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Book Reviews   |    
Health Care Turning Point: Why Single Payer Won't Work

Health Care Turning Point: Why Single Payer Won't Work
by by Roger M. Battistella.; Cambridge, Massachusetts, MIT Press, 2010, 192 pages, $21.95

Reviewed by Steven S. Sharfstein, M.D.
Psychiatric Services 2011; doi: 10.1176/appi.ps.62.11.1397
View Author and Article Information
Dr. Sharfstein is president and chief executive officer, Sheppard Pratt Health System, Baltimore, Maryland.

The reviewer reports no competing interests.

Copyright © 2011 by the American Psychiatric Association.

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Reviewing Health Care Turning Point was truly a challenge for me because I have been an advocate for a single-payer solution to America's broken health care system for more than three decades. It is something like reading the editorial pages of the Wall Street Journal or watching Fox News, which I occasionally force myself to do. When I do this, I often come away with a combination of disgust, rage, and a sense of bewilderment at the intellectual emptiness and cruelty of the political right in this country. But after reading Health Care Turning Point, I did not feel that way and, in fact, came away with a greater appreciation of the complexities inherent in serious health care reform.

This book is less about “why single payer won't work” and more about how the system is currently broken and why the Patient Protection and Affordable Care Act (PPACA, passed after this book was written and published) might actually have a chance at working toward improving things.

Professor Battistella makes the following argument: the current health care system is broken because of an insatiable public demand for health care combined with the costly advances in medical innovation that have led to unsustainable cost increases for the foreseeable future. Single payer won't work, according to Professor Battistella, because it is “utopian” and divorced from the current reality of unaffordable care. He prefers a market-driven solution “reconnecting the individual to the economic consequences of health care choices.”

He is, however, an unabashed advocate for universal coverage, and he considers a mandate that individuals purchase insurance through insurance exchanges to be the best alternative to the current employer-based insurance coverage. Government subsidies would be necessary for people who could not afford the premiums, but in general, individuals and consumers would bear much more of the cost of care and the cost of health care decisions under Battistella's concept and more than the PPACA currently envisions. Battistella's pragmatic approach is based on what he believes is feasible in terms of the current health care system, its financing, and the politics of reform.

Has he persuaded me to abandon my long-standing views supporting single payer? No—I believe that a combination private/public system, such as embodied by our Medicare program (public financing and private care), does a good job of protecting people from the economic consequences of serious medical costs and does so efficiently and effectively, much more so than the thousands of insurance companies, health maintenance organizations, preferred provider organizations, and so on that we have in America today. But Health Care Turning Point has turned my head a little and made me realize how important it is to have an educated group of consumers who can choose providers on the basis of their quality of care and hold them accountable and to focus on slowing the cost spiral that bedevils reform. So, all of you fellow single-payer advocates, read this book. Life is complicated, and health care reform even more so.




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