decades, experts have puzzled over why the US spends more on health care but suffers poorer outcomes than other industrialized nations. Now Elizabeth H. Bradley and Lauren A. Taylor marshal extensive research, including a comparative study of health care data from thirty countries, and get to the root of this paradox: We've left out of our tally the most impactful expenditures countries make to improve the health of their populations-investments in social services.

In The American Health Care Paradox, Bradley and Taylor illuminate how narrow definitions of "health care," archaic divisions in the distribution of health and social services, and our allergy to government programs combine to create needless suffering in individual lives, even as health care spending continues to soar. They show us how and why the US health care "system" developed as it did; examine the constraints on, and possibilities for, reform; and profile inspiring new initiatives from around the world.

Offering a unique and clarifying perspective on the problems the Affordable Care Act won't solve, this book also points a new way forward.
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  1. ISBN-10
    9781610392105
  2. ISBN-13
    978-1610392105
  3. Edition
    1st
  4. Publisher
    PublicAffairs
  5. Publication date
    November 5, 2013
  6. Language
    English
  7. File size
    3.7 MB
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Editorial Reviews

From Booklist

Public-health experts Bradley and Taylor argue that, despite numerous and widespread efforts to rein in health-care costs, America is still paying more and getting less when the overall health of the country is contrasted with those of its international peers, even accounting for differences in national policy. The authors’ iteration of the fundamental cause of the system’s root paradox—it rewards a person who waits until they’re so sick they require expensive care while at the same time shaming the expensive-care provider for, well, charging for the expensive care—is not new. What is new here is their call for a holistic approach, integrating social and medical services into a cohesive cross-disciplinary system with the goal of supporting good health. Health-care systems fail because they don’t address the life circumstances (education, housing, employment) required to sustain wellness. To be clear, the authors don’t endorse a nanny state that becomes all things to all people but, rather, a government that is a catalyst for holistic innovation, nurturing good health at all socioeconomic levels. --Donna Chavez

Review

"Bradley and Taylor have identified social services as the unnamed culprit behind high health care costs and poor outcomes. Highlighting the non-medical determinants of patients' health may not only make physicians' jobs easier but also prove to be a prudent strategy for payers. This book offers an important reality check about what actually creates health in the United States." William Gillespie, MD, Chief Medical Officer of Emblem Health, and president of AdvantageCare Physicians

"The American Health Care Paradox has enough intellectual heft to bring an opera house to its feet. Drawing on data from dozens of international and domestic site visits, wide-ranging scholarly studies and in-depth interviews with patients, practitioners, health care administrators and social service staff from all over the world, the authors tackle the unenviable task of explaining why we think of health care the way we do—to the near total exclusion of social services. And they manage to do it with astonishing clarity, conciseness and narrative ease." Pauline Chen, the New York Times
"An important attempt to shift the discussion on health in the United States" Kirkus
"Their argument has intuitive appeal [and] is made more attractive by their clear prose and by their many helpful descriptions and historical explanations of US health care policy." Arnold Relman, New York Review of Books
Admirably presented as an apolitical examination of an urgent situation, Bradley and Taylor's carefully researched and lucidly reported findings offer what appears to be an easily rendered fix, but their equally striking depiction of uniquely American hostility to government involvement in private matters, exposes a daunting uphill battle." Publishers Weekly

"It seems like there are daily stories of skyrocketing medical costs here in the US coupled with our bad health outcomes compared with other developed countries. This book argues compellingly that we may have been looking for solutions in the wrong places. We won't find the answers by changing medical payments or improving quality of care as important, as those are. But rather that health begins, is nurtured, protected and preserved in our families and neighborhoods where people live, learn, work and play. The authors find that supporting families and children in ways that make their houses, neighborhoods and schools secure and enjoyable pays off in health in concrete and measurable ways. It is time we started to get serious about building a culture of health and making it easier for people to live that kind of life than merely paying the costs to repair the damages from injury and disease." James S. Marks, MD, MPH, president and director of Health Group at the Robert Wood Johnson Foundation

"If we're so rich, why aren't we healthier? I'd wondered about that for years, always assuming it was a medical question with a medical answer. I now know the answer lies not in what happens in our hospitals but what happens (or fails to happen) in our social services. This compelling, groundbreaking, and utterly persuasive book has opened my eyes." Anne Fadiman, author of The Spirit Catches You And You Fall Down
"This book provides new insight on why it is the United States' is spending so much on medicine without seeing commensurate health outcomes. Bradley and Taylor provide a clear account of life in the chasm between health and social services, where so much of our health care investment is lost, and put forth concrete ideas on how we can do better." Dr. Paul Farmer, MD, PhD, Harvard Medical School, Brigham and Women's Hospital, Partners In Health, and author of To Repair the World and Haiti After the Earthquake

Product details

  • ASIN ‏ : ‎ B00E257VKG
  • Publisher ‏ : ‎ PublicAffairs; 1st edition (November 5, 2013)
  • Publication date ‏ : ‎ November 5, 2013
  • Language ‏ : ‎ English
  • File size ‏ : ‎ 3.7 MB
  • Text-to-Speech ‏ : ‎ Enabled
  • Screen Reader ‏ : ‎ Supported
  • Enhanced typesetting ‏ : ‎ Enabled
  • X-Ray ‏ : ‎ Not Enabled
  • Word Wise ‏ : ‎ Enabled
  • Print length ‏ : ‎ 274 pages
  • Page numbers source ISBN ‏ : ‎ 1610392094
  • Customer Reviews:
    4.6 out of 5 stars 193 ratings

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  1. Elizabeth H. Bradley

    Elizabeth H. Bradley

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Customer reviews

4.6 out of 5 stars
193 global ratings

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Customers say

Customers find the book well-researched and informative, with one review noting how it summarizes complex data. Moreover, they appreciate its readability, with one highlighting it as a must-read for scholars and practitioners of public health. Additionally, the writing quality receives positive feedback, with one customer describing it as an easy read for a hard topic. Customers value the book's simplicity and its positive impact on health, with one review mentioning how it contributes to a healthier and more productive workforce.

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24 customers mention "Insight"24 positive0 negative

Customers find the book insightful and well-researched, with one customer noting how it summarizes complex data.

"This thought provoking and paradigm-shifting book is a must read for anyone interested in the American healthcare system...." Read more

"This well-written, insightful book helps refine our understanding of the disappointing performance of the American healthcare system...." Read more

"A well-researched and timely read that provides another perspective that's largely missing from the ongoing health care reform debate...." Read more

"...The American Health Care Paradox analyzes the wide range of graphs and statistics, as well as past strategies and interventions, that evidence..." Read more

17 customers mention "Readability"17 positive0 negative

Customers find the book readable and interesting, with one noting it's a must-read for scholars and practitioners of public health.

"This well-written, insightful book helps refine our understanding of the disappointing performance of the American healthcare system...." Read more

"Interesting read...." Read more

"...So far so good, and the book is certainly worth reading for this insight alone. Where it falls short, I think, is in the realm of solutions...." Read more

"...The book makes a great case that our ability to improve health is not simply through the traditional approaches of managed care, tort reform, and..." Read more

8 customers mention "Writing quality"8 positive0 negative

Customers find the book well written, with one mentioning it is an easy read for a hard topic.

"...Bradley and Taylor have hit on an idea that is clear, simple and obvious..." Read more

"...Very enlightening and well written." Read more

"...An extremely well written book, with unique and interesting perspective, that just "makes you think." Love it." Read more

"Thsi book is well organized and well written...." Read more

4 customers mention "Health"4 positive0 negative

Customers appreciate the book's focus on health, with one noting its positive impact on workforce productivity and another highlighting its emphasis on social supports.

"...investment in lower health care utilization, with a healthier and more productive work force...." Read more

"...and insurance regulations; rather, it's through a concerted effort to invest in social supports to enhance social determinants" Read more

"...social determinants play a significant role in health and well being of individuals, and communities." Read more

"Food for thought on health in america..." Read more

3 customers mention "Simplicity"3 positive0 negative

Customers appreciate the simplicity of the book, with one mentioning it takes no shortcuts.

"...Bradley and Taylor have hit on an idea that is clear, simple and obvious..." Read more

"This book takes no shortcuts, and directly addresses the heart of an enormous issue in contemporary America...." Read more

"...and outcomes - and summarizes complex data in a very simple and easy to follow way, providing data for conclusions that many of us in the field have..." Read more

Top reviews from the United States

  • Ben Gifford
    5.0 out of 5 stars Must read: well written and thought provoking
    Reviewed in the United States on February 4, 2014
    Verified Purchase
    This thought provoking and paradigm-shifting book is a must read for anyone interested in the American healthcare system. Bradley and Taylor have hit on an idea that is clear, simple and obvious (so much so that readers may be embarrassed for not having discovered the idea first). The “American Healthcare Paradox” of why America spends comparatively so much on healthcare yet receives so little is unraveled when social spending is considered: America comparatively spends an average amount on the sum of medical and social spending and therefore has middling results. Incorporating a more holistic view of expenditure on the broader determinants of health solves the paradox.

    Some may find the book frustrating because it aims to shift the focus of the discussion, rather than provide quick and easy answers. This is precisely the value of the book. Our current situation is complicated, and the overall underperformance cannot be improved easily or quickly. A successful approach to the problem requires a shift in the public discussion and a collective acknowledgement of our shared burden in causing this issue. Bradley and Taylor include an apolitical and helpful history of how the American system developed into its current form.

    While I find myself more towards the individualistic (vs. community orientation) side of the spectrum than Bradley and Taylor, their arguments have caused me to currently question and challenge my own assumptions. No matter your current views, this book is likely to have a similar effect on all readers.
    10 people found this helpful
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  • John R. Pakutka
    5.0 out of 5 stars A must read for all politicians, public policy analysts and healthcare payers
    Reviewed in the United States on June 5, 2014
    Verified Purchase
    This well-written, insightful book helps refine our understanding of the disappointing performance of the American healthcare system. More importantly, it points us toward solutions. Better coordination between healthcare and social service sectors is a must; otherwise more money in an already expensive system is unlikely to improve the health of our population, and any cost savings derived from the many initiatives spawned by the Affordable Care Act is likely to be at the expense of outcomes.
    One person found this helpful
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  • Lurch1058
    4.0 out of 5 stars "Live free and die"
    Reviewed in the United States on May 7, 2015
    Verified Purchase
    A well-researched and timely read that provides another perspective that's largely missing from the ongoing health care reform debate. The basic premise of the book is that the medical establishment is functioning as an expensive social safety net, that prudent investment in that safety net would help reduce both short term crisis and long term chronic health care costs, and therefore realize a return on that investment in lower health care utilization, with a healthier and more productive work force. Unfortunately, as her analysis of the contrasting attitudes between the U.S. and the European Social Democracies toward concepts of The State and Health underlines, such a shift in spending, regardless of the politics involved, would require a minimum of a generational change in thinking. Recommended.
    One person found this helpful
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  • Victor Johansen
    5.0 out of 5 stars Addresses the heart of the issue
    Reviewed in the United States on November 27, 2013
    Verified Purchase
    This book takes no shortcuts, and directly addresses the heart of an enormous issue in contemporary America. The American Health Care Paradox analyzes the wide range of graphs and statistics, as well as past strategies and interventions, that evidence America's commitment to creating a healthy population. However, when presented with the evident subpar health outcomes, Bradley and Taylor do not--unlike most others--insist that we throw more money at the issue. Instead, the authors dig deeper to discover the earliest roots of negative health outcomes, and specifically discusses how we can adjust our spending to better solve the problems we are faced with. Using research from countless other countries--especially Scandinavian ones, which consistently produce some of the best healthcare outcomes--Dr. Bradley and Ms. Taylor present convincing evidence that we can improve healthcare outcomes by (paradoxically) shifting spending away from health services, and instead towards sectors that function as highly efficient interventions: employment and housing programs; disability, sickness, and unemployment benefits; family and housing support; pensions, and perhaps most importantly, education.

    This book teaches the critical message that with a problem as complex as healthcare, there will be no easy solutions or shortcuts. We need to take a step back to acknowledge and address the societal factors that burden our healthcare system, because they are at the heart of our stunted healthcare outcomes.
    14 people found this helpful
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  • BearBear
    5.0 out of 5 stars Informative and well written
    Reviewed in the United States on February 21, 2018
    Verified Purchase
    So far it's a fantastic description of the healthcare system and the theories behind the US falling behind. Offers insight for why the US is falling behind, and offers solutions for where to focus out efforts as a nation and in the public health fields.
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  • Thomas Martin
    5.0 out of 5 stars Interesting Paradox
    Reviewed in the United States on January 12, 2014
    Verified Purchase
    Interesting read. The authors contribute to my understanding about healthcare and expanding upon the concept of "holistic." By bringing in housing, employment, food security and the like, going to see the doctor is just the last step toward good health.

    The highlight to me were the examples of clinics and programs that are already doing social services as well as traditional medicine.
    2 people found this helpful
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  • Anne Mills
    4.0 out of 5 stars A Key Diagnosis, But Short on Remedies
    Reviewed in the United States on March 16, 2014
    Verified Purchase
    This book asks why we spend so much on health care without getting very impressive results, and argues that it is because we spend so little on non-medical social services. In the US, of course, per capita spending on health care is almost double the industrial country average. Our spending on social services, however, is drastically lower. The authors argue, convincingly I think, that these two statistics are not unrelated. So far so good, and the book is certainly worth reading for this insight alone. Where it falls short, I think, is in the realm of solutions. That may be because the low level of social spending in the US reflects hundreds of years of history and strong political habits of mind, which aren't easy to change. All in all, an important book, if not an entirely satisfactory one.
    One person found this helpful
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