By relating actual stories of Americans who have been thwarted by their HMOs, George Anders tells the story of health care in the United States by taking it to an individual level of people who have suffered mightily at the hands of their HMO. 

Cost efficiency is the parent of our current health care system. Anders will acknowledge that costs were getting out of hand, but now the pendulum has swung back in the opposite and dangerous direction. The key message is, don't get sick if you have to depend upon the generosity of your HMO. To quote Anders: "The system's great vulnerability is the unexpected case." 

When medical decisions are made by people who are interested in saving money, you can be sure that your own interests are not paramount in their minds. Again to quote Anders: 

"These executives become medical commissars, deciding what doctors patients will see, what pills they take, and what hospitals they can use in a crisis. The architects of this system are supremely confident of their ability to make the right choices for millions of Americans; they believe they are creating such a decisive improvement over the fragmented, high-cost health care of prior years that it is only a matter of time before almost every American belongs to such a plan." (p. 13) 

This be true were it not for the possibility that by the time every American belongs to such a plan, that sizeable numbers of them will have seriously suffered at the hands of their HMO. This pain alone be enough for government leaders to step in again to regulate the system. 

The weakness of Anders' book is that he doesn't have a lot of great suggestions about what to do. He spends thirteen long chapters outlining the problem beautifully, and then offers a short fourteenth chapter called, "Building a Better System." And herein lies the problem. All of the answers end up costing more dollars which is what got us into the current system in the first place. He argues that "all that is missing is a mechanism to bring better human judgment into the system." We suspect at TMI, that the mechanism is customer/patient feedback, which is not listened to well in the health care industry. 

Anders agrees that if patients speak up before serious damage is done, then changes can be made. The challenge is to teach patients how to speak up. Most are terrified by their doctors, or give them all the authority because of the complex knowledge that constitutes the health care industry. 

Despite its shortcomings, we would highly recommend this book as a wake up call identifying the problems that we have yet to face with health care. Anders story is one that needs to be told and then heard. 

Janelle Barlow, President  

TMI USA 

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