Unraveling U.S. Health Care: Everything you Always Wanted to Know about health care but were afraid to ask

This clearly written, concise guide to health care needs and issues in the United States provides invaluable information to both residents and visitors alike. I will recommend it to my American friends. Five stars.

David

Roberta,
I am taking the liberty of making some suggestions to chapter 4, which you should feel free to ignore (and actually should in the case of the beer ones). I have not finished, but forward these as the comment is getting long.  
Best,
Maeve
Measuring the real cost of any public program should consider economic factors,

This sentence has something missing- suggest
In order to measure the real cost of any public program, economic factors should be considered,
or
Someone measuring the real costs...

opportunity costs, rather than cost.

At that time Norway was the wealthiest with $53,100 dollars of gross national income per person, compared to the USA’s $44,200 per person in that time frame.

I think per capita is a nice turn of phrase. 
suggest "for he same period" rather than "In that time frame"

Fast forward to 2010 to see where these countries are now, given the global financial melt-down. Depending on which source you use, here is where these countries ranked in 2010 public information.

I find the imperative voice a bit off putting.. Suggest either
"Let's fast forward to 2010 to see how these countries have fared in light of the global financial meltdown. Depending on which sources we use, the following is an assessment of how these countries ranked in 2010, based on publicly available information.

or
In light of the financial meltdown, it is interesting to compare these figures with the ones for 2010, based on publicly available sources.

World Bank 2009 report

Suggest
The world bank reports  income for full time wages (only) and is based on 2007 data[2], so it doesn’t accurately reflect the global economic depression since then. Due to the fact that millions of people were out of work for  years 2008 and 2009 in the United States, the wage level will probably drop in future reports.


Norway
 
Suggest
The World Bank lists Norway as 3rd richest as regards gross domestic product (GDP), which includes earnings and savings.  The average national GDP per Norwegian is listed as $86,440[3] in 2009. However, the average wage for-full time work  is a much lower, at $40,742 per person, which would put Norway in 9th place. What the report doesn’t say is that a beer costs the equivalent of ten bucks there, because purchasing power impacted by the cost of living is not taken into consideration in the calculation of GDP. It also explains why there are no world famous Norwegian beers. 


Ireland
Suggest 
World Bank data lists Ireland in 6th place, with $51,049 per person[5] and the average income per Irishman at $44,310 in their 2009 report.[6] When we look at the average wage for full-time employment,  Ireland shows up at $44,013 for fourth place. But the best beer in the world is made there- dark and frothy and delicious. 

Luxembourg,- you use who and then which. Also, some commas missing. I suggest:
What is really interesting is the country that is  in 1st place, which, according to the World Bank, is the tiny European burgh of Luxembourg, with a GDP of $84,003 per person in 2009. And, if that isn’t enough to embarrass you, their citizens live three years longer than the average American.[7] The average full time wage is $49,663, which is much lower than the other values (NOT SURE WHAT YOU MEAN) because it does not include cash reserves in investments accounts. In  spite of this, Luxembourg is still  in first place in this criteria. Singles ads anyone?

Suggest
...Norway spent $2,920 per person compared to the United States' $4,487 per person, and Ireland's $1,935.

More soon,
Maeve

Great book! Will go on my shelf when I rearrange it. Highly Starred.
Thanks,
Scott Trimas
The Chimera Factor

Re-backing this bible of healthcare which all Americans, including Congress, should read - ideally before the next Election...

So well written. This is it. And it gives reasoned analyses on how the system can go forward, by an expert.

Kay-Christina
(*Annacara*)

Chapter 4 ends poorly. The whole problem with Entitlements - Social Security, Medicare and Medicaid - is not that they are terribly expensive right now, but if the system is not fixed Entitlements will be crushing people in a few decades. A person who is 10 years old now, will, in thirty years, be paying 95% of his income, or more, in taxes. Most of these taxes will go to pay the Entitlements for all of the old people. You talk about bullies. If the system isn't fixed it will crush people with tyrannical taxation.

You have to fix the end of Chapter 4. You have to acknowledge that Entitlements in the USA must be fixed - obviously in a sane way not a draconian way - or else reasonable people will never buy your book.

I skipped ahead to Chapter 10. You say Rochester Minnesota is on the Mississippi. Sorry, but it ain't so. A small point of course, but since you're from minnesoooota i had to mention it.

You deal with Malpractice Insurance in Chapter 12. Litigation and Tort Reform. Sometimes the guilty should be slammed with heavy punitive damages, but if a doctor makes an honest mistake, why should he be slammed by having to pay any punitive damages? What's a fair price to pay for someone's pain and suffering? How much do you make all doctors bleed via their insurance premiums because some doctors make big slip-ups? These are tough questions which demand answers. Give us answers healthpolicymaven!

Chapter 3. We got a list of 17 things. I think you might need to start this chapter with your experience in the E.R., which comes as # 17. About the other 16 things, I think you'll lose lots of readers if you try to make this chapter too concise. Feel free to explain things in great detail. Are MRIs usually a huge waste of money? It seems to me you should imagine you are talking to a typical 19-year-old, and you should explain these matters in terms he or she can understand. The way you explain the problems with service on demand policy is confusing. I get it, I guess. If you're not going to die if you don't get to a doctor right away, then you don't need to be seen by a doctor right away, but your explanation might need an example or two. Take the last sentence in # 2, about front-end deductables etc. This is comprehensible to millions of people, but you might want to explain it to the millions who don't understand. I get what you're saying in # 3, but a few examples might help.

Chapter 1. Several commentators here at authonomy have advised you to tone it down. One guy said, more or less, in reference to the money spent on the Pentagon: `DON'T MENTION WAR-MONGERING.'…You're being pulled in different directions. People are telling you to keep it scholarly but readable, whereas, your instincts tell you to be scholarly but also inflammatory. Inflammatory books ought to be more readable and less dull than the typical scholarly soporifics…at one point you talk about doing some pimping - which implies you will tell us who the johns and prostitutes are in the US health care industry. Even though an editor told you to use the word `schlep', you still got the word `pimp' in your book. It should be taken out, in my humble opinion, but you have to decide these matters yourself. Still, aren't you being a little too hard on yourself and some other people? It's tough to make a buck in this world. Not everyone can be a primary care giver. You were 19 when you entered the world of insurance. It is this part of your biography which will be especially appealing to many readers. You have an MPH. But you also struggled for years to succeed in the corporate world. This means you have a combination of real world experience and ivory tower experience, and this makes your bio impressive in the eyes of people who distrust academics with no experience in the business world.

I dealt briefly with Chapter 2 in my first comment, so lets skip to Chapter 3...

You say on your bio page: `So for the rest of you who are looking for a genuine analysis, good or bad, and have the cojones to contact me, I still do reads on request.'
Some people would say this makes you sound too combative, and therefore you should get rid of it. But I think it's ok. I mean a bio page should tell us about a person, and if every bio page was crafted by a PR professional then we wouldn't learn much about people.
Your avi pic is very good. Those people on this site who don't use pictures of themselves are doing it all wrong. They declare to the world that they are ashamed of how they look. That's not what you want to do when you're trying to sell a book. I rotate my avi pics. I got one where I'm smiling, one where I look kind of tough, like an ex-con, one where I look sort of blase etc. I suppose it's always best to go with one where you are smiling, and yours is perfect.
The picture of the fat lady on your cover is rather provocative, and funny.
On your bio page you list a number of reasons why people should read your book. By far the strongest reason is that the citizens of a democracy must be well-informed on many issues, including health care policy, in order for that democracy to be just and equitable. People outside the USA can find ideas to improve their nation's health care system by reading books about the problems with the American system.
Title: `Health Care for Amateurs' - you got to admit that it doesn't grab the imagination. Your first title was better.
SP: We have redundancy. It's a guide. No need to use two sentences telling us your book is a guide to explaining US health care.
LP: We have another sentence telling us it is a guide. Do you really want to say your book has a Robert Pelton swagger? Who, after all, is Robert Pelton? Well, I checked him out on Wikipedia. People who know who Robert Pelton is might not think it is right for you to say your book has a Robert Pelton swagger, because, he was nearly assassinated in Uganda, and he is always risking his neck in dangerous places. Does healthpolicymaven risk her neck in dangerous places? If not, perhaps you shouldn't say your book has a Robert Pelton swagger to it. This might seem like a nit pik but this is one argument against your pitch.
Chapter 1…to be continued…

You're absolutely right in your first paragraph about these deceptions - though of course you have to decide if it's best to be aggressive and call them `deceptions' or simply `myths' which are based on honest ignorance.

How much should the tax payers pay to keep an elderly cancer patient alive? That's a tough question.

In the UK I believe the government will not pay for surgery and treatment if it will cost more than $450,000 to keep an elderly cancer patient alive for an additional 10 years. Whereas in the US, Medicare will pay much more than that. The system is cruel if it doesn't pay money to save lives, but then the system goes bankrupt when it does pay.

The most obvious way that the US already has socilized healthcare, not a system based on the Free Market, is that the government controls the number of medical and nursing schools, and the number of certified professionals, and hence the government controls the supply of doctors and nurses. In a free market, the government doesn't control the supply of something. In the USA we have people with 3.8 gpa`s who can't get into medical school. We have thousands of qualified people who are excluded from the medical profession. The fewer doctors that a nation has, the higher the wages for those doctors. But it is impossible to improve any nation's health care system unless that nation increases the number of its qualified doctors and nurses. The doctors must, to some degree, have high salaries, because they will need to pay huge insurance premiums, and of course the rewards for years of study and hard work must be generous, or else people will not care to endure the years of rigorous medical school and post-graduate training required to become doctors. But, the more a nation prevents qualified people from entering the medical profession, the more it hurts its people.

Kia ora Roberta,

Just time for two chapters over coffee before work but I found your book to be very interesting. I will definitely be back to be your chapters on investment in childcare as I feel that this area is the starting point of reform and progress. I studied the policies of the World Bank and IMF for my MEd. and read about the tragic effects of their user-pays policies in Education and Health in developing countries. Their rationale at the time was that introducing cost would lead to natural competition and improvements in quality of service. This market-driven Neo-liberalism was a disaster as the 'customers,' -a word which should NEVER be used for Health and Education simply could not afford access and all manner of effects were witnessed on health and education statistics in these countries. The WB and IMF reluctantly changed their tune about 8 years ago, and now the WB advocates free education for primary school children with user pay fees kicking in at secondary school. THIS MAKES ME MAD!!! It's like dangling a carrot or a few years of hope in front of a child with big dreams for the future. I witnessed this first-hand when I volunteered as a teacher in a mountain village in Nepal. I taught through a change in year when my oldest students would become secondary students. When I walked in the classroom this first day of the new year, the greeting I received from the students, "Good morning, Sir!" had a different tone to that previously. It was completely male. All the girls had had to drop out because their families could not afford to send all their children to school and when it came to deciding who would receive and who would not, it was the girls who missed out.

All this I can see reflected in the US. Without a strong, sustained investment across the board in childcare, infant mortality statistics, immunity injection statistics and child health in general will worsen and the gaps between the haves and have nots or those who have do not have access to quality healthcare will widen. Child health and educational progress and development are inextricably linked. Educational development and crime statistics also have obvious connections. I think the Scandinavian systems which tax the hell out of people but place huge importance on early childhood development have it right.

Whew! Ok that's my spiel! I admire and share your moral and political stance on these issues, Roberta. I'll be back to read and comment more (maybe with a closer focus on your writing very soon)

Highly rated and of course, recommended!

Best,

Kaal Kaczmarek

Hey Roberta

I don't know much about the US healthcare system being a Brit, so from that point I found this quite an interesting read. I did think it was a bit info heavy at times, though that's to be expected given the type of book it is. Whether you've done your research isn't something I can comment on, obviously, but you seem to know what you're talking about!

I like the way it's laid out, things are easily referenceable thanks to your headings. I'm not sure if you have graphs/charts in here but in some places in your second chapter (numbers 13 and 17) there was a weird little icon thing?

I can't comment much on the content but I found it written in plain english, it was easy to understand and overall, well presented.

Silva

hi roberta
i have read only the first two chapters coz of time constraints so will comment only that much
though this book is about the us healthcare system,
i was thinking why not start the book
with say..
usa ecnomically most advanced in almost all rankings but what is its rank vis a vis healthacare.
then go on to give a brief oveview of the global scenario highlighting france
and compare its health care quality scores with that of usa. or may be compare 2-3 countires scores eg...cuba, france

and then shift to why this discrepancy...the truth about usa care
and then u highlight pvt vs publc
and the then section moving on to public
and then the other sections

well you will have to have a lot of charts and diagrams in this chapter else everything will go above head

i know my remarks are harsh and blunt but still
since u have touched a topic so close to my heart ... i couldnt help it

by the way i had been following in bits obama and bush debate on healthcare
but not in depth. quite a few things are new to me.
will read more as and when i get time.
u need to put in a lot more work to put this book together, coz still things are raw i guess.
regards
dr amit

Unravelling US Health Care: Everything You Always Wanted to Know… by Roberta E. Winter


Intro and Chapter 1

Hi, Roberta. I think I’ll just be looking at this at the level of general engagement of the writing, as you asked I should. All to be taken as imho of course.


Pre-Introduction.

The first main paragraph in bold, maybe you could split it into 2. Start the next one at ‘There are explanations…’ , but maybe reword it then to something like,

‘In this book you will find the explanation of how all the …’


Introduction

A lot of brackets in that first paragraph, doesn’t aid flow.
- Maybe cut entirely ‘(most clients…)’
- ‘(at least 15 years)’ – could cut or use an En line before the part in brackets and remove brackets.

I would cut ‘Tied for the eldest student’ and say this,
‘…to enter the world of health care advocacy; one of my classmates was younger than…’

[when I was merely 19 years old]
‘when I was just 19 years old’

I’m a menace with my own long paragraphs :), but I would suggest a break at ‘For the next 15 years’ and reword to something like,

‘In the following 15 years I researched and…’

[Once I criticized..]
‘On one occasion I found myself criticizing…’

I don’t think you need the comma at ‘ education meeting, for the poor job’

Typo; you are missing a space before the brackets at ‘in 2004 (but I…)’

[This book gives you…]
‘This book will give you…’

[…in the United States, everything…]
‘in the United States; everything from…’

[if any of these circumstances apply you]
‘if any of these circumstances apply to you’


Maybe you might think about changing the intro heading to

‘Introduction – healthpolicymaven - why you need to read this book’
It grabs a little more and then gives a feeling of roundness to the whole thing as you introduce ‘healthpolicymaven’ towards the end.


Chapter 1: The Truth About U.S. Health Care

Good chapter title.

For readability and digestion maybe bullet points rather than semi colons for the first group of myths. Or maybe, to help get the points over as an argument more than perhaps happens with lists, pair the myth with the reality:

Myth 1. The system is privatized

Reality. U.S. health care is a combination…


Myth 2. A national health care program…

Reality …



Private versus Public Health Care in America

I’d prefer, for readability, if you put the Kaiser info all in a footnote at the end of ‘health care on their own’, though I am suggesting this from a point of total ignorance as to who Kaiser is/are and you may want to mention them specifically for some reason here, and again in the next paragraph, though you could footnote there too.


Formatting – ‘Infant Deaths’, you use a colon, but for the next ‘Scores’ – Vaccination rates and Life Expectancy you use a line break. I think for consistency maybe use a line break after ‘Infant Deaths’


[For more details..]
‘To get up close and personal and to see how this affects you in your state, read on my friend’
- because this chapter, to a UK outsider like me anyway, has a lot of detail and info to process, so to get readers reading on it might be as well to revise out the word ‘details’


Overall, honestly, it’s hard for me to give a full nailed-on opinion because I am quite far I think from your target audience. I can see though a book in its spirit that is like Naomi Klein’s ‘Shock Doctrine’ which I read and enjoyed, and I can imagine that there is potential to dip into the same stream of success with your book.

You do present a lot of information in this chapter, and for that reason if you could break up a few of the paragraphs it might help me as a reader. But at the same time, in the intro you do tell readers to focus on chapters that may have more relevance to them so the feeling of occasional information overload that I had in this chapter may not be so important. But, there again, if you could fully engage a lay reader in this field like me it would bode well.


I did look for the medical tourism chapter, but that looks like chapter 13 and is not uploaded here. If you upload it I'll be happy to take a look.


I wonder if the copy editing has led to a change in balance towards facts. You implied a loss of a certain strand in the 'voice; - non-fiction has a 'voice too'. I guess it will depend how much of the 'healthpolicymaven' is felt in the book, judging from what you said about those writings.


I hope I was able to be a bit useful. These are very important subjects and I’m sure to the readers in America you will find a lot of interest and this book could easily become a talking point for several debates. ... just catching a review from Mr Grassroots now I think that could well be the case. I really wish you every success with this, and do please ask if you want me to look at anything again or further uploads.

Best,

John

Firstly, you had me at the title, and then at the short pitch. I follow American politics quite closely and I've been a bit bemused by the whole healthcare thing, so this book is just what I needed, and I love the aim of it being like Lonely Planet - chatty and easy to follow. From the chapter headings it looks very thorough, and I'd certainly be interested in reading this.

You are very upfront about your views from the beginning - using words like debunking the myths etc. Obviously it's fine to have an opinion, fine even to express it but it may be that the very people you are seeking to reach would be put off when they open the book and see you have an agenda, if what they wanted was something more neutral to get their head round it. I'd suggest something like "Let's take a look at commonly held beliefs about American healthcare today..." So you don't go about calling them myths straight off - you could even include some truths in that list.

Obviously that's just my opinion though, and I'm British so there may well be cultural differences!

- Unravelling US Healthcare -

(Based on authonomy chapters 2, 3, 4 and 9)

It was never going to be difficult to convince me of the flaws in a largely private medical system. I've often argued with people on the point, moreso since I moved to Germany and found myself paying for unnecessary treatments and tests time and time again. But nevertheless, the arguments in here are strong. Finding out how poorly the US fares in terms of infant mortality is extremely sobering. And the myriad of interests involved in steering/derailing healthcare is quite dizzying. The growth of healthcare tourism is also astounding. Was that right, 750,000 in 2007 and up to 6,000,000 in 2010? The jump seems remarkable and I would have liked to have know why the increase was so extreme.

The one thing I wondered throughout was who the intended audience is. As I say, the argument is convincing but it does seem to be rather academic in overall tone so that could hinder its ability to speak to a wider audience, not that I know about these things though.... Authonomy chapter 2 for example is filled with a lot of statistics that can be quite dizzying when trying to take them all in at once. I expect though that the master copy of the manuscript contains tables and charts that would illuminate things better and make them easier to comprehend. Nevertheless, if the intended audience is a general readership, the book could perhaps benefit from one or two case studies/anecdotes to illustrate the points being made in a way that people can easily relate to. I thought the author's anecdote about personal experience of the healthcare serice was effective because it allowed me to picture the effects of the current state of affairs far more vividly than the statistics previously. So perhaps more of the same might be of use....(?)

I am no expert on the subject though and have no clue whatsoever as to the market for such a topic so there is a reasonable chance that I may be speaking out of an orifice with which a proctologist would be familiar....

Two nitpicks
-a typo in authonomy chapter 2' "United State"
-the postgrad analysis of the nationalisation of healthcare is mentioned/introduced twice, in chapters 2 and 3 (I think).

I hope at least something I've said here has been useful.

All the best with it,

Ross

This is an illumination of the darkness

Hi This book is very informative and it must reach market.

The writing is clear and well edited. The subject matter isn’t really of that much interest to me (Authonomy is a British site, so you were always going to face some disinterest in this particular topic), but any kind of David vs Goliath type narrative can win a reader over, I believe. Not sure if that’s what you’re going for.

The start with personal biography, followed by a lot of facts and figures, was a little on the dry side. Possibly an anecdote or representation of the issues through a dramatised scene may have been more effective as an opener (maybe the bicycle accident?).

More of a text book for interested parties, rather than an eye-opener for the laymen, is how it came across to me. Maybe if I had the book in my hand and could flick through it to bits that interested me my response would have been different, but not something I could get into.

Dear Roberta,

Unraveling U.S. Health Care: Everything you always wanted to know about health care but were afraid to ask – I have read your book's pitch, chapter 1 and jumped to chapter 11. Your book is an exciting and an instrumental one with great deal of information healthcare. An American family should find it a must-have in the home. Equally, policy makers, healthcare service providers as well as researchers should find it handy.

Remain blessed.

I completed this book with great interest. Roberta, you have the potential to be the Suze Orman of health care policy, with the right strategy and marketing. I would like to see more simplification in your writing so the average person can understand (yes, like Suze). Establish yourself as an expert in this area. I will recommend a good book (but I assume you have already read it) titled Deadly Spin by Wendell Potter. Not just a great book, but the simple message concept. And please write if you have any questions whatsoever. I appreciate your support too, but frankly, I don't tie those two together. I love the potential of this book on its own merits. Thanks. Mr. Grassroots.

Hi
Your book is one of the books I wish to see in bookstores. You have rightly pointed out that this site is full of fictions. I believe people want to read fictions only. That is the reason many subjects of non-fiction are written as fiction. While writing fictions authors find ample space for their imagination that spoils the authenticity of the content. It is surprising why people are not interested to read the truth but the stories.
Anyway yours' is an exceptional concept; Soon, I will read it and comment further.

This is Greaaaaaat! I intend to finish reading the book and will tout it every chance I get. Thanks. Mr. Grassroots.

This is Greaaaaaat! I intend to finish reading the book and will tout it every chance I get. Thanks. Mr. Grassroots.

i read your introduction and some of the others parts you have posted, it offends my tea party sensibilities, no just kidding, there is no sense in the tea party when it comes to health care, you are one of those stubborn facts people, thank god for you, i hope your work helps some person obtain the right health care, if possible, it would have been nice if eisenhower warned us about the medical insurance complex also, do i think you know what you are talking about, yes, do i think you write in a clear manner, yes, do i think there is swagger in your presentation, yes, but swagger with good intention, that you focus on how to help your reader redeems you, and hell with as much work as you have put into the field you deserve showing you have conquered the ins and outs, the only problem i see is that the we are in a crazy period, and who knows if health care's landscape will not dramatically change here, but this might be a reason for another book, best of luck to you and putting you on my watch list and giving you stars, if you can will you look at one of my pieces, "ghost dance" of "crow diary" i would appreciate it

Roberta,
It's heartening to see someone finally step up to the plate and clear the fog surrounding healthcare in the United States. That it is such a controversial matter stems from adequate healthcare being highly dependent on a profit-driven insurance industry many ordinary folks cannot afford, making healthcare a privilege rather than a right as in Canada. Your book is a must-read for every American concerned about health.

Kenneth Edward Lim
The North Korean

Unraveling U.S. Health Care: Everything you Always Wanted to Know about health care but were afraid to ask by Roberta E. Winder.

Roberta, this is a superb book which everyone will want to read. I want to thank you for writing it. The research alone must have been stupendous. Of the 12 circumstances you list in the introduction, most people will qualify for at least 8. Chapter 2, the overview is startling especially point #2. I am still reading with my mouth open. I have been told that France holds the flag on many countries for their quality of healthcare and according to your analysis; it looks like this is correct. I think I need to relocate . . . The uninsured population, here in the states, need help. 17% is staggering especially when you consider deaths from untreated diseases. I can’t imagine how frightening it would be to have glaucoma and go blind because I can’t afford the medication, let alone the premiums for health insurance to cover hospital and doctors visits. And if my husband didn’t have a job (we are a one income family) we would no doubt be in this bracket. Excellent writing style and fast pace. Very well done! This is a fantastic journalistic view and I heap stars on your efforts. Claire ~ Chasing Pharaohs.

Roberta,
You've done a fabulous job of laying out the information for the reader. Most people have no idea of everything involved in either health care or the insurance industry. As I was reading this I was reminded of a friend who, when she went to the hospital for the birth of her daughter, took her own pillows and toiletries. She rejected the 'kit' upon admission and the disposable pillows they offer, having a head nurse sign a document stating she didn't receive those 'supplies'. When her bill went out, she was billed for them just the same. Needless to say, she took the document to the billing office and demanded it be taken off. They had no choice but to adjust her bill. Most people don't even realize these things.
You stand armed and capable of educating people about these matters, and are clearly off to a great start. Thank you for the hard work you've put into this. I'll be shelving your book as soon as I fulfill a few other obligations.
My best regards,
Lisa (Shadow Puppet)

Hi Roberta, although not a US citizen this type of informative docu-book is right up my street and I wish I had time to read and learn more about the American healthcare system. What I did read, I found well structured, pacy and easy to read. You have a good style for this type of book - highly readable. Regards, Kerry M (Her Soul To Keep)

Roberta,
I didn't read a whole lot of this... just enough to get the feel of presentation, continuity, and readability (at least my opinions as a reader). From what I read, and the layout at the beginning, I'm confident you will carry it off well. It's easy to follow, nothing goes bump in the flow, and you write with confidence, which gave me confidence in your writing ability. To me the subject is a little dry, but you present it personally rather than clinically, so that makes me feel involved.
Well done, and on my shelf. Best of luck with it.

Roberta,

I started reading your Opus and thought I would give you my cent and half:

Having been part of the healthcare debate for ages, what I liked the most about your opus, is that is clear, concise and data driven and yet it does not overwhelm the reader with technical/scientific lingo, nor does it get bogged down in political debates

There is one bit of information that I didn't see and might shape the discussion, going forward;

Most of the healthcare costs are spend by the population in or near retirement, 79% of which are white.
We are asking the millenium generation, which will be 50% non white to fork out 50 cents of every dollar they pay on taxes to pay for healthcare.

The risk here, is that something like what is happening in Europe will happen here:

that is a debate about healthcare that increasingly becomes dominated by generational and race issues.

That Europeanization of the debate will only make it even more intractable

David

OK fellow scribes, I have incorporated your suggestions and updated most of my chapters. If there are a few pagination issues, it is because I have text and comment boxes with personal anecdotes in the book which are not up-loadable here. Also, please know that the charts and graphs make it easier to understand and they too are not up-loadable on this site. I will end up with an electronic version of the book, which by the way, is finished. I just haven't put it all on the site. Anyhow, just wanted to let you know the progress of the healthpolicymaven.
Praevalere

Hi Roberta,
The sure-handedness of your profile compelled me to look over your work despite my aversion to the topic. And my aversion is soley due to the rigmarole surrounding healthcare today. As you call it: the bureaucratic nightmare of it all.
I love that you used the word "schlep." This work is well-written, very clear and authoritative---and so needed. I'm sincerely glad to have a beacon like you on the site and in the world. Best wishes. 6 stars!
John Campbell (Walk to Paradise Garden)

Hi Roberta,
The sure-handedness of your profile compelled me to look over your work despite my aversion to the topic. And my aversion is soley due to the rigmarole surrounding healthcare today. As you call it: the bureaucratic nightmare of it all.
I love that you used the word "schlep." This work is well-written, very clear and authoritative---and so needed. I'm sincerely glad to have a beacon like you on the site and in the world. Best wishes. 6 stars!
John Campbell (Walk to Paradise Garden)

Thanks so much for the kind comments. My book is done and has recently been professionally edited. I am making some rewrites now. It is just over 50,000 words, so a modest effort bloomed into something a bit more meaty. I am finishing my citations and index material, as well as doing the technical review now.
I have had trouble accessing my profile on this site the past several days and had to do it through a google search to answer your review. I will definitely take a look at your book. I have a deadline for the 15th so it may be a few more days. Again, thanks for your kind reply.
Roberta

Hi Roberta. I write fiction but before I retired I was a Human Resources Director for a large University. Part of my growth to that position was to serve a stint as Compensation Manager for the University Medical Center.

We have the best medical care in the world, but it's not available to the general public. The administration of insurance sucks. People, like you, are starting to become vocal about the abuses by the insurance industry but it will require many, many more to get the word out.

I'm only through the Introduction, but I really think you need to finish this book. I'll give you all the support I can. I'm putting you on my WL and will keep track of your book.

My book, A PLACE IN LIFE, is an experiment in first person writing and, at this time, I'm interested in first impressions. I'd appreciate it, if you can find the time, if you could take a look at a chapter or two of my book and comment, good or bad. Don't worry; I can handle criticism.

Thanks in advance.

Old Bob
A PLACE IN LIFE

Hi Roberta. I write fiction but before I retired I was a Human Resources Director for a large University. Part of my growth to that position was to serve a stint as Compensation Manager for the University Medical Center.

We have the best medical care in the world, but it's not available to the general public. The administration of insurance sucks. People, like you, are starting to become vocal about the abuses by the insurance industry but it will require many, many more to get the word out.

I'm only through the Introduction, but I really think you need to finish this book. I'll give you all the support I can. I'm putting you on my WL and will keep track of your book.

My book, A PLACE IN LIFE, is an experiment in first person writing and, at this time, I'm interested in first impressions. I'd appreciate it, if you can find the time, if you could take a look at a chapter or two of my book and comment, good or bad. Don't worry; I can handle criticism.

Thanks in advance.

Old Bob
A PLACE IN LIFE

I'm from the uk and haven't a clue about health care (the wife handles grown-up stuff) but I can give you a UK copy-edit for ch2 - so here it is - discard that which is of no use:

(you can find the instances using CTRL + F and pasting in suggestions into the field).

over spending [just one word in uk]

per person for [on] health care

remove comma after *for those of you

remove semicolon after *and quite possibly

and only has [have] Medicare

comma after *especially medical spending

payroll taxes which [that] are already

like [such as] education

With some smart [If we implement some smart]

outpatient doctor's [doctors' ?] services

veteran's [veterans' ?]

included in any of my analysis [remove 'any of' for clarity]

... low income), [remove comma]

hodge podge [one word or hyphenated]

One of the wealthiest countries ... [isn't qualified] try: We are one of the wealthiest countries in the world and have...

As far as chronic ... [not qualified] try Concerning chronic ... or similar

For example [comma]

Roberta,

I have read the prologue and the first chapter of Everything You Always Wanted to Know. I think your book is important and I found it informative. Although my employer-provided insurance seems to work for my family and our needs (especially in light of our relatively good health), I am still dismayed by the state of health care in our nation.

It’s clear that you hope to strike a balance between your serious subject matter and your tongue-in- cheek tone (e.g., “war mongering”; “OMG”), but when you write that way you risk your audience disregarding your facts because they don’t find you credible. I think you should strive to make your writing accessible, but not sarcastic or belittling because then you will lose all readers save for those who are already on your side (at the same time, self-deprecating is always good, so comments like the comment about the age of your pants is fine). The point is that if all of your readers are already on your side, what’s the point of writing this? Ostensibly, you hope to educate readers that don’t already share your views and ultimately persuade them that the change you advocate is the best thing to do. In other words, if your book has an agenda (and it clearly does) you need to adopt a tone that seems objective and professional, even if you’re not objective. Likewise, if your writing is infirm, it is easy for those who disagree with you to dismiss you as an amateur. Thus, it’s imperative that you polish this work.

In chapter 1, for example, I think you need to tinker with the words, because the GNP doesn’t produce anything. In other words, I think you meant to state that “for each dollar of GNP . . .” or “for each dollar earned in the United States . . .” You might have it right, but I thought the GNP was a measurement. Also, that sentence uses the verb “is” but then refers to the past, so I think you need to revisit the subject/verb agreement. As noted above, you may alienate readers with the “war mongering” statement, but perhaps you don’t care. Regardless, in the next sentence, you write “more than other industrialized country” so you need to either make “country” plural or insert “any.” Remove the comma after “For those of you” and you need a semi-colon, rather than a comma, after “Kool-Aid.” (not to mention, that expression is overused and cliché).

In the next paragraph, insert a comma after “medical spending” (as an uneducated reader, I don’t know the difference between health care costs and medical spending, so that may require explanation). In the next sentence, you should delete the first “by”. You need a colon, rather than a question mark, after “let me put it to you this way”. Also “unsustainable” is not an “impact” so that sentence doesn’t make sense as written. Rather, the unsustainable practice/program has an impact. Remove the comma after “health care model”. Replace the “and” in the last sentence of that paragraph with a “to”. Better yet, rework the whole sentence.
In chapter 1, under the heading “Medicare Payments Impact the Entire U.S. Healthcare System“ in the first paragraph, change “what will be paid by private sector insurance companies” to “what private sector insurance companies and plans will pay” (thereby eliminating the passive voice).

In addition to the line editing that you need to undertake in the first chapter, the organization needs a lot of work too. You bounce from idea to idea, but there’s no real cohesion or flow. Rather, you just throw out statistics and ideas in a haphazard fashion to show that U.S. healthcare is a mess. Each of your paragraphs should have a topic sentence, followed by a couple of sentences that support the idea presented in the topic sentence, followed by a conclusion sentence that allows you to transition into the next paragraph. For example, your first paragraph has nothing to do with the first sentence of that paragraph. Rather, you say something about math, then you begin to draw an analogy to the reader’s older relatives, but the next sentence makes the reader the patient. Do you see why that’s inconsistent and thereby jarring for the reader? Regardless, not all of us have dealt with what you assert we’ve all dealt with.

Also, don’t tell your reader that “it’s critical” we “retool” OUR thinking because it sounds like you’re talking down to us. Good teachers don’t preach, they educate; it’s an important distinction; in other words, you must lead students to reach their own truths based on logic and fact, not tell them they must believe what you say because you said so. To fix this, all you need to do is write “it is important that citizens/Americans/patients, etc.” rather than “it is important that YOU.” Better yet, go with “we” and “our”.

You have a timely issue here that affects everything from the local E.R. to our national security; you obviously know a great deal about it and have put a great deal of thought into it. Nonetheless, if you want readers to take you seriously, especially readers who begin your text either as neutral or opposed to your position, you must make sure that your writing is error free. I hope that you will take the time polish this important work.

Best,

Rob
(Aralen Dreams)

A very easy-to-read book which brings the U.S. health care system to light in a very clear manner. An excellent review of the system backed up with many facts and figures gives it quite a reliable feel.
Now a bit of constructive criticism. The book does a very good job of being unbiased in presenting the problems although to make it a completely factual help book it may be beneficial to make it slightly less opinionated in some areas. e.g. "we all know the country routinely spends more than it makes, ESPECIALLY FOR WAR MONGERING."
Secondly, I would like to congratulate you on how well you present the problems of the system. They are cleared explained and well elaborated.
All in all, I feel that this is a very good book, you have a very clear reading style. Definately worthy of a bookshop.
Wishing you all the best,
James

Roberta,
I am so glad I cam across this book. Most fascinating.This is an important book on a complicated subject that should be of interest to everyone living in the US. Not an easy subject to tackle, this being such a controversial issue but you did so factually with a clear logic and a carefully controlled outrage. You've obviously spent a lot of time researching and I commend you on giving out this information. well done
njoyed
*moods and expressions

Wow, you have clearly done your research! I know where to go if I have any questions at all about US health care! Being in England and with no plans to go to America any time soon, I can't say it was overly useful for me, but I have no doubt it is a crucial piece of writing which deserves some attention. I hope you find a publisher for it, Well done!
Karen

To all of my wonderful international readers, I have spent the last couple of months drafting the latest chapter (9) which i a visitors guide to US health care and includes centers of excellence by procedure and medical tourism destinations. I have also listed the most popular tourist destinations and listed quality medical services near by. Anyway, if any of you citizens of the world would take a gander at chapter 9 and let me know if I have hit the mark, I would be vastly grateful. It is my longest chapter yet at just under 6,000 words.
Roberta

Thanks and I will take at peak at your manuscript at well.
Roberta

A very necessary book and I like the structure: logical and easy to use as a reference book. I can't judge the contents (I'm not knowledgeable in this matter) but it's definitely a useful subject. I'm surprised there's not a lot already published, or is there? If not, publishing should be an easy downhill road for you. Wish you all the best!
Claude
Strings of Madness (a coming-of-age novel with a rather unusual maturing experience...check it out and let me know what you think!)

Thanks for the observations. I am trying to be fairly unpolitical in the book so it will serve as a guide, not a policy paper. I do think that adding a chapter on the end of life process and palliative care would be valueable. I agree with your observations and will tinker with the "why is us health care so expensive chapter."
Thanks again for your prescient comments.
Roberta

Roberta - Lot of good facts there and I like the structure you have used. As Obamacare begins to make its impact felt more people will want to understand the system and will try to find material written in plain English. However, a lot of focus on numbers may seem intimidating to the layperson (fortunately, I have an entire Masters in International Health Systems).
In the (3) chapters I read I didn't see a lot of my pet philosophical, ethical, and social peeves addressed - tort law reform, defensive practice of medicine and unnecessary diagnostics and procedures, and the absurd price tag of healthcare in the final year of life and the fact that people make the system throw everything save the kitchen sink at a dying 80 yr old.
Best of luck with your publishing efforts!

A very necessary book and I like the structure: logical and easy to use as a reference book. I can't judge the contents (I'm not knowledgeable in this matter) but it's definitely a useful subject. I'm surprised there's not a lot already published, or is there? If not, publishing should be an easy downhill road for you. Wish you all the best!
Claude
Strings of Madness (a coming-of-age novel with a rather unusual maturing experience...check it out and let me know what you think!)

Roberta - Lot of good facts there and I like the structure you have used. As Obamacare begins to make its impact felt more people will want to understand the system and will try to find material written in plain English. However, a lot of focus on numbers may seem intimidating to the layperson (fortunately, I have an entire Masters in International Health Systems).
In the (3) chapters I read I didn't see a lot of my pet philosophical, ethical, and social peeves addressed - tort law reform, defensive practice of medicine and unnecessary diagnostics and procedures, and the absurd price tag of healthcare in the final year of life and the fact that people make the system throw everything save the kitchen sink at a dying 80 yr old.
Best of luck with your publishing efforts!

Hi J,
First of all, wow, thanks for such a detailed analysis of the first chapter. What I have done is make journal entries for the suggestions from this community and I have implemented some of them, but there is lots more to do. My plans are hire a professional editor as I think it will be easier to someone else to just clean up some of the errors you so aptly point out. I am just scrambling to finish it this quarter. It sounds like you may have read the IOM report, so you are way ahead of most folks on the health care learning curve. I do understand about the lack of insurance/access to health care problem, so thanks for sharing. As for my tone with the "math impaired line", yes I do intend to be sarcastic and it is meant to be a slap in the face, a "wake up dumb shit" attitude. Americans are just not knowledgeable enough about the health care problem and are lazy in getting up to speed on policy and resource issues. This is a country where a large number of people still think they can do better on their own than pooling their resources with others. Thanks ever so much for the cogent response, I am very moved by it.
Roberta QUOTE] First, I wish to say I think everyone who lives in America should read this important work, and everyone who is contemplating a move to America should also read this. The research is tremendous and the writing "voice" is engaging.

I was drawn to your book because health care is an issue near and dear to my heart. My parents were fighting for national health care four decades ago. Having passed the half century mark myself and having lost our family health insurance three years ago, I think about health care and the fact that our family can't afford it on a fairly regular basis.

A year ago I had such a bad migraine headache that after eight unbearable hours, two of which were spent projectile vomiting, I finally went to the emergency room. Three hours later I was back home, having received a shot of Imitrex that costs about $150.00 from the pharmacy, but which I didn't have on hand at home because we can't afford it. The total hospital bill was over $1800 for that three hour visit. We are still paying it off, and our credit has been ruined because we refused the hospital's only option for a payment arrangement -- they wanted to refer us to a bank in Texas that would take on the debt. The bank would have paid the hospital in full right away and worked out a payment arrangement with us that would have ended up costing us over $3600 for that three hour visit. So we said we wouldn't do it, but would pay $50 a month. The hospital didn't like that idea so they passed us on to a collection agency, where we have made a payment arrangement and we pay $50 a month on our bill. So we will only pay the $1800, over several years, rather than $3600 over several more years, but our credit rating is now in the toilet thanks to - depending on your viewpoint - either my migraine headache, or the hospital's new policy of handing all debt over to a for-profit bank or to a for-profit collection agency, rather than having an in-house bill collections office that oversees payment arrangements.

So, yes, I have an interest in health care issues in the United States - one of the few "developed" nations that allows over 20 million people to die each year rather than providing medical care.

Now, to your book!

The Introduction is captivating. I enjoy your writing style very much, particularly your sense of humor. Love reason number 12 for reading (purchasing) the book!

Chapter One -

Paragraph One - "Geese" I think is "Geez" in "Geese, even expensive Switzerland spent..."

In the paragraph beginning "Medicare spending in America is expected" further down where it says "89.1 million folks on that medical program." there needs to be a space between the number and the word "million"

With the sentence "For those of you who are math impaired" I get a sense that I'm being spoken down to, and I don't think that is what you're going for. While it's true that many people do not get numbers or exponential expansion or are able to imagine what "millions" are, either in humans or in dollars, nor do they seem able to grasp the concept of "five years down the road," there might be another way to get this across. You can make numbers understandable.

... And, as I read on, you have done just that.

As I said before, I enjoy your sense of humor - this is a dreary, depressing topic, and it's nice to have a little humor thrown in.

Under the section "U.S. Armed Forces" the sentence "In Washington, the gargantuan Fort Lewis and McChord Army and Air Force bases share the same medical facilities now, with a very modern hospital services." Either remove "a" before "very" or make "services" singular instead of plural.

In the same paragraph, "It is difficult to include active duty military health care budgets in the total health care spend for U.S. residents..." "spend" should be "spent" I think.

Under "Value for the Dollar in Health Care" paragraph two, "At that time, Norway was richest country in the world..." the word "the" needs to be inserted between "was" and "richest."

Same paragraph, you need a space between "1997" and "(based on a WHO..."

Okay, this is as far as I've read with critiquing in mind. I've actually read a good deal further, but I don't have the time to do line-by-line any further right now. I hope to come back for that sometime soon.

In sum, you've written a very important book, you've spent a great deal of time and done tremendous research. You've pulled things together very well and I sincerely hope that the health care policy wonks all have copies of this on their desks and by their night stands (as well as everyone who votes and everyone who writes to their congressional reps).

Wishing you all the best,
Judy

First, I wish to say I think everyone who lives in America should read this important work, and everyone who is contemplating a move to America should also read this. The research is tremendous and the writing "voice" is engaging.

I was drawn to your book because health care is an issue near and dear to my heart. My parents were fighting for national health care four decades ago. Having passed the half century mark myself and having lost our family health insurance three years ago, I think about health care and the fact that our family can't afford it on a fairly regular basis.

A year ago I had such a bad migraine headache that after eight unbearable hours, two of which were spent projectile vomiting, I finally went to the emergency room. Three hours later I was back home, having received a shot of Imitrex that costs about $150.00 from the pharmacy, but which I didn't have on hand at home because we can't afford it. The total hospital bill was over $1800 for that three hour visit. We are still paying it off, and our credit has been ruined because we refused the hospital's only option for a payment arrangement -- they wanted to refer us to a bank in Texas that would take on the debt. The bank would have paid the hospital in full right away and worked out a payment arrangement with us that would have ended up costing us over $3600 for that three hour visit. So we said we wouldn't do it, but would pay $50 a month. The hospital didn't like that idea so they passed us on to a collection agency, where we have made a payment arrangement and we pay $50 a month on our bill. So we will only pay the $1800, over several years, rather than $3600 over several more years, but our credit rating is now in the toilet thanks to - depending on your viewpoint - either my migraine headache, or the hospital's new policy of handing all debt over to a for-profit bank or to a for-profit collection agency, rather than having an in-house bill collections office that oversees payment arrangements.

So, yes, I have an interest in health care issues in the United States - one of the few "developed" nations that allows over 20 million people to die each year rather than providing medical care.

Now, to your book!

The Introduction is captivating. I enjoy your writing style very much, particularly your sense of humor. Love reason number 12 for reading (purchasing) the book!

Chapter One -

Paragraph One - "Geese" I think is "Geez" in "Geese, even expensive Switzerland spent..."

In the paragraph beginning "Medicare spending in America is expected" further down where it says "89.1 million folks on that medical program." there needs to be a space between the number and the word "million"

With the sentence "For those of you who are math impaired" I get a sense that I'm being spoken down to, and I don't think that is what you're going for. While it's true that many people do not get numbers or exponential expansion or are able to imagine what "millions" are, either in humans or in dollars, nor do they seem able to grasp the concept of "five years down the road," there might be another way to get this across. You can make numbers understandable.

... And, as I read on, you have done just that.

As I said before, I enjoy your sense of humor - this is a dreary, depressing topic, and it's nice to have a little humor thrown in.

Under the section "U.S. Armed Forces" the sentence "In Washington, the gargantuan Fort Lewis and McChord Army and Air Force bases share the same medical facilities now, with a very modern hospital services." Either remove "a" before "very" or make "services" singular instead of plural.

In the same paragraph, "It is difficult to include active duty military health care budgets in the total health care spend for U.S. residents..." "spend" should be "spent" I think.

Under "Value for the Dollar in Health Care" paragraph two, "At that time, Norway was richest country in the world..." the word "the" needs to be inserted between "was" and "richest."

Same paragraph, you need a space between "1997" and "(based on a WHO..."

Okay, this is as far as I've read with critiquing in mind. I've actually read a good deal further, but I don't have the time to do line-by-line any further right now. I hope to come back for that sometime soon.

In sum, you've written a very important book, you've spent a great deal of time and done tremendous research. You've pulled things together very well and I sincerely hope that the health care policy wonks all have copies of this on their desks and by their night stands (as well as everyone who votes and everyone who writes to their congressional reps).

Wishing you all the best,
Judy

Dear Roberta, Thanks for your comments and your message re: The Sacrificial Lamb. They are well thought out and balanced. I regret a bit that you jumped from Chapter 4 straight to Chapter 10 since I value your expressed insights.
I have also reviewed your own book, and although I reside in Canada, I recognize its vital importance from my own international perspective, and so I am very pleased to back your book. Best regards, Lorne.

Hi, Roberta. Seems well researched. Writing is competent. Not much other than that I can say about non-fiction. I think the job you've done on it is worth backing. Best of luck with it.

EVERYTHING YOU ALWAYS WANTED TOKNOW ABOUT US HEALTH CARE
This seems to be a very important book that you've written here; as a Brit I can only guess at half of what is implicated. Lots of research gone into this sometimes baffling subject. I can see this being a must for some citizens and I wish you well with publication. Well done.
Faith
The Assassins Village