BEYOND THE COVID-19 PANDEMIC

Time to radically revamp the American health care system in light of the flawed response to the Covid-19 pandemic and many other dysfunctions, argues this sweeping manifesto.

Kapur, a public policy professor at the University of Maryland College Park, and debut author Chalil, a physician and chairman of the Indo American Press Club, start by noting medical difficulties faced by the United States during the Covid-19 pandemic. These include shortages of masks, personal protective equipment, and ventilators; mass layoffs that caused people to lose their insurance; and bankruptcies among some hospitals that suspended elective procedures to make way for virus cases. They continue with a wide-ranging critique of American medicine, spotlighting its higher costs and poorer health outcomes compared to other developed countries; the lack of accessibility of needy and uninsured patients; shortages of hospitals, doctors, and nurses; and the pressure on providers to improve profits by cutting corners and to defend against malpractice suits with unnecessary tests. To remedy these problems, the authors propose a “Grand Plan To Restructure Healthcare in the U.S.” with a mix of public provisions and market-based competition. They envision a “SafetyNet” of public county hospitals providing basic care to all regardless of insurance or ability to pay. A second system of private hospitals, providers, and insurance, funded by “Enhanced Health Savings Accounts,” would run in parallel and compete in price and quality in a national and global market, with medical services advertised like groceries, complete with coupons. Other plan features include a unitary electronic medical record, caps on malpractice damages, a Comprehensive Consumer Healthcare Score that awards points for healthy lifestyles that could lower insurance rates, initiatives to train more health care professionals, a National Strategic Healthcare Reserve of emergency supplies, and new technologies, from online diagnosis to medical robots.

Kapur and Chalil present their case for far-reaching reforms of American health care in lucid prose that has an incisive bite. (“Calling it a healthcare system is a misnomer. It is a disease-care system, one that focuses on diagnosing and treating symptoms instead of taking on the job of educating individuals and families to take a proactive approach to their health.”) But the book suffers from a meandering, repetitive structure and an occasional lack of focus and rigor; it pursues tangents that some readers may consider dubious, like a brief for traditional Indian ayurvedic healing as an adjunct to Western medicine; and it sometimes gets facts wrong. (The 1918 Spanish flu did not kill “a third of the world’s population”—mortality was between 1% and 6%—and British Prime Minister Boris Johnson did not “support a herd immunity theory until he was hospitalized with the COVID-19 virus”; he imposed a national lockdown to prevent contagion on March 20, 2020, seven days before he tested positive.) The authors’ plan is something of a hodgepodge, with myriad moving parts to achieve many disparate goals, and it’s hazy on some important points, like the costs and funding mechanisms of the public SafetyNet hospitals. Still, Kapur and Chalil manage to steer clear of the dogmas of the right and left to offer a thoughtful, cogent analysis of the manifold problems in the U.S. health care establishment and a wealth of concrete proposals for dealing with them.

A detailed and innovative blueprint for fixing what ails American medicine.