The basic health care system in the United States is not working and must be fixed. The cost of a new, effective system of health care delivery would be instead of rather than in addition to what the US population is now paying for an inadequate, incomplete system. We must put the fiscal responsibility for health care delivery on the medical care sector that makes the decisions on what medications, what procedures and who gets treatment and when, that is, the providers of care, mostly the doctors. By doing this we can correct the more than fifty percent overpayment and misuse of funds currently in vogue. The book deals with the concept of the possibility of eventual coverage of everyone through the Medicare system as the current population ages. It explains the leverage that that single payer universal system such as Medicare, can generate to change the incentives for the providers of care resulting in a reduction of the overall cost. It also sets forth the concept of choice for the patient, the allocation of resources, and the restructuring of the medical education system as well as the recruitment and training of providers. Other problems such as organizational development, provider groups, malpractice, reinsurance through a universal system and other solutions are also dealt with. Today 45 million Americans have no health care coverage, while approximately 50 million are under insured due to high deductibles and co-payments. Many who are eligible for Medicare, federal health care insurance for the aged and Medicaid, federal health care for the poor, may be without coverage due to lack of access to services in the areas that they live. Practical solutions to these problems are addressed. Robert Gumbiner, MD, with more than 40 years experience in the health care field as a practicing physician, a manager and a force in medical management education, derives much of his experience from successfully developing and managing one of the largest managed care companies in the United States for over 30 years. Drawing on this extensive management experience as well as years of studying health care systems around the world, Robert Gumbiner debunks the myths held by opponents to national universal health care and capitated prepayment. His development of the first capitated prepayment plan for Medical in the 60's in California and first contract for prepayment Medicare on the West Coast in the 80's gave credibility to his ideas that succeeded in reducing health care costs. He shows step-by-step how we arrived at our current dysfunctional system and argues persuasively how we have been misled by special interests in the medical/industrial complex into thinking a health care system funded through the government and managed for effective utilization will eliminate choice. In the final analysis the book's major theme is that the cost of a complete comprehensive system is "instead of and not in addition" to what we are currently paying and how to go about instituting such a system. It offers solutions that have been developed by the author throughout his long career in managing health care delivery systems. It is not a theoretical concept but based upon ideas, errors, successes and a logical, practical model.
