Uwe E Reinhardt (1937–2017)

Since around 2005, I’ve attempted to learn the big picture of American healthcare while focusing on my little niche in the system. After 16 years (and several legislative bills with major changes), I find myself as befuddled by the economic organization as I was at the beginning. Before dying in 2017, Reinhardt was a leading voice in healthcare economics. A Canadian by citizenship and a German by birth but an American by living, he mastered the nuances of this field and weighed in on many big questions confronting America in this book.

Reinhardt had an uncanny ability always to keep people in the center of his economic analyses of healthcare. In the epilogue, his wife and research partner suspects this was because he and his siblings were sustained by the German socialized healthcare system as youth. As such, the first half of this book is dedicated to economics, and the second half, to ethics.

Two forewards are provided by liberal economist Paul Krugman and conservative US Senator and physician Bill Frist. This ideological breadth of respect bespeaks of how respected Reinhardt’s voice is. He is no mere partisan, but instead a scholar. He pragmatically and wisely contends that the Canadian and German health systems might not serve as good models for American democracy. He is skeptical of “Medicare-for-All” proposals. His advice tries to combine the better aspects of conservative and liberal proposals.

Importantly, he argues that one often-unstated question in American debates is most important. Do Americans want healthcare as a “social good” available for all or as an “economic good” accessible disproportionately by economic class? In speculating about what a commonly acceptable system would consist of, he laudably tries to find middle ground. Few voices in American society (in 2021) seem open to such middle ground on healthcare, so I welcome this approach.

Healthcare is the biggest economic segment in American society. As such, this short and readable book should be on the radar for intelligent, politically interested citizens. It has particular import for healthcare workers in a often confusing system. It presents the big quandary of the financials – the weakness of the system – without denigrating the quality work by physicians, nurses, technologists, and other contributors. Like any good economist, he advocates for evidence-based healthcare administration and specifies a better allocation of resources. This last testament of this luminous figure should be read to elevate the level of our social dialogue.… (mehr)

If you're a health policy dork, you probably enjoyed Uwe Reinhardt's columns in the New York Times. Here, in his last book, Reinhardt presents a brief explanation of why the US health system is so broken and the ethical considerations we refuse to discuss openly. There's a lot of data and tables, which he explains thoroughly, and an analysis of the 2017 reform proposals.

I think his final parting shot of allowing the rugged individualists to do what they want, at a sharp price, wouldn't work the way he think it might (people really DO think they'll be just fine), but it's not fleshed out as a policy proposal.… (mehr)

Healthcare is expensive in America. Skyrocketing costs ensure that it is eventually going to be too expensive for anyone except the richest among us. In Priced Out Uwe E Reinhardt discusses the reasons behind this. It is a fascinating account of the whys and wherefores.

The basic idea is that healthcare costs are inflated by administrative costs and the complex and confusing system of health insurance in the United States. Although I don’t agree with Donald J Trump in a lot of his ideas and personality, I do feel that he is correct in saying that we pay too much for healthcare. With charts and graphs galore, Reinhardt explains this and compares how much we pay to countries of similar standards of living. Through all of this Reinhardt explains the economic cost of our healthcare.

In the second half of the book, Reinhardt explains the ethical portion of our healthcare. It appears that this is a troubling idea unique to the United States. If you have a person who is both healthy and wealthy, should they be forced to pay for someone that might have the need for cancer treatments? Put another way, should the people that take care of themselves to be forced to pay the same premiums and get the same care as someone who is a couch potato? This is an interesting question. The kneejerk response is no, from both sides of the political divide. There are exceptions to this; for instance, the book mentions Jimmy Kimmel and his son.

So the book also goes into the problems of the Affordable Care Act, or Obamacare, and the proposed bill that would replace it with something else. This book was written in 2017 and I am grossly misinformed on a lot of things since I don’t like watching the news, therefore, I don’t know if anything like a new healthcare law was passed.

Reinhardt died in 2017, leaving behind a great legacy, and this book. I enjoyed it a lot, but much of it did bother me. It just seems wrong that we are still having this discussion in the year 2019. In any case, this book was great.… (mehr)