Book Review by Dave Racer
Building any
kind of enterprise on the foundation of a false assumption is not only
fool-hearty, it is expensive and can be dangerous. Greg Scandlen, in his
must-read new book, Myth Busters: Why
Health Reform Always Goes Awry, proves this in his first chapter.
I have read
dozens of books on health care – reform, practice, theory, finance – and most have
been helpful. I’ve written and/or edited 18 books about healthcare myself. Here’s
my confession: I wish I had consulted Greg Scandlen on “Roemer’s Law” early on.
In 1959, Milton
Roemer, MD, published a study that changed the dialogue about the delivery of
and payment for healthcare. Roemer, who had advocated for a single-payer
healthcare system for America during the 1950s, claimed to have “…found a
correlation between the number of hospital beds per person and the rate of
hospital days used per person,” as Scandlen reports it.
Roemer’s Law,
succinctly states “A built bed is a filled bed.” The unproven idea assumes that
people are eager to enter hospitals. Based on my own experience, I can attest
to the fallacy of this myth.
Still today,
healthcare reformers have bought into the idea that the supply of medical and
hospital care has to be limited and/or controlled by third parties and
governments. If not, they warn, doctors will prescribe as much care as possible
to line their own pockets. Hospitals will overbuild and somehow go out and
recruit patients to fill their beds. Scandlen destroys this myth showing that
hospital occupancy rates declined “from 77 percent to 67 percent” during
1970-2000. And while anecdotal “evidence” may exist about doctors here and
there over-prescribing out of personal greed, this does not call for a
government takeover of healthcare.
The myth
perpetrated by Roemer’s Law continues to be foundational for federal and state government
control over our personal healthcare. It has led to strict regulation of the
patient-physician relationship so much so that today, physicians are not free
to practice as they believe best for patients, and patients have no clue about
the cost of their healthcare.
Third-party
payers and government bureaucrats have insinuated themselves into the financial
transaction between patients and their physicians, hospitals, pharmacies, and medical
device suppliers. Patients have almost no incentive to save money or shop for
healthcare value when someone else pays their bills. Meanwhile, patients have
to pay the price fostered by another myth, that insurance companies are
fighting to reduce the price of care.
“You may have
noticed in this sorry saga that all of it was pushed by academics and
politicians, and all of it was imposed upon hospitals, doctors, employers, and
insurance companies. Who is missing? The
patient/consumer/employee/taxpayer,” [emphasis added] Scandlen writes.
In this great
book, Scandlen destroys the arguments supporting 30 predominant myths, each of
which contributes to the high cost of healthcare. This book needed to be in the
hands of lawmakers and regulators decades ago, but I’m glad it’s available
today. I recommend it to anyone, especially politicians and academics, that
believes we ought to get the facts right before setting on the laws and
regulations that govern our individual healthcare.
Scandlen, Greg. Myth Busters: Why Health Reform Always Goes
Awry. First Printing. Pennsylvania: CreateSpace Independent
Publishing Platform, 2017. 160 Pages. Paperback.
