Demand Better
Revive Our Broken Healthcare System

Sanjaya Kumar, MD and David B. Nash, MD

Demand Better! is a must-read for patients and doctors wanting better health care in the United States.

Last year my father dislocated his shoulder while we were in Venice. By the time a medical practitioner could check it, the muscles had tightened up. It couldn't be just popped back in without a lot of pain. So a water ambulance took him to the local hospital. He was x-rayed, then given general anesthesia. His shoulder was popped back while he was under. He spent the night in the hospital under observation receiving IV fluids. We picked him up the next day after they finished one or two more tests on him, gave him a sling, and home going instructions. Aside from the IV glass bottle hung on a nail on the wall rather than a plastic bag on a pole, his treatment was not different from what we could tell. The total cost for all that care? My parents paid less than $2,500, which insurance reimbursed. If that had happened here in the States it probably would have cost up to four times more.

Demand Better! Revive Our Broken Healthcare System address the problems in America's current model of health care provision. Doctors and hospitals get paid per procedure, so are inclined to order more to earn their paycheck. The procedure may not make any clinical difference to the patient, though. Patients in this country feel they must have every test or procedure possible to ensure they're getting the best care. According to Drs. Kumar and Nash, this leads to the following myths about health care.

Myth 1: There is a high degree of scientific certainty in modern medicine
Myth 2: More healthcare means better healthcare
Myth 3: Our healthcare is safe
Myth 4: Our healthcare payment system works
Myth 5: Our medical schools prepare the best future doctors

Drs. Kumar and Nash go through each of the Myths they identify and explain in easy language what is wrong in the system. In the second half of Demand Better! they discuss ways to change. They have real life examples of the problems and the programs that are being put in place that are showing improvement.

For example, one solution they discuss is to pay a flat fee to doctors, hospital, and allied health for a treatment. They then have to divide the fee between them. What does that do? It improves communication between all the parties involved, resulting in less errors, better care for the patient, and reduces the chance of a patient readmission. Extra tests aren't ordered if they're not needed, but still can be. Can't happen in this country? There are already some hospital systems working with this model. Drs. Kumar and Nash show the examples and the outcomes.

Healthcare reform in the United States needs a lot of work. It won't be easy to change mind sets. But Demand Better! challenges us as patients to be aware of and involved in our care. It challenges health care professionals to look more closely at preventive care as well as react to symptom needs.

Demand Better! Revive Our Broken Healthcare System is easy to read and all to often startling in its facts - which are cited in bibliographies at the end of each chapter. At times it gets a bit dry, especially if you're trying to read this book like a novel. It isn't. It's an expose that is a challenge for us to make Americans healthier with cost effective methods.