Crony Capitalism in US Health Care: Anatomy of a Dysfunctional System (Routledge Focus on Business and Management)

"The US political system has come to depend upon money too much. The US health care industry spends the most on political lobbying among all the 13 industrial sectors in the US economy. The government regulatory agencies at both federal and state levels have been "captured" by the health industry interest groups meaning that the regulatory agencies respond to the interests of the industry but not those of citizens. This book employs a broad theoretical framework of crony capitalism to understand US health care system dysfunction. This framework has not been applied before in any serious manner to understand the shortcomings in the US health care system. Specifically, the book examines the role of seven key players using this framework - politicians/interest groups, pharmaceutical companies, private health insurers, hospitals/hospital networks, physicians, medical device manufacturers, and the American public. Crony capitalism is a destructive force and is rampant in US health care system, causing much waste, inefficiencies, and malaise in the system. Current efforts and initiatives, such as patient-centered medical homes and precision medicine, for improving/reforming the system are of mere academic interest and tantamount to taking aspirin to treat cancer. They do not even pretend to address the root cause of the problem, namely, crony capitalism. Offering prescriptions to fix the U.S. health care system based on a comprehensive diagnosis of the dysfunction, this book will be of interest to researchers, academics, policymakers, and students in the fields of health care management, public and non-profit management, health policy, administration, and economics, and political science"--Publisher's description Cover 1 Half Title 2 Series Information 3 Title Page 4 Copyright Page 5 Dedication 6 Table of Contents 8 About the Author 10 Preface 12 Acknowledgment 15 Part 1 Explication of the US Health Care System Dysfunction 16 1 The Nature and Extent of the Problem 18 Overly Expensive, Unaffordable 18 A Source of Anxiety, Insecurity, and Despair for Many Americans 20 Wasteful, Starving Other Sectors of Economy 21 Unsafe, Poor Clinical Outcomes 23 Scam Like Features of US Health Care System 24 Conclusion 24 References 25 2 The Crux of the Problem 27 Distinguishing Greed, Profit, and Crony Capitalism 27 Crony Capitalism 28 Crony Capitalism Toolkit 30 Crony Capitalism in the US Health Care System 31 Enormous Waste in the US Health Care System and What Underlies It 32 US Health Care System as a Peculiar Mix of Capitalism and Socialism 35 Conclusion 36 References 37 3 Medicine Without Evidence 38 Evidence-based Medicine 38 Comparative Effectiveness Research 39 Why Evidence-Based Medicine and Comparative Effectiveness Research Receives So Little Attention? 40 Entrenched Culture of Consuming More Health Care 41 Conclusion 42 References 42 Part 2 Key Players Contributing to the US Health Care System Dysfunction 44 4 Politicians/Interest Groups 46 Spending On Lobbying and Number of Lobbyists in the Health Care Industry 47 The Capture of US Health Policy By Business and Interest Groups 48 Institutional Sclerosis 50 Conclusion 50 References 51 5 Pharmaceutical Companies 53 The Nexus Between Drug Companies and Politicians 53 The Nexus Between Drug Companies and Physicians 54 The Compromised FDA 55 The Pharmaceutical Benefit Manager 56 Lack of Innovation 56 Corrupting of Science 56 The Opioid Crisis 57 Generic Drug Manufacturers Have Come to Play the Game Too 58 Conclusion 58 References 58 6 Private Health Insurers 60 A History of Undermining Health Care Reform 61 The Linchpin of the US Health Care System Cabal 63 Deadly Spin 63 Administrative Complexity 66 Unfettered Corporate Power 68 Conclusion 70 References 70 7 Hospitals and Hospital Networks 72 Overuse of Medical Procedures and Services 73 The Cost Conundrum: Two Different Models of Care 74 The Hospital Charge Master: An Exploitative Pricing Tool 75 The Coding as an Industry 76 Super Concentration of Hospital Markets and Undermining of Competition 77 Surprise Billing 78 The Emergency Room Services 79 Collusion Between Hospitals and Insurance Companies 79 Lab Tests and Ancillary Services Such as Physical Therapy 80 Hospital-induced Injuries, Illnesses, and Deaths 80 Cozy Relationships Between Hospitals and Local TV Stations 80 Conclusion 81 References 81 8 Physicians 84 The Company Insurance Model 85 The Fee-For-Service Model 86 The Biomedical Model 88 The Breakdown of Basic Ethics, Hippocratic Oath 88 Physicians and Conflicts of Interest 89 Who Sets the Price for Medical Procedures and Treatments? 91 Medical Malpractice Tort a Convenient Excuse for Defensive Medicine (Overtreatments)? 92 Physicians Blame the System and Other Players in the System 92 The Malfunctioning Social Contract Between Medical Profession and Society 93 Conclusion 94 References 94 9 Medical Device Manufacturers 97 A Tight-Knit Oligopoly 98 Nexus With Physicians 98 Shoddy Oversight by FDA 99 Unethical Behavior 99 Conclusion 99 References 100 10 American Public 101 Habits, Attitudes, and Lifestyle of the Americans 101 The Commonly Harbored Myths About the US Health Care System 102 Shaping/Manipulating of Views/Attitudes of American Public by the Industry Spin Machine 104 The Prevalent Biomedical Model of Health Care in the US 105 Conclusion 106 References 107 Part 3 How to Fix the US Health Care System Dysfunction 108 11 Addressing Crony Capitalism, Root Cause of the Dysfunction 110 The Role of Business 112 Political Campaign Reforms, Repeal of Citizens United, and Small Donor Revolution 113 Politics By Principle and Influx of Entrepreneurs 114 Conclusion 114 References 115 12 Health Insurance, Payment, and Pricing Arrangements 117 Administrative Complexity 118 Pricing Failures of Health Care Procedures, Treatments, Drugs, and Services 120 Failures of Care Delivery and Coordination 122 Overtreatments or Overuse of Medicine 123 Basic, Practical Solutions 123 Conclusion 124 References 125 13 Well-Informed Citizenry 127 Conclusion 130 References 130 Conclusion 131 Index 135 "The US political system has come to depend upon money too much. The US health care industry spends the most on political lobbying among all the 13 industrial sectors in the US economy. The government regulatory agencies at both federal and state levels have been "captured" by the health industry interest groups meaning that the regulatory agencies respond to the interests of the industry but not those of citizens. This book employs a broad theoretical framework of crony capitalism to understand US health care system dysfunction. This framework has not been applied before in any serious manner to understand the shortcomings in the US health care system. Specifically, the book examines the role of seven key players using this framework - politicians/interest groups, pharmaceutical companies, private health insurers, hospitals/hospital networks, physicians, medical device manufacturers, and the American public. Crony capitalism is a destructive force and is rampant in US health care system, causing much waste, inefficiencies, and malaise in the system. Current efforts and initiatives, such as patient-centered medical homes and precision medicine, for improving/reforming the system are of mere academic interest and tantamount to taking aspirin to treat cancer. They do not even pretend to address the root cause of the problem, namely, crony capitalism. Offering prescriptions to fix the U.S. health care system based on a comprehensive diagnosis of the dysfunction, this book will be of interest to researchers, academics, policymakers, and students in the fields of health care management, public and non-profit management, health policy, administration, and economics, and political science"-- Provided by publisher Explication of the U.S. health care system dysfunction -- The nature and extent of the problem -- The crux of the problem -- Medicine without evidence -- Key players contributing to the system dysfunction -- Politicians/interest groups -- Pharmaceutical companies -- Private health insurers -- Hospitals and hospital networks -- Physicians -- Medical device manufacturers -- American public -- How to fix the U.S. health care system dysfunction -- Addressing crony capitalism, the root cause of dysfunction -- Health insurance, payment, and pricing arrangements -- Well-informed citizenry