David Blumenthal - Böcker

Based on extensive inside sources, a revealing account of how the Obama, Trump, and Biden administrations transformed both health care and politics in America For nearly a century, every Democratic president—and many Republicans—entered office promising to restructure America’s health care system. Barack Obama finally broke through but, in the process, opened a tumultuous decade in which battles over health care dominated American politics. David Blumenthal and James A. Morone go behind the scenes to describe how three very different presidents—pursuing very different goals—maneuvered through the fraught politics of health care. President Obama ended the century-long quest for reform but ignited a screaming culture war that blazed into the Trump administration and blew up during the COVID epidemic. President Trump, facing the greatest health crisis in a century, denied and dithered. Then he directed a medical triumph in Operation Warp Speed. He and President Biden, facing the pandemic’s devastation, mounted the most successful anti-poverty program in eighty years. But in the tumult, Trump launched a shattering new political war, not over coverage but over science itself. Authoritative and gripping, this book describes the remarkable achievements of these years while also showing how respect for science clashed with scorn toward the deep state and left the nation unprepared for the next health crisis.

The VA National Formulary generated controversy, which motivated congressional scrutiny and a directive to the VA to commission this report reviewing the experience with the National Formulary and formulary system. This Institute of Medicine committee was pleased to assist the Congress with this review, in part because the committee saw in the VHA example an opportunity to understand and anticipate problems that all publicly funded programs are likely to encounter in this new age of pharmaceuticals. The Congress asked the committee to review the restrictiveness of the National Formulary, its impact on the costs and quality of care in the VHA, and how it compared to formularies and drug management practices in the private sector and in other public programs, especially Medicaid. Detailed in the pages that follow, the committee's findings and conclusions on these questions are, the committee believes, highly instructive, though not always in the ways that we anticipated.

Thousands of measures are in use today to assess health and health care in the United States. Although many of these measures provide useful information, their usefulness in either gauging or guiding performance improvement in health and health care is seriously limited by their sheer number, as well as their lack of consistency, compatibility, reliability, focus, and organization. To achieve better health at lower cost, all stakeholders - including health professionals, payers, policy makers, and members of the public - must be alert to what matters most. What are the core measures that will yield the clearest understanding and focus on better health and well-being for Americans? Vital Signs explores the most important issues - healthier people, better quality care, affordable care, and engaged individuals and communities - and specifies a streamlined set of 15 core measures. These measures, if standardized and applied at national, state, local, and institutional levels across the country, will transform the effectiveness, efficiency, and burden of health measurement and help accelerate focus and progress on our highest health priorities.Vital Signs also describes the leadership and activities necessary to refine, apply, maintain, and revise the measures over time, as well as how they can improve the focus and utility of measures outside the core set. If health care is to become more effective and more efficient, sharper attention is required on the elements most important to health and health care. Vital Signs lays the groundwork for the adoption of core measures that, if systematically applied, will yield better health at a lower cost for all Americans.

Even the most powerful men in the world are human - they get sick, take dubious drugs, drink too much, contemplate suicide, fret about ailing parents, and bury people they love. Young Richard Nixon watched two brothers die of tuberculosis, even while doctors monitored a suspicious shadow on his own lungs. John Kennedy received last rites four times as an adult, and Lyndon Johnson suffered a 'belly buster' of a heart attack. David Blumenthal and James A. Morone explore how modern presidents have wrestled with their own mortality - and how they have taken this most human experience to heart as they faced the difficult politics of health care. Drawing on a trove of newly released White House tapes, on extensive interviews with White House staff, and on dramatic archival material that has only recently come to light, "The Heart of Power" explores the hidden ways in which presidents shape our destinies through their own experiences. Taking a close look at Franklin D. Roosevelt, Harry S. Truman, Dwight Eisenhower, John Kennedy, Lyndon B. Johnson, Richard Nixon, Jimmy Carter, Ronald Reagan, George Herbert Walker Bush, Bill Clinton, and George W.Bush, the book shows what history can teach us as we confront the health care challenges of the twenty-first century.

With computerized health information receiving unprecedented government support, a group of health policy scholars analyze the intricate legal, social, and professional implications of the new technology. These essays explore how Health Information Technology (HIT) may alter relationships between physicians and patients, physicians and other providers, and physicians and their home institutions. Patient use of web-based information may undermine the traditional information monopoly that physicians have long enjoyed. New IT systems may increase physicians' legal liability and heighten expectations about transparency. Case studies on kidney transplants and maternity practices reveal the unanticipated effects, positive and negative, of patient uses of the new technology. An independent HIT profession may emerge, bringing another organized interest into the medical arena. Taken together, these investigations cast new light on the challenges and opportunities presented by HIT.

With computerized health information receiving unprecedented government support, a group of health policy scholars analyze the intricate legal, social, and professional implications of the new technology. These essays explore how Health Information Technology (HIT) may alter relationships between physicians and patients, physicians and other providers, and physicians and their home institutions. Patient use of web-based information may undermine the traditional information monopoly that physicians have long enjoyed. New IT systems may increase physicians' legal liability and heighten expectations about transparency. Case studies on kidney transplants and maternity practices reveal the unanticipated effects, positive and negative, of patient uses of the new technology. An independent HIT profession may emerge, bringing another organized interest into the medical arena. Taken together, these investigations cast new light on the challenges and opportunities presented by HIT.

As the population ages, policymakers must evaluate the nation's readiness to assist a growing group of people with conditions requiring chronic and long-term care. Based on the 2002 annual meeting of the National Academy of Social Insurance, this new volume offers a variety of viewpoints from policymakers, researchers, and experts who examine how well the needs of the elderly and disabled Americans are being met by today's financing and delivery systems, in light of potential reform options. Particular attention is paid to care coordination issues—namely, the impact of acute-care policies on long-term and chronic care—to draw attention to how the segmentation of healthcare provision can create disruptions in patient care. Authors address the advantages and disadvantages of varying levels of state, federal, and private involvement in long-term care. Clearly, for people to access appropriate long-term care today and tomorrow, a careful balance of financing sources and integrated health care must be achieved. Researchers, analysts, and policymakers, therefore, will find this volume useful to informing thoughtful analysis of important long-term care issues.