Where Does It Hurt?

An Entrepreneur's Guide to Fixing Health Care

By: Jonathan Bush, Stephen Baker

Narrated by: Patrick Lawlor

Length: 7 hrs and 21 mins

Publisher's summary

A bold new remedy for the sprawling and wasteful health care industry. Where else but the doctor's office do you have to fill out a form on a clipboard? Have you noticed that hospital bills are almost unintelligible, except for the absurdly high dollar amount? Why is it that technology in other industries drive prices down, but in health care it's the reverse? And why, in health care, is the customer so often treated as a mere bystander - and an ignorant one at that? The same American medical establishment that saves lives and performs wondrous miracles is also a $2.7 trillion industry in deep dysfunction. And now, with the Affordable Care Act (Obamacare), it is called on to extend full benefits to tens of millions of newly insured. You might think that this would leave us with a bleak choice - either to devote more of our national budget to health care or to make do with less of it. But there's another path.

In this provocative book, Jonathan Bush, cofounder and CEO of athenahealth, calls for a revolution in health care to give customers more choices, freedom, power, and information, and at far lower prices.

You’ll learn how:

• Well-intended government regulations prop up overpriced incumbents and slow the pace of innovation.
• Focused, profit-driven disrupters are chipping away at the dominance of hospitals by offering routine procedures at lower cost.
• Scrappy digital start-ups are equipping providers and patients with new apps and technologies to access medical data and take control of care.
• Making informed choices about the care we receive and pay for will enable a more humane and satisfying health care system to emerge.

Bush's plan calls for Americans not only to demand more from providers but also to accept more responsibility for our health, to weigh risks and make hard choices - in short, to take back control of an industry that is central to our lives and our economy.

©2014 Jonathan Bush and Stephen Baker (P)2014 Gildan Media LLC

Critic reviews

"This is a compelling, entertaining story—an insider’s perspective on American health care by someone who has been closely involved in its reshaping. Few people amass Jonathan Bush’s kind of experience or articulate as clearly what lies ahead." (Abraham Verghese, physician and author of Cutting for Stone)

Data?

Unfortunately data is not all it takes. Great ideas but misguided. Should have interviewed more prating physicians not only administrators.

Really enjoyed this book

Appreciated very much that the candid though biased approach of the book. Unique point of views articulated very well about different parts of the industry.
Provides a great guide for innovation for the next few years.

if this ain't JBush, nothing is. Spot on.

I found myself saying "Exactly!" over and over. Same as Gawande said about Bob Wachter's "Digital Doctor," which I also love. Bush is crazy and right.

Note - in a different industry (typesetting) I was disrupted 30 years ago (by desktop publishing), so I know the signs and I know how incumbents can't see it coming. Power to the users!

Very thought provoking

I am very involved in health care IT and I have to say this was an excellent book. Very accurate and thought provoking.

Superb and Informative Reading

Has the drive and data of Tom Peters’ Liberation Management and the soul of Tracy Kidder’s Soul of a New Machine. Thank you.

No critical thinking

In the introduction he states that our health care system is expensive and not as good at delivering results as other countries. His conclusion is to introduce free market economics as the solution. So the answer to fixing the only health care system which operates on free market principles is to double down. We operate in a free market he might not like the market or the rules since he failed at running his first business.

He harps on several points but does not seem to have any knowledge of the realities.

1. Overpriced hospitals. Here he is confused by costs vs charges. Hospitals are required by law to care for all patients regardless of their ability to pay. Since at many emergency departments over a third of all patients do not pay. So the hospital must raise charges to cover these patients. As specialty hospitals grow taking away paying patients this only makes it worse. Hospitals are struggling throughout the country. Many are closing or selling themselves because they can not survive.

2. Customer satisfaction is bad because there is no free market. If you look at press ganey the largest surveyor of patient satisfaction doctors and hospitals are doing great. Over 90 percent of hospitals and 99 percent of doctors score over 4 on a 5 point scale. Much better than Airlines which have been deregulated and are more free market or restaurants as a group.

3. There is no innovation. This is just looking at the facts he wants and ignoring all others. there has been great innovation. Pick a specialty cardiology has gone from 2 weeks bed rest for myocardial infarction to stents in 90 minutes from arrival. We have better tests to find heart attacks. Surgery has gone from large incisions to laparoscopic and in some cases robotic.

4. If only people could choose things would be better. This is nonsense. When someone is sick they rely on doctors to help guide them. Also many would say that they do not feel spending 100$ more on a meal which might increase there chance of enjoyment of the meal by 1% is clearly not worth it to them however, spending money on a better chance to survive an illness? They would spend that. Also look at all the money spent on alternative medicine. Here people have the freedom to choose and they choose options that offer no benefit. The National Institute of Alternative medicine just completed a 10 year review and found no evidence to support use of anything tested as alternative medicine.

5 Choices are needed in insurance. Health insurance is not like cable TV. I do not know which illness I am going to get this year. I am sure if I do not want ESPN today I will not want it later this year. People will opt out of lots of choices then when they become ill they get covered by the either the government or the hospitals that provide the service. We removed the moral hazard. I am not advocating not treating people I am saying that if we are arguing for free markets you are arguing for letting people suffer because of their choices which we do not do.

I do agree with him when he talks about information, reducing overhead and getting rid of fee for service. A free market tries to maximize one thing and that is profit. If it can do it my delivering expensive less effective health care it will as it has proven. So eliminating fee for service is a start. Going to a single payer is another good step. Less paperwork and back office support is needed with a single payer. However, these will not reduce lawsuits which contribute to costs of healthcare. Doctors win about 90% of malpractices cases so most cases are about poor outcomes not medical care. The free market would say if we can make money by suing we will sue. Many cases are settled to avoid the years of pretrial and trial costs which only encourages more lawsutis.