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Skin in the Game    by John Hammergren & Phil Harkins order for
Skin in the Game
by John Hammergren
Order:  USA  Can
John Wiley & Sons, 2008 (2008)

Read an Excerpt

* *   Reviewed by Deb Kincaid

John Hammergren is Chairman and CEO of McKesson Corporation, America's largest health care services company. His co-author, Phil Harkins, is CEO of Linkage, a global organization development company. Collaboration by these two corporation executives resulted in Skin in the Game: How Putting Yourself First Today Will Revolutionize Health Care Tomorrow. The authors feel America's health care crisis is fundamentally a business problem, requiring a business approach to solve it.

According to Hammergren and Harkins, everyone wants 'accessible health care for all that is cost-effective, safe, reliable, and patient-centered, while always improving in quality and delivery, and provided in a way that encourages the quest for new medicines and improved standards of best practice.'

How do the authors propose to halt the health care crisis? First, by restructuring the entire health care industry - including providers, payers, and consumers - into a marketplace model subject to market forces; and second, by integrating all health care information into a secure but highly accessible database.

Hammergren and Harkins also delineate government and marketplace roles. Clearly, the authors want the government to keep its hands off, except in areas that benefit the market - like mandating that every person carry health insurance.

The book contains seven chapters and an appendix, and opens with discussion of the failures of the current system as seen from provider, payer, and consumer points of view. Then, we get short history lessons about the drug business and the establishment of hospitals and medical schools. The remaining chapters examine the historical and future roles of medical professionals, insurance, and technology, closing with the potential health benefits of genomic and proteomic research, and a recap of the authors' Blueprint for Change.

From the front of the book to the back, the authors drum the message that the consumer will be empowered and in control - but, other than in provider transparency, there's little evidence of it. On the contrary, corporate organization and leadership firms like Linkage, and multinational providers of information technology and services like McKesson, will call the shots.

While speaking of preordained treatment algorithms and protocols designed to streamline patient care, the authors gush with cloying stories of pharmacists who'll have time to chat with you 'like the pharmacy of the early 1900s;' and of doctors who will have 'more time for connecting personally and meaningfully with their patients.' Sorry, I don't buy it. In a marketplace model, time is money, and pharmacists and doctors aren't going to chat - they'll have to see more patients; i.e., process more widgets on the production line. Doctors and patients won't be empowered, but dehumanized. Is it any wonder America's physicians oppose the marketplace model? Surely healthcare can be improved without removing its heart.

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