802 Bookshelf: As Sick As It Gets – The Shocking Reality of America’s Healthcare: A Diagnosis and Treatment Plan

by Rudolph Mueller, M.D., Olin Frederick, Dunkirk NY, 2001, 228 pp., hardcover, $22.95

Volume CII, No. 6June, 2002

John Glasel

Bookstore browsers might pass by Dr. Rudolph Mueller’s new book, “As Sick As It Gets.” Those who remember Helen Hunt’s one-liner trashing her health insurer in the movie “As Good As It Gets” will chuckle at its title, but they’ll likely shrug due to the seeming impossibility of solving America’s health care problems. Those who think they have adequate health insurance won’t want to think too much about the tragedies faced by less fortunate others, so they’ll be tempted to walk to the next aisle. Policy wonks may also pass this book by, thinking “Don’t tell us how bad things are — we know.” (Wonks always think in the first-person plural.)

Well, the shruggers, the well-insured and the wonks would all be wrong. This fine study’s “treatment plan” shows pessimists the various ways other countries structure universal health care and how it could be achieved here in the United States. Part of its “diagnosis” explains to those with insurance that their policies are likely to contain small print that could leave them risking bankruptcy if serious illness or injury should strike. It also shows how they, along with the rest of us, pay through the nose for the many inefficiencies of our system. Policy wonks are treated to detailed comparisons of American costs and treatment outcomes with those of other industrialized democracies. In a friendly, easy-to-read style, Dr. Mueller demonstrates how our health care could be made more humane, affordable and efficient, illustrating his points with well-explained graphs that can be understood even by non-wonks.

For anyone (like one unfortunate presidential candidate of a few elections ago) who doubts that the American health system is in crisis, “As Sick As It Gets” examines America’s glaring problems, e.g.:

  • More than 80 million uninsured and under-insured Americans don’t seek care until their illnesses become acute, requiring more costly treatment and resulting in poorer outcomes.
  • Americans pay more for prescription drugs, which are sold more cheaply abroad.
  • Doctors and hospitals perform unnecessary tests and procedures to forestall lawsuits.
  • Enormous sums are spent on paper-shuffling in our complicated “multi-payer” system.
  • Insurance companies and HMOs skim large profits and administrative costs from premium dollars before spending a cent on health care.
  • Total U.S. health costs are far and away the world’s highest, both as a percentage of gross domestic product and per capita.

Dr. Mueller subtracts other nations’ average costs from American health outlays, adds up the differences, and presents the grand total as a truly staggering estimate of how much we overspend. A good part of the excess is added to everyone’s doctor bills, hospital charges and insurance premiums (even if employers pay them, the cost is ultimately subtracted from employees’ pay). The rest is funded by our income, sales and property taxes, since more than half of American health care is paid for by local, state and federal governments.

What’s more, we’re not getting our money’s worth. According to the World Health Organization’s report for the year 2000, we rank 37th in overall health care quality. With the help of more fine graphs, “As Sick As It Gets” shows the U.S. well behind other major nations in such measures as life expectancy, infant mortality rate and potential years of life lost before age 70.

More than a mere recitation of discouraging statistics, Dr. Mueller’s book puts an all too human face on the problems of American health care. Dozens of individual case histories from his own practice in Jamestown, N.Y., show how pain, suffering and premature death afflict not only the uninsured but also many more whose policies require unaffordably high out-of-pocket expenses or won’t cover needed tests, treatments, and pharmaceuticals. More than a score of his patients’ gut-wrenching stories demonstrate how even superior health insurance can present serious problems.

Most people don’t like to think about getting sick or being injured. When we do, some of us have faith that we’ll somehow receive world-class care. How many times have we been told (even by presidents) that our country has “the greatest health care in the world?” After reading “As Sick As It Gets,” you won’t believe that one any more.

This book will help readers to better understand the American health care system: what’s wrong, why it’s wrong, and how it can best be fixed. With all relevant issues and up-to-date figures presented between its covers, it’s a great resource for those already in the know. Dr. Mueller’s keen analysis is “must reading” for people in a position to influence our country’s health care policy and also for citizens who want to join the debate – or just vote intelligently.