The Vision Thing/ New Book

It’s not easy reviewing your own book. Should it get three stars or four? Two thumbs up? Or should that be three? These decisions are so wrenching I’m going to put them aside and talk about something completely different.

The biggest problem with health policy folks (other than lacking a sense of humor) is that they almost never tell us about their vision for health care. They can chatter endlessly about minor policy matters, but fall completely silent when it comes to the big picture.

This is in stark contrast to such past writers as Samuel Butler and B.F. Skinner on the left and Ayn Rand and Robert Heinlein on the right — all of whom were only too happy to tell us about their visions.

By a health care vision I mean at a minimum:

  1. In an ideal health care system, what are doctors and patients doing that is different from and better than what they are doing today?
  2. What keeps them doing it? That is, how are they rewarded for doing whatever they are doing and discouraged from doing something else?

A possible hurdle is that many people in health care are still socialists. These are people who think that a plan devised by a few at the top will be carried out by the many at the bottom, even though it’s not in their self-interest to do so. This is not a vision. It is a hallucination. Thinking you can give an order and everyone will carry it out in lock-step is not creative thought. It is an abdication of thought.

Anyway, our new book is chock full of ideas for health care reform at the state level. The last chapter gives the vision: how doctors and patients will live under our reforms. I am giving you a link to save you a lot of trouble. If you don’t like the vision, you don’t need to read the rest of the book. If you do like the vision, you can order the book and see how to get from here to there.

I wish all authors were this kind to their readers.



To read the vision chapter, go to

To order a copy of Handbook on State Health Care Reform, with a forward authored by Gov. Jeb Bush, and authored by John C. Goodman, Michael Bond, Devon M. Herrick, Gerald L. Musgrave, Pamela Villarreal and Joe Barnett go to

If you don’t want the NCPA to profit from the sale, you can view the full text on line at

Comments (5)

Trackback URL | Comments RSS Feed

  1. Jaime Herrera says:

    I just followed the link you provided at the bottom of the page to find the entire book – I am looking forward to reading it. Thank you for the health alerts and for the health policy analysis (and ideas) that you provide.

  2. Chris Ewin says:

    I enjoyed your vision chapter and agree with the dysfunctional, bureaucratic and regulatory obstacles patients and physicians face in our health care system.. A little feedback…specifically about primary care physicians (family physicians, internists and geriatricians) on the front line with private practices… In my opinion, non-physician health care policy leaders, politicians, insurers and employers need to have a better understanding of physicians WORKFLOW. The rules and regs are crushing their small business practices. Financially, the unnecessary burden of massive coding and microbilling is an inefficient system for the government and the insurers dealing with primary care physicians. Primary care is being suffocated and physicians are leaving their practices. There is no good economic reason for insurers or the government to be involved in financing primary care except to maintain their control of every medical transaction. In all respects, it is money wasted by the insurers, government and physicians. It almost doubles the cost of primary care with no value added. What is worse, is that the brightest and smartest medical students aren't entering primary care. The solutions are coming from the physicians with "direct practices"……. I hope you and your colleagues come to our conference and listen to the innovative ways physicians have adapted to this mess… Vision without execution is just a hallucination.

    Chris Chris Ewin, MD, FAAFP President, SIMPD

  3. Dave Racer says:

    Dang it. Greg and I were going to write the next great “how to” book, and you may have scooped us. Way to go, pal. So, you follow the literature. What’s missing out there right now? What’s the angle we should take?

  4. Paul Stevens says:

    A critical element of effective and efficient service delivery is providing the appropriate level of service. I recently had the opportunity to see such a process work in my own case.

    As a resident of Ontario, with publicly funded health care, I have had my share of bad experiences. But I also, this past summer, was referred for treatment to a nurse practitioner, at about a third to quarter the cost of a doctor, for a simple checkup that she was more than qualified to do. I also had a knee replacement, as I chronicle in my blog at , and had it done quickly and efficiently by a specialized orthopeodic team, with no complications. Three weeks later I was starting to walk without a cane.

    Key to a least cost medical system is funneling patients to appropriate levels of care. Keep the kids with earaches out of the doctors offices and emergency centers. Even antibiotics for simple infections can be prescribed by NP’s. Save the doctors and specialists for higher level needs.

  5. John Dale Dunn says:

    Since i have a perverse interest in junk science, i offer, for your consideration, evidence that the 100,000 deaths you say are annually due to physician and nurse negligence are a contrived number intended to serve the interests of the IOM and the little cottage industry of patient safety wonks in boston. note that the most prominent of the patient safety researchers, troyen brennan, says the IOM misused his reasearch. he said it on the pages of the NEJM. he now works for aetna. it doesn 't get any better than that. kind of like a perry mason tv show where the bad guy breaks down on the stand and admits his perfidy.