What people are saying about the books by John Geyman, M.D.

Review from Family Medicine, Crisis in US Health Care: Corporate Power vs the Common Good (May 2018)

Alida M. Gertz, MD, MPH
Fam Med. 2018;50(5):395-396.

Publication Information: Friday Harbor, WA, Copernicus Healthcare, 2017, 358 pp., $18.95, paperback

Crisis in US Health Care: Corporate Power vs the Common Good by John Geyman, is a must-read not only for family medicine physicians, but also for anyone interested in how the American health care system has devolved to the dysfunctional state we find it in today. Although it has served well the few who have managed to profit immensely from the corporatization and privatization of the system, in becoming a business, it has strayed far from the social service that it is in most developed countries, and in one of the richest countries in the world, health care is no longer considered a human right, but instead, a commodity to be bought and sold.

Dr Geyman is the perfect bearer of this bad news, as his decades of experience dating from the 1960s to the present in family medicine as a rural practitioner, as a department chair, as a residency director, as a journal editor, and as a writer, among other roles, give him a unique and clear perspective of the changes that have occurred over time and that have brought us to where we as Americans find ourselves today. 

The book traces the history of medicine in the United States starting in the mid 20th century just before Medicare was enacted, and tells the story of the political and economic forces that shaped our health care system. The first part of the book details systems changes over the past 60 years, while the second part chronicles a personal perspective during this same time frame. The final part, a summary of the state of the health care system today, also gives some insight into possible future directions.

Dr Geyman builds on the work of many other writers, doctors, academicians, businessmen and women, and historians to support his perspectives and the details of his story. He clearly has a firm grasp on research that has shown what works and what doesn’t work to improve the health of a population, and he is very adept at pointing out what we as a profession have done well and what we have done poorly to serve or disserve the American people.

Much of the book focuses on the intricate tale of how market forces and insurance companies inched their way into power, and slowly eroded the medical system and its value system until money ruled, and social justice, and physicians’ sense of service, fell to the wayside. His remarkable descriptions of the series of circumstances and decisions that led us astray are beautifully told in this book, which can only be described as a work of art.

Clearly a proponent of a single-payer system, Dr Geyman explains why the current system, including the Affordable Care Act, and particularly any system the Trump administration puts in its place, has been and will continue to be a system that serves the interests of big business only, and not the interests of the population, nor individual health care as a human right, nor public health. A single-payer system, he argues, as most developed nations have moved to, is the only system that will fairly serve all, and is the only system that, if implemented, could salvage American health care from the nearly unsalvageable wreckage it has become.

The best part of this book is that Dr Geyman takes his readers through the evidence in such an easily accessible and understandable manner, and his arguments are so eloquently made that one is tempted to think that they almost came up with the ideas and flow of logic themselves. At over 80 years of age, he sees our flawed system with such clarity, his writing is so fluid, and his point-by-point plans for working toward a better health care system are so cogent that this is easily the best book on the problems and potential solutions to our broken health care system that has been written in the last 20 years. I highly recommend it to anyone interested in the subject, or in fact to just anyone who is a citizen of the United States.

Review of Flight As a Lifetime Passion - 2nd Edition 2017

Ya know, I've scanned a lot of general aviation books about C-172 cross-country's and such.....not that there's anything wrong with that!.....but I really got a kick out of yours because you touched on a whole bunch of what general aviation has to offer. And you did it by flying airplanes that personally moved you. The reason you did it is in your title......"as a lifetime passion."

From run of the mill general aviation airplanes, to soaring, to floats, to towing, a Kitfox, a Breezy, Duce, Chipmunk, the Curtis, a beloved C-180 and to an RV-12 to top-off the fun, you've compiled an excellent sampling. Am proud of ya; ya done good! 

But.....the hang're on your own on that one!  You can be my proxy and thanks for being so. I think I'm too 'chicken' for that!

You approached aviation much like I do. I flew quite a few different airplanes but gravitated to concentrating on the ones I really loved to fly, the ones that moved me.  Hence the RV-8 to kinda close out the career: with a military background I love the agility, the visibility, the tandem seating, the tailwheel (not to mention the affordability of operating it)....I call it my "retirement fighter." 

So, ya, well done, John.  And, with your book,  well expressed.

Lauren Paine, Jr., retired military and airline pilot, RV8 builder and owner,
and author of the Flying Life: Stories for the Aviation Soul.


Kirkus Star Review
Crisis in U.S. Heath Care: Corporate Power vs. The Common Good

. . . [This] book examines all aspects of medical care in the United States and how it has changed over the past 60 years. . . The service ethic of medicine, Geyman declares, has been replaced with the “business ethic,” and the result is poorer patient care. Another serious problem he addresss is the skyrocketing cost of health care. High insurance deductibles, extraordinarily escalating pharmaceutical prices, and a tendency on the part of physicians to order excessive tests and procedures to increase compensation have put basic medical care out of reach for millions. . .
This accessible, comprehensive book makes a strong case for a complete overhaul of the U.S. health care system. No fan of the Affordable Care Act, which he says has failed to reduce costs and is a boondoggle for corporate interests, Geyman concludes that the only viable alternative is a single-payer system: “Today’s health care system, serving its corporate masters more than patients, is unfair, ineffective, inhumane for those left out, and financially unsustainable.” . . . Articulate, loaded with informative details, especially timely . . . (full Kirkus Star Review)


“A Doctor’s View of Corporate Profiteering in the Medical Industry”
A review of Crisis in U.S. Heath Care: Corporate Power vs. The Common Good

Dick Burkhart, Ph.D., Board member, Unitarian Universalists for a Just Economic Community, Seattle, WA

John Geyman is a family practitioner and administrator who has experienced first hand the transformation of the US health care system into an immensely wasteful and corrupt health care industry. Though Obamacare has extended coverage, it has also propelled profiteering, contributing “to the medical profession’s loss of its moral compass”. Supposed savings have been soaked up by executives and owners. Privatization has meant perverse incentives, replacing the medical ethic of compassionate care by profits at the expense of the poorest and sickest.

This book is an up-to-date and readable overview of how the health care industry actually works, set against the backdrop Dr. Geyman’s personal journey over the last half century, from a classical family practice in the mountains of northern California, to leadership of the University of Washington Department of Family Medicine, to a retirement of investigation, reflection, and writing. Other books dive more deeply into the politics and scandals, but I suggest starting here.

The US has the best health care in the world for those who can pay for it, yet by far the worst health care system of any developed nation. We spend twice as much per person with poorer overall outcomes. Like most other medical reformers, Geyman recommends improving Medicare and making it universal (“Medicare for All”), with the US citizenry pocketing the savings. Both professionals and patients will be a lot happier.


Single payer healthcare is coming to America. It’s inevitable.
Guest post by Ed Dolan

Available at

“The debate over U.S. health care — where to go next to rein in costs and improve access to quality health care — has become bitterly partisan, with distorted rhetoric largely uninformed by history, evidence, or health policy science. Based on present trends, our expensive dysfunctional system threatens patients, families, the government, and taxpayers with future bankruptcy.

“This book takes a 60-year view of our health care system, from 1956 to 2016, from the perspective of a family physician who has lived through these years as a practitioner in two rural communities, a professor and administrator of family medicine in medical schools, a journal editor for 30 years, and a researcher and writer on health care for more than four decades. There has been a complete transformation of health care and medical practice over that time from physicians in solo or small group practice and community hospitals to an enormous, largely corporatized industry that has left behind many of the traditions of personalized health care.

“This is an objective, non-partisan look at the major trends changing U. S. health care over these years, ranging from increasing technology and uncontrollable costs to depersonalization and changing ethics in medicine and health care. This book points out some of the highs — and lows — of these changes over the years, which may surprise some readers. It also compares the three basic alternatives for health care reform currently being debated.”


“John Geyman has written an expert and highly readable account of the American health care system—how in the past 60 years it changed from a system devoted to caring for patients to one devoted to maximizing revenues—and he tells us clearly how to fix it.”

—Marcia Angell, M.D., former editor of The New England Journal of Medicine
and author of The Truth About Drug Companies: How They Deceive Us and What We Can Do About It


"John Geyman, one of America’s most distinguished family doctors, has given us a masterful overview of what’s wrong with our health care system and how to fix it. He supplements the daunting facts and figures with an engaging account of his life as a country doctor and medical leader."

—David Himmelstein, M.D. and Steffie Woolhandler, M.D., both general internists
health policy experts, and professors of public health at the City University of New York

John Geyman has been around the block a few times. Family physician, department chair, journal editor, and relentless patient advocate: his perspective on the American healthcare crisis is unexcelled. In his latest book, he uses his own sixty year career in medicine as a frame story, dissecting the deterioration of American medicine under the onslaught of market-driven special interest groups. He urges us to learn from successful healthcare systems around the world: include everyone in a national single payer healthcare plan.
Readers need not take his word for it, though his meticulous research documents his case with flawless precision. Every nation with a single payer healthcare plan already provides better care to more people for less money. If we break our devotion to what has clearly failed, we can instead divert funds we already spend to provide all Americans with the care they need, when they need it. The road through market-driven healthcare to patient-centered healthcare is open. Dr. Geyman shows us the way.

—Samuel Metz, MD, Adjunct Associate Professor of Anesthesiology
Oregon Health & Science University, Portland OR


Dr. Geyman’s description and analysis of the resultant hollowing out of the soul of medical care as the ongoing corporatization of medicine in America continues, and his prescription for change as seen through the lens of his 60 years long career, is invaluable. It is also a cautionary lesson about an even larger danger to America—that of capitalism-run-amok—a lesson that goes far beyond health care, and should be understood by anybody concerned about the soul of our country.

—Phillip Caper, M.D., internist with long experience in health policy since the 1970s,
and past chairman of the National Council on Health Planning and Development


In Crisis in U.S. Health Care, renowned medical reformer Dr. John Geyman offers a dazzling critique of U.S. medical practice and policy. The book begins with a well-documented, convincing historical study of how government programs, including Medicare and Medicaid, have supported the commercialization of American medicine, accompanied by enormous financial costs. The result has been to create an inequitable and unsustainable system in which, he argues, technology has been overvalued and individual patient care undervalued. Part 2 presents a parallel, moving autobiography of his own earlier service as a family physician in the Northwest and as a leader in the fi eld of family medicine, which brings national debates down to earth. The central question here is what (and for whom) medicine should be for, over and above its status as a business. In the concluding section Geyman urges readers to dig into history, remember the principle of the common good, accept the social and economic benefits of a healthy society, and redefine the role of government to these ends. While there are no simple ways forward, Crisis provides an accessible, very readable and necessary jolt.

—Rosemary A. Stevens, Ph.D., professor of history and sociology of science at Weil Cornell Medical College
leading medical historian, and author of many books on U.S. health care, including The Public-Private
Health Care State: Essays on the History of American Health Policy


Our health care system is designed to serve first the market stakeholders and only secondarily the patients. John Geyman explains to us the history and fl awed policy decisions that brought this about. As an icon in family medicine, both in patient care and in the academic arena, he adds his invaluable personal experiences to provide us with a crystal clear picture of what is wrong and what we can do about it—finally placing patients first, where they belong.

—Don McCanne, M.D., family physician, senior health policy fellow
and past president of Physicians for a National Health Program (PNHP)


Geyman’s latest book is at its best in portraying American medical care from the 1950s to the present through the lens of a well-informed, literate family doctor and teacher, one who knows more about American medical history than the pundits quoted on American television and on the pages of American newspapers.

—Theodore Marmor, Ph.D., professor emeritus of public policy and management at Yale University,
author of The Politics of Medicare, coauthor of Social Insurance: America’s Neglected Heritage
and Contested Future,
and member of the National Academy of Medicine


In all of American medicine there is no voice more authentic, more informed or more committed to the common good than that of Dr. John Geyman. In a career of over fifty years as practitioner in rural communities or as professor in the highest echelons of academic medicine, Dr. Geyman has championed care of the common man and woman, one and all. His current analysis and update of our medical system is both surgical and scholarly. Six years into the ACA, and literally on the eve of a new presidential administration, Geyman tells us the system is still broken and that it’s breaking us. The cause (and its cure) are detailed herein with his usual no-nonsense clarity. He compares three pathways we might take to move medicine out from corporate greed and back to the common good.

—Rick Flinders, M.D., family physician and inpatient program director,
Santa Rosa Family Medicine Residency, Sutter Santa Rosa Regional Hospital, Santa Rosa, CA


The Human Face of ObamaCare: Promises vs. Reality and What Comes Next

Review Posted Online: Nov. 17th, 2016

America’s medical system faces severe and worsening problems under ObamaCare and can only be cured by a revolutionary turn toward public health insurance, according to this exposé.

Geyman (Souls on a Walk, 2012, etc.), a medical school professor and former editor of The Journal of the American Board of Family Medicine, argues that while the number of uninsured has dropped because of the 2010 Affordable Care Act, spiraling costs and a decline in quality have left many Americans with unaffordable, inadequate, and insecure health care. He notes that tens of millions still go without insurance; that soaring deductibles and co-payments mean that even insured patients often face crippling bills or have to forgo needed care and drugs; and that out-of-network fees and other fine-print gotchas result in huge unanticipated costs that still bankrupt families. Meanwhile, he contends, insurance companies have reduced their coverage and drastically restricted patients’ ability to choose their own hospitals and physicians, requiring them to drop their longtime doctors in favor of strangers and endure long waits because shrunken provider networks don’t have practitioners who can treat them. Geyman pulls no punches in detailing the failings of ObamaCare, but he’s equally hard on the market-based reforms of Republican opponents of the system (“If the Republicans have their way, individuals and families might pay less for skimpy insurance products, but would pay much more for necessary health care”). Instead, he fingers profit-driven health care as the root of the problem, and advocates a Canadian-style, single-payer National Health Insurance program funded entirely by the government and delivered by private, not-for-profit hospitals and doctor groups. Geyman’s lucid and very readable (though sometimes repetitive) treatise has plenty of statistics to back up his arguments. But its heart is a series of individual health care horror stories wherein ordinary families find that ObamaCare promises of affordable treatments, universal access, and a choice of providers prove to be hollow. (One patient Geyman profiles was slapped with a $117,000 bill when an out-of-network consulting surgeon he had never met was called in while he was unconscious during a neck operation—a fee his insurer refused to pay). The result is a smart, savvy analysis that shows the human cost of a broken system.

A compelling, hard-hitting indictment of U.S. health care and half-measure ObamaCare reforms.


"This is a beautifully researched, deeply disturbing, and entirely useful book. Dr. Geyman cuts through the fog and explains clearly the momentous choices America faces in the next era of health care reform."

—Donald Berwick, M.D., president emeritus and senior fellow,Institute for Healthcare
Improvement and former administrator, Centers for Medicare and Medicaid Services


"In his new book, Dr. Geyman takes us beyond abstract numbers to explain why the Affordable Care Act is not by any means the final solution to fixing what continues to be for too many Americans a dysfunctional, inequitable and unaffordable health care system. He makes a compelling case for replacing our costly and inefficient multi-payer system with single-payer national health insurance."

—Wendell Potter, former CIGNA executive, senior fellow on health care at the
Center for Media and Democracy, and author of Deadly Spin: An Insurance
Company Insider Speaks Out On How Corporate PR Is Killing Health Care
and Deceiving Americans, and Obamacare: What's In It For Me? What
Everyone Needs to Know About the Affordable Care Act.


"In his latest book John Geyman takes stock, honestly and objectively, of the state of American health care five years into the implementation of ObamaCare. He examines the law's effects on our healthcare system, on the healing professions, and on individual Americans and makes a persuasive case the ObamaCare is unsustainable. He presents three possible scenarios for future reforms.
After reading this comprehensive and persuasive critique, I am more convinced than ever that an improved and expanded "Medicare for All" system is not only the best for the vast majority of Americans but is the only reasonable option for those of us who believe health care should be focused on the prevention and treatment of illness rather than wealth-extraction from patients.
The only question now is how much longer the public will tolerate the accelerating corruption of our healthcare system Geyman documents and the charade that masquerades in Washington as a real debate about health care policy.
This book is a must read for any American who has been or will be exposed to the American healthcare system. That would be all of us."

—Philip Caper, M.D., internist with long experience in health policy
since the 1970s, and past chairman of the National Council
on Health Planning and Development


"Dr. Geyman advocates for single-payer health care with his usual wit, reason, and immaculate documentation. This time he fortifies his points with personal stories from across the country, describing the wreckage left by the Affordable Care Act. Putting human faces on ObamaCare brings the argument home poignantly. The people telling their stories of our failed health care system could be our friends, our families, and us. The unhappy consequences of ObamaCare touch us all."

—Samuel Metz, M.D., adjunct associate professor of anesthesiology,
Oregon Health and Science University, Portland, OR


"Many liberal Democrats supported ObamaCare as a step toward a universal single-payer public health insurance system. As Dr. John Geyman's book makes clear, ObamaCare was instead a leap into the arms of a rapacious private insurance industry that hiked premiums, denied care, cancelled policies, narrowed networks, jacked deductibles, drove doctors to burnout, fueled the rise in medical costs, raided the public treasury, bloated the bureaucracy and corporate profits, privatized Medicare and Medicaid, decreased the quality of care, and left 30 million Americans uninsured. Next time, can we learn from this debacle? Read this book. Then just say no to the private health insurance industry and those who would play their deadly game."

—Russell Mokhiber, Single Payer Action


"This book has heartbreaking stories of U. S. citizens who face medical and financial catastrophes due to our dysfunctional healthcare system which now includes the ACA. We need to listen to these stories to feel the true impact of how the profit-based medical industry is harming our society. A major paradigm change to single-payer is discussed as an equitable and viable solution.

—Ray Drasga, M.D., long-time community-based oncologist and leader
toward universal health care in his own specialty organization,
the American Society of Clinical Oncology.


"Although many had high hopes for ObamaCare, as John Geyman shows us the human faces, we realize that reform fell too short for too many. He shows us not only those human faces but also the pained face of health care justice. He provides us with an understanding of what is wrong with our system, and then describes options for the future. He encourages us all to participate in the reform dialogue so that we can finally get this right. The Human Face of ObamaCare is a great place to start."

—Don McCanne, M.D., family physician, senior health policy fellow
and past president of Physicians for a National Health Program (PNHP)


"Dr. John Geyman gives us a clear summary of failed incremental reform attempts over many decades. The Affordable Care Act, AKA ObamaCare, is the latest example, and Geyman highlights its many shortcomings, including perverse incentives, rising costs, narrow choices, and still-incomplete coverage. He concludes with a cogent, compelling argument for a single-payer national healthcare system: the approach that's worked everywhere else in the world."

—Richard Deyo, M.D., Kaiser Permanente Professor of Evidence-Based
Family Medicine, Oregon Health and Science University,
Portland, and author of Watch Your Back!


"An insightful critique of ObamaCare and an impassioned plea for a single-payer system, enlivened by stories of real people poorly served by the Affordable Care Act. An invaluable contribution to the discussion of how to make health care in America better and more affordable for everyone."

—Kenneth Ludmerer, M.D., professor of medicine and the history
of medicine at Washington University in St. Louis, and past
president of the American Association for
the History of Medicine


"The Affordable Care Act (ACA) was passed with great fanfare in 2010 with the promise to increase the number of Americans who have affordable health insurance, reduce unfair insurance restrictions, and reduce the costs of health care. In The Human Face of ObamaCare, Dr. Geyman holds the ACA up to the microscope and contrasts its promises and outcomes. Combining stories of patients with sound economic analysis, Dr. Geyman illuminates where the ACA has fallen short of its goals and points the way to an improved health care system that would be more affordable for both patients and for our country."

—Jeffrey Cain, M.D., past president American Academy
of Family Physicians


"Dr. Geyman has done it again: another up-to-the-minute report on the current state of our ailing health care system. This time, he includes a report card on the first five years of the Affordable Care Act, where it has succeeded and failed, and his forecast of what may come next. Like everything else he has written, his research is thorough and remarkably current. Where others rehash yesterday's statistics and arguments, Geyman's books are like breaking news. In this book he makes the facts personal: faces and cases of recurring failures in our privately-insured and profit-driven system to meet the medical costs of our people when they're sick. The system is still broken in 2015, Geyman explains, and it is breaking us. Finally, unlike so many critics of ObamaCare, Geyman shows us a rational and practical way out."

—Rick Flinders, M.D., family physician and inpatient program director,
Santa Rosa Family Medicine Residency, Sutter Santa Rosa
Regional Hospital, Santa Rosa, CA


"I have enthusiastically supported the Affordable Care Act, but have always regarded it as Health Reform 1.0. Health Reform 2.0 or 3.0 would inevitably be universal health care. The Human Face of ObamaCare does an excellent job of updating us on the successes and failures of the ACA and showing why universal health care is currently the best option for America's future."

—Howard Brody, M.D., Ph.D., Director of the Institute for Medical
Humanities, University of Texas Medical Branch, Galveston


How Obamacare Is Unsustainable: Why We Need a Single-Payer Solution for All Americans

"John Geyman has provided us with the most lucid, best documented, and most compelling portrait of what's wrong with the Affordable Care Act yet available. He also argues forcefully for the fix we need. This is an invaluable contribution to our understanding of U.S. health care, and the essential playbook for policy change."

—Larry Churchill, Ph.D. professor of medical ethics,
Center for Biomedical Ethics & Society, Vanderbilt
University Medical Center, Nashville, TN and
co-editor of Ethical Dimensions of Health Policy


“John Geyman, in his book, How Obamacare Is Unsustainable: Why We Need a Single-Payer Solution for All Americans, really gets it. He artfully describes how we have arrived in the mess we find ourselves, explains the underlying pathologies in our health care system and politics that have led us here, and clearly describes the only rational, evidence-based way out. A must read for anybody interested in understanding our current health care dilemma and the best way to fix it.”

—Phillip Caper, M.D., internist with long experience in national health policy work
dating back to the early 1970s, past chairman of the National Council on Health Planning
and Development, and founding member of the National Academy of Social Insurance

“A brilliantly clear account of how the Affordable Care Act—or Obamacare—emerged in 2010 legislatively and has since then confronted, with great difficulty, the problems of insuring those without health coverage. I can think of no book that competes with Geyman’s in explaining this complicated subject.”

—Ted Marmor, Ph.D. professor emeritus of public policy and management
at Yale University, author of The Politics of Medicare, co-author of
Social Insurance: America’s Neglected Heritage and Contested
Future, and member of the Institute of Medicine.

“This important book provides a vivid, data-driven critique of the Affordable Care Act, describing how the new law accentuates many of the ills it was designed to correct. Thus, despite the ACA’s good intent, we still have soaring costs, unequal access to care, and a health care system where materialism dominates moral commitment and the drive for profits trumps the needs of patients at every turn. The book also provides a passionate argument for a single-payer system. A major contribution to the debate about the future of health care in America.”

—Kenneth Ludmerer, M.D., professor of medicine and history at Washington University in St. Louis,
author of Time to Heal, and past president of the American Association for the History of Medicine

“How Obamacare Is Unsustainable by John Geyman provides an historical perspective of how the health insurance industry in the U.S. has evolved over the last 100 years to the point where we are today. He then details the problems the Affordable Care Act has experienced since its inception and offers a sensible solution that can lead to affordable access to quality health care for all. A must read for anyone concerned about the dysfunctional state of our health care system since it is comprehensive yet simple to understand.”

—Ray Drasga, M.D., recently retired oncologist
and national leader toward a single-payer health care system

“Once again, Dr. Geyman hits the mark in laying out the current threats to the practice of medicine and the health of all residents of the United States. This is the book health justice activists can rely on and refer back to, time and again. It gives us all the facts and talking points we need—simply outlined yet fleshed out, point by point. Also, clearly laid out, is the strategy to unseat the vested interests that are working against the systemic changes we desperately need to build a new national system that will make concrete the right to health care for all of us.”

—David McLanahan, M.D., clinical associate professor of surgery
emeritus, University of Washington School of Medicine

Souls on a Walk: An Enduring Love Story Unbroken by Alzheimers

“Souls on a Walk traces the clinical progression of the disease with a human voice giving the reader the opportunity to place himself into the story and ask ‘how would I be able to handle either role?’ Both were a caregiver to the other by reason of early recognition then diagnosis, i.e. before the disease took complete control of both lives. I read the book straight through, and could not put it down.”

—Ed Greub, Friday Harbor, WA


“Brains don’t get Alzheimer’s disease; people get Alzheimer’s disease. John Geyman utilizes his observational skills honed over decades as a family physician to present a compelling account of his wife Gene and how the disease affected both of them. Love shines through from every page.”

–Howard Brody, M.D., Ph.D., Director of the Institute for the Medical Humanities at the University of Texas Medical
Branch in Galveston and author of Stories of Sickness


“What a provilege to read Souls on a Walk. I was surprised by the powerful pull of the story—every reader knows the ending, at least its broad outlines, yet it was an emotional page-turner.”

—Greg Bates, president and publisher
of Common Courage Press, Monroe, Maine

Healthcare Wars: How Market Ideology and Corporate Power Are Killing Americans

“Dr. John Geyman’s Health Care Wars is a tour de force—replete with facts that are organized for reader understanding and civic arousal. Citing irrefutable evidence from unrebutted studies, in properly enraging detail about lost lives and plundered family budgets, Dr. Geyman lays down the steps needed to replace corporatized, wasteful, corrupt health sales with full Medicare for all, containing incentives for prevention, cost control and the rise of honest, competent health care as if people matter first.

Health Care Wars is a remarkably comprehensive, contextual and action-driven book with some marvelously insightful cartoons which show that in humor there is truth.”

—Ralph Nader, author of the recent
Getting Steamed to Overcome Corporatism
Build It Together to Win


“Americans don’t have a health care system, they have a free enterprise system beholden to corporate executives, shareholders and investors from the industries that benefit the most from high costs. While pharmaceutical companies, insurance companies and medical product companies profit, taxpayers are getting squeezed at an accelerating rate. To make sense of the system and understand why the health care cost debate is only beginning you have to read the succinct words of one of America’s wise men, John Geyman, MD. Regardless of what the Supreme Court decides and which party controls Washington, Dr. Geyman’s words of wisdom will guide us for the foreseeable future. A must read for all interested in health care policy.”

—Charles North, MD, MS Captain (ret) United States Public Health Service,
professor of family and community medicine, University of New Mexico

“It has long been recognized that health care does not follow the rules of free markets, yet the United States continues to rely on a dysfunctional financing system that fails to correct for these market deficiencies. In Health Care Wars, John Geyman shows us how this has been a disaster, while providing us hope through the prospect of empowerment of patients and taxpayers.”

—Don McCanne, M.D., Senior Health Policy Fellow,
Physicians for a National Health Program (PNHP)

“Health Care Wars debunks the propoganda served up by self-serving commercial interests. Author John Geyman blows away the smokescreen hiding the profit motives of health-care related entities. He diagnoses the disorders inherent in the present health care non-system. This book imagines a humanitarian health care system unsullied by profit motives and guided by scientific evidence.”

—Joseph S. Silverman, M.D., Distinguished Life Fellow,
American Psychiatric Association

The Cancer Generation: Baby Boomers Facing a Perfect Storm - Second Edition

“A book for every baby boomer. As baby boomers age, the U. S. will inevitably face a cancer epidemic. John Geyman shows how utterly unprepared we are to deal with it. The arguments in favor of replacing our crumbling health system with something better are overwhelming, but especially for people with cancer – a devastating and extraordinarily expensive disease. Geyman explains in easy-to-understand language what needs to be done.”

—Marcia Angell, M.D., senior lecturer at Harvard Medical School
and former editor-in-chief of the New England Journal of Medicine


“Cancer is not an equal opportunity experience. Geyman provides a compelling argument for why access to health care in America should be universal and why the business
model for medicine needs to be modified to encompass what is socially good.”

—Frank L. Meyskens, Jr., M.D., Professor of Medicine and Biological Chemistry,
Director, Chao Family Comprehensive Cancer Center, University of California, Irvine


“The Cancer Generation is the most honest and thorough accounting of the status of our nation’s war on cancer that I have ever read. It captures that extraordinarily complex blend of hope and fear, disappointment and optimism that characterizes a diagnosis of cancer for individuals and the spectrum of cancer for the country. John Geyman’s book is easy to read and totally convincing, the cancer storm is here and is about to intensify. But this thoroughly researched book provides far more than a warning about our rising cancer burden. Geyman utilizes his life’s experience as a primary care physician and policy expert to identify the decisions and investments that we must make today to navigate our way through the cancer storm to a healthier future.”

—Richard Wender, M.D., Professor and Chairman, Department Of Family Medicine,
Thomas Jefferson University, Philadelphia, PA, and past president of the American Cancer Society


“Dr. Geyman’s prediction of looming catastrophe in cancer care is painstakingly researched and ultimately very convincing. He argues persuasively for single-payer National Health Insurance as the only solution. God help any of us who gets cancer 5 years from now if policymakers do not take his analysis seriously.”

—Louis Balizet, M.D., practicing oncologist, Rocky Mountain Cancer Centers, Pueblo, Colorado


“In The Cancer Generation, John Geyman continues his provocative and disturbing full body scan of American health care by examining cancer care. Since 40% of us will be diagnosed with cancer in our lifetimes, the topic is not an abstraction and Geyman’s report is not a pretty one. Commercialism, avarice and our painfully dysfunctional insurance system too often gang up to make a medical challenge a personal catastrophe. We can do better, he tells us once again.”

—Fitzhugh Mullan, M.D.
Murdock Head Professor of Medicine and Health Policy, The George Washington University and Founding President of the National Coalition for Cancer Survivorship


“Having had considerable family experience with cancer and heart disease, and having just read John Geyman’s Do Not Resuscitate, I had not expected to gain much from his new book, The Cancer Generation, but I was wrong. By concentrating here on the increasingly important issue of cancer in the United States, Geyman brings into sharp focus the problems of our multi-payer system in a way that not only clarified the issues in my mind but also bolstered my sense of urgency that we must establish a single-payer health care system. This book provides powerful ammunition toward that end because it presents with clarity much recently available factual information and valuable commentary on health care reform.”

—Neil Davis, Ph.D.
Professor Emeritus of Geophysics, University of Alaska


“If you want an accurate diagnosis and practical treatment recommendations for a vexing and complex problem, you should seek the counsel of an experienced family physician who has carefully kept abreast of the latest scientific evidence. Dr. John Geyman here offers us his counsel on the vexing problems posed by America’s broken health care system. While he focuses especially on cancer, most of his recommendations apply equally well to the other common chronic illnesses that afflict us.”

—Howard Brody, M.D., Ph.D.
Director, Institute for the Medical Humanities,
University of Texas Medical Branch, Galveston, Texas


“No topic could serve as a better proxy for the deficiencies in the financing and delivery of health care in the United States than the ever increasing prevalence and expense of cancer. In The Cancer Generation, John Geyman describes the tragic and costly impact of the cancer burden, but then provides us with hope by describing a plan that would reduce these burdens of cancer.”

—Don McCanne, M.D.
Past president, Physicians for a National Health Program
and PNHP Senior Health Policy Fellow

Breaking Point: How the Primary Care Crisis Endangers All Americans

“Anyone seeking a broad understanding of factors leading to the developing crisis in primary care should read John Geyman’s Breaking Point: How the Primary Care Crisis Endangers the Lives of Americans. Geyman, a pioneer in family medicine education and a prodigious writer, does it all, providing a comprehensive, well annotated description of the historical development of primary care, its contemporary status and its essential role while also providing his prescription for the future. A must for all concerned about health system change.”

—Jack Colwill, M.D., Professor Emeritus of Family and Community
Medicine, University of Missouri School of Medicine


“This timely, masterly book from a leader in family medicine is a wake-up call for better understanding of the potential for improving medicine through well-organized primary care. It is also an analysis of the practical barriers that have prevented this from happening (so far, at least), and a manifesto for change in the future. A well-documented challenge for anyone, including medical students, who want to understand the strengths and weaknesses of American medicine, the continuing promise of primary care to save lives and promote efficiencies, and the incentives and disincentives that make the American system what it is.”

—Rosemary A. Stephens, Ph.D., MPH, Medical Historian at Weill
Cornell Medical College and author of The Public-Private Health Care
State: Essays on the History of American Health Policy.


“John Geyman continues his scholarly investigation of the structural, financial and educational origins of the crisis in American health care in Breaking Point. This book is a blueprint for restructuring the primary care workforce shortages that plague the current system and, as Geyman illustrates in great detail, will be hugely worse in the next decades with health care reform. What we need are clear, direct and achievable goals to work toward and, particularly in the chapter on Rebuilding and Transforming Primary Care, Geyman distills over fifty years as a scholar, thought leader, and national figure in health reform into ten principles that should guide that transformation. The book should be a source document for answering the question of how we got to this point as well as where we have to go next.”

—John J. Frey, M.D., Professor of Family Medicine and Head of
Community Health Connections, Institute for Clinical and Translational
Research, University of Wisconsin School of Medicine and Public


"What good is a super high-tech health care system when you can't find a doctor when you need one? In Breaking Point, John Geyman explains why it is crucial for us to rebuild our primary care infrastructure, and how we can do it."

—Don McCanne, M.D., Senior Health Policy Fellow,
Physicians for a National Health Program (PNHP)


“Breaking Point is a superb, up-to-date analysis of the crisis in primary care and its implications for the health of the American people. Dr. Geyman clearly and systematically addresses the benefits of a health system based on primary care for both quality and cost, the inadequacy of the current primary care workforce and efforts to replace it, and the reasons for this inadequacy. He destroys the myths that have led to our current primary care/specialist imbalance and makes concrete and realistic suggestions on how to solve these problems. His case, based on data and research, is strong and compelling and should be required reading for all concerned with the health system and workforce reform.”

—Joshua Freeman, M.D., Professor and Chairman, Department of Family
Medicine, University of Kansas School of Medicine


“Dr. Geyman is one of the most outstanding wise men and scholars of the family medicine movement in the United States today. His insightful analysis of the history and impact of primary care will inform those interested in improving the health care delivery system. He provides a clear way forward to achieve universal access, better quality, and lower the cost of medical care. Elected officials, advocates and policy makers will benefit from his suggestions as the ongoing debate continues. This book should be required reading for medical and public health students, academic medical leadership and policy makers at all levels of government.”

—Charles North, M.D., MS, Professor of Family and Community
Medicine, University of New Mexico School of Medicine


“Dr. Geyman continues to shine as a beacon of intellectual clarity and common sense. Economic incentives remain aligned to force students into subspecialty care despite decades of awareness of the primary care crisis among educators, corporations and politicians. In Breaking Point, Dr. Geyman presents the statistics behind the ongoing shortage and its damaging effects on our nation, yet provides a glimmer of hope for resolving this crisis.”

—Lee Burnett, D.O., Executive Director, The Student Doctor Network


“Breaking Point is not just a title, it is a reality of primary care now and for decades to come. Readers will begin the process of eliminating what has not worked while focusing on what should be accomplished for a true primary care foundation.”

—Robert C. Bowman, M.D., Professor of Family Practice, A T Still
School of Osteopathic Medicine in Arizona


“Dr. Geyman—an esteemed pioneer in the Family Medicine movement—describes how the U.S. movement toward specialty medicine—and away from Primary Care—has led to higher costs, poorer quality, and the elimination of close relationships between patients and their physicians. In addition to clearly describing the problems, Dr. Geyman offers realistic solutions including restructuring of incentives and the redesign of primary care practice itself. This inspiring book is a ‘must-read’ for health-care policy makers, physicians, physician assistants, nurse practitioners and the students in all of these disciplines.”

—Ruth Ballweg, MPA, PA-C, Associate Professor and Director MEDEX
Northwest Physician Assistant Program, University of Washington School of Medicine

Hijacked: The Road to Single Payer in the Aftermath of Stolen Health Care Reform

“...a passionate account of why the battle has just begun, and how we, the people, can win.”

—Bill Moyers


A trenchant and highly readable account of how the special interests sabotaged health reform, leading to a law that won’t provide universal care nor control escalating costs.?Geyman shows us the way to real reform when the current law implodes. An eye-opening book.

—Marcia Angell, M.D., Senior Lecturer in Social Medicine, Harvard Medical School,former editor-in-chief, New England Journal of Medicine

“In what may be Dr. Geyman’s best book to date, Hijacked lays bare the corporate influences that led Congress to its politically compromised version of health care “reform,” the Patient Protection and Affordable Care Act of 2010 (PPACA). Hijacked shows how this controversial legislation does more for corporate shareholders than it does for patients. But it goes beyond the problems to describe comprehensive approaches to true health care reform.”

—Lee Burnett, D.O., Executive Director, The Student Doctor Network

Hijacked: An Important Book For All Concerned Americans
I want to thank Dr. John Geyman for writing this important book, HIJACKED! The Road to Single Payer In the Aftermath of Stolen Health Care Reform. As Dr. Geyman documents in disturbing detail, the Obama health care plan is Obama's in name alone. The plan was written by the health care industry and its lobbyists to serve its financial goals, not patients or providers. It provides a trillion dollar gift to that industry over the next decade, on a level with the Obama bailout of the banks and insurance companies. As with all good doctors, Dr. Geyman provides real hope for all Americans in light of this grotesque travesty; it is up to us, individually, to take his message seriously and bring enough pressure from the bottom up to force our political institutions to do the decent thing for all Americans and implement a true single payer health care plan.

— review by David R. Baker on November 18, 2010

A Single Payer Plan Primer

This is a well written and documented book on the single payer health system that we have been striving toward in this country for several generations, by the authoritative and accomplished Dr. John Geyman. It is a great place to start in forming an action plan on this topic. Thank you CCP!

— review by Still Learning on November 2, 2010

Just what the doc ordered!

After just finishing "Lives At Risk" and finding it woefully inaccurate and full of right-wing propaganda, this is a breath of fresh air. This guy gets it. I'm a pharmacist of 25 years experience and what this doctor prescribes is a prescription this country should definitely fill. The last chapter summarizes nicely why the existing non-system will inevitably fail and why we need a single-payer system. Should be required reading of anyone running for office.

— review by Jonathan M. Lloyd on February 16, 2011


By reading John Geyman’s very timely Hijacked, those who are uncomfortable with the reform process that took place will be able to understand more precisely what went wrong. He explains why our concerns are fully warranted, but, instead of abandoning hope, he provides us with a road map for reform that will ensure that all of us will have the health care that we need.

—Don McCanne, M.D., family physician, Senior Health Policy Fellow,
Physicians for a National Health Program (PNHP)

Do Not Resuscitate: Why the Health Industry is Dying, and How We Must Replace It

"With Do Not Resuscitate, his 6th incisive critique of American medical care, John Geyman rounds out his 360 degree examination of commercialization, profiteering, and professional lassitude in the health care in this country. His articulate and data-driven prescription is, once again, single-payer, national health insurance--a message that is ever more pertinent to our troubled system and brings reality to the rhetoric of need for change in America."

—Fitzhugh Mullan, M.D., Murdock Head Professor of
Medicine and Health Policy The George Washington University


"Do Not Resuscitate could not be more timely. John Geyman describes precisely the reasons why it would be a terrible, costly mistake to continue to rely on the private insurance industry to pay our health care bills. He shows us that it is an industry based on an obsolete business model that wastes tremendous resources simply to avoid paying for health care. He further describes how it is possible for everyone to have high-quality, comprehensive, affordable health care, but only if we adopt an equitable and efficient financing system that is specifically designed to accomplish that."
—Don McCanne, M.D. Senior Health Policy Fellow,Physicians for a National Health Program (PNHP)


"If there ever were a time for national health care reform it is now. This book is a prescription, and an inspiration."

—Robert Hayes President, Medicare Rights Center


"Geyman brings important news that everyone should recognize now, and will surely see in the coming years: that the private health insurance industry is obsolete, producing plans that are unaffordable when their coverage is good, and unusable when ordinary Americans can afford them. He shows how, in their death throes, they are becoming increasingly destructive. But unlike many other volumes, he shows that there is a way out, through a national single payer, non-profit fund that would cover all of us. Read it, and join the movement for universal care."

—Leonard Rodberg, PhD Professor of Urban Studies,Queens College, City University of New York


"There are two ways to heal the healthcare crisis in the United States. The first one doesn't work:
1. Pay more and more money to insurance companies to entice them to cover the uninsured and firmly regulate them so they stop denying healthcare to those who are already covered. Also stop their incursion into government-funded programs such as Medicaid, Medicare, SCHIP, and Veteran's Healthcare.
2. A national single payer healthcare system that covers everyone, costs less money (because it cuts the insurance companies out of the control of our system) and provides more healthcare for every single person in the country. John Geyman's book explains it all."
—Marilyn Clement, National Coordinator Healthcare-NOW

"Congratulations on this very timely and helpful book. Keep up the great work!"
—David Satcher, M.D., PhD16th Surgeon General of the United StatesDirector, National Center for Primary Care, Morehouse School of Medicine

Shredding the Social Contract - The Privatization of Medicare

"John Geyman has written a trenchant and timely contribution to the important debate on the future of Medicare--a debate that should engage families as well as policymakers."

—Christine K. Cassel, MD, president of the American Board of Internal Medicine


"Everyone knows that the Medicare program is in trouble. The problem is how to fix it. Many politicians advocate further privatization of the program as a solution. John Geyman concludes that this is the wrong solution. He comprehensively and persuasively reviews the evidence, including both published research and the experiences of many of Medicare's beneficiaries, to support this conclusion. We rather need, Dr. Geyman argues, a renewed commitment to the original vision of social insurance on which the program was based. This readable and practical account should be read by anyone who is concerned about the Medicare program and its future, which should be all of us."

Timothy Stoltzfus Jost, Robert L. Willett Family Professor, Washington and Lee University Law School


"Dr. Geyman is a modern day Paul Revere. He warns America-with a stirring mixture of evidence and passion-of the wrecking ball the apostles of greed are taking to Medicare, a national treasure under attack."

—Robert Hayes, President, Medicare Rights Center


"A passionately argued and powerful counterweight to the claptrap about 'modernizing Medicare' from the current Administration. Historically informed, this work by a doctor/advocate is well worth reading for its understanding of the assault Medicare actually faces by those who claim to be improving it. "

—Ted Marmor, author of the Politics 0f Medicare

The Corrosion of Medicine - Common Courage Press

The Corrosion of Medicine shows that "We do not have to passively accept the role of being workers in an industry controlled by market entrepreneurs. ..."

— Don McCanne, M.D. See his full message at end of this web page.


"As public demand grows for thoroughgoing reform of our disastrous system, physicians must play a constructive role. No reform can work if they continue to be part of the problem, not the solution. It is for this reason that I am enthusiastic about Dr. Geyman's fine new book. He shows clearly that physicians are central to any health system, and offers a powerful argument that they need to reclaim their moral commitment to put patients' needs first." — from the Foreword by Marcia Angell, senior lecturer at Harvard Medical School and former editor-in-chief of the New England Journal of Medicine

"John Geyman shines a bright light on the challenges to professionalism in the 21st century. If our profession can respond to his call to action, both physicians and patients will be the better for it."

— Christine K. Cassel, M.D., President of the American Board of Internal Medicine


"Everyone recognizes that our health care system is in crisis. Geyman uncovers the fundamental source of that crisis, in the decades-long attempt to impose market values on the practice of medicine. He shows that only by resisting the pressure to turn medical care into just another market commodity can medicine be restored as a profoundly moral and caring profession. This comprehensive look at the commercialization of medicine reveals, too, why physicians must take the lead, supported by the patients who depend on them for our care. We and our doctors should read it, and heed it."

— Leonard Rodberg, Professor of Urban Studies, Queens College, City University of New York


"John Geyman has once again taken on one of the essential moral issues of our time--money and medicine. The Trojan horse of American business has brought money into medicine in ways doctors of an earlier epoch could never have imagined. Market principles have everywhere seduced physicians and left the profession compromised, weakened, and frustrated. Geyman's diagnosis is instructive and his prescription lucid. Corrosion is a major contribution to the reform movement in American health care."

— Fitzhugh Mullan, MD, Murdock Health Professor of Medicine and Health Policy, The George Washington University

Falling Through the Safety Net: Americans Without Health Insurance

This is a most important book by one of America's leading experts. We are paying dearly in health system inefficiency and unnecessary pain and suffering because of the cracks in our safety net. Without attention to this issue as illustrated in this text, we will never eliminate disparities in health among different racial and ethnic groups in this nation. —

—David Satcher, 16th U. S. Surgeon General, Director, National Center for Primary Care at Morehouse School of Medicine


A compelling description of our dysfunctional health care system, a reasoned analysis of its problems, and a persuasive argument for a single-payer insurance plan as the best solutionÑwritten by someone with real understanding and first-hand experience. A much-needed lesson that ought to change a lot of minds. I recommend it strongly.

— Marcia Angell, M. D., Senior Lecturer in Social Medicine, Harvard Medical School, Former Editor-in-Chief, New England Journal of Medicine


This book elegantly reveals how our current system goes so wrong and then provides a ray of hope as it shines a light on the only logical solution to the health care crisis. It is a must read for any one who care about providing care to patients in need.

— Claudia M. Fegan, MD
President of Physicians for a National Health Program


"Once again, the legendary master of family medicine addresses with clinical compassion the widespread concerns about "unsurance" and uncovered medical costs. Geyman's well-researched recommendations should be read by everyone."

— Donald Light, Professor of Comparative Health Care Systems, Princeton


"For better and for worse, the safety net is what stands between millions of Americans and no health care at all. Dr. John Geyman's Falling Through the Safety Net provides a brilliant road map to this nation's patchwork of medical coverage for the uninsured. As a practitioner, teacher, and medical leader, Geyman has learned his way around the safety net first hand. His book reflects that knowledge as well as his resolve to move beyond the safety net and put a firm floor of medical care in its place. Falling Through the Safety Net is an intelligent instruction manual for dealing with our present dilemmas and a vital prescription pad for moving beyond them. Powerful reading for all."

— Fitzhugh Mullan, MD, author, Big Doctoring in America: Profiles in Primary Care.

Additional Reviews

How Obamacare Is Unsustainable: Why We Need a Single-Payer Solution for All Americans
by John Geyman, M.D.
Friday Harbor, WA, Copernicus Healthcare, 2015, 315 pp., $18.95, paperback

Book Review by Ronald L. Malzer, PhD

From early 2009, when President Obama called for legislation implementing universal access to health care, to the signing of the Patient Protection and Affordable Care Act (ACA) in March 2010, and continuing to the time of this review (mid-2015), “Obamacare” has been sharply criticized by the political right as excessive government interference with our market-based system.

John Geyman, MD, professor emeritus at the University of Washington School of Medicine, makes exactly the opposite case in How Obamacare is Unsustainable. He argues that American health care has been plagued by an excess of unregulated profit-making, to the serious detriment of affordable quality health care. In his view, the ACA did little to address this fundamental problem. He calls instead for the implementation of a comprehensive, national health insurance system (NHI). He has written this book, published in January 2015, as a three-part argument, backed by numerous tables, statistical reports, and analyses.

Part One provides a history of health care reform efforts in the United States, from 1917 to the present. Dr Geyman documents five efforts, prior to the ACA, to implement significant health care reform. He notes that only one push led to a solid success: the passage of Medicare legislation in 1965. Dr Geyman holds up Medicare as an NHI prototype. But rather than finding a path to universal access, Dr Geyman argues, organized medicine over the last century has allowed “transformation from a service-oriented cottage industry into big business,” with health care access a marketplace commodity, rather than a right.

Part Two contains Dr Geyman’s critique of the ACA, identifying not only inherent flaws, but also multiple problems the ACA doesn’t attempt to address. He does concede: “To be fair, ACA has accomplished some good things for many Americans” (p. 164), including, he reports, newly insuring at least 10 million Americans. But he concludes that ACA was doomed to failure from the start: “Health care ‘reform’ through the ACA was framed and hijacked by corporate stakeholders . . . The interests of insurers, the drug and medical device industries, hospitals, and organized medicine took precedence over the needs of patients for broad access to affordable quality health care.” (pp.166-167).

Dr Geyman sees very little value in attempting incremental reform and argues in Part Three for a sweeping health care system overhaul: financing, access, and delivery. He asserts that a well-crafted national insurance program would: (1) reduce the total cost of health care, (2) provide better population-wide health outcomes, and (3) address a moral inequity by giving health care access to all, not just those whose insurance or personal wealth allows it. He advocates financing a single-
payer plan through a payroll tax. He argues that, over time, this would be more than offset by cost reduction. He maintains that excess profits would gradually be squeezed out, and unneeded procedures diminished in frequency, with quality evidence-based care incentivized in the national health plan.

How Obamacare is Unsustainable can be criticized from a number of perspectives. Libertarians are unlikely to be persuaded. Polling data exists to challenge Dr Geyman’s contention that a single-payer system enjoys strong majority public support; public endorsement of government-based health funding varies greatly over time.1 Those of us who see ACA as the maximum reform obtainable in the current political climate may find Dr Geyman’s assertions too harsh that ACA has accomplished little.2 Having weathered two Supreme Court reviews, Obamacare, incomplete a reform as it is, will likely be the last reform effort for some time.

With US per capita health care spending wildly exceeding that of other democracies, and health outcome measures registering quite poorly,3 the burden of proof for the future rests on those finding value in maintaining free enterprise as the dominant mechanism of the health care system.

Dr Geyman’s thesis poses at least two moral questions: (1) Is it acceptable to leave millions of Americans uninsured and unable to afford needed medical care? and (2) Have we as health care providers/professionals, with incomes high relative to our counterparts abroad, acquiesced to a badly structured system, one limiting our ability to provide beneficence to our patients?

This thoroughly researched and passionately articulated work deserves a careful reading by all of us in the health care system. John Geyman, MD, deserves immense respect for his tireless advocacy on behalf of a vision for a better and fairer health care system for all.

—Ronald L. Malzer, PhD
La Crosse-Mayo Family Medicine Residency
La Crosse, WI


How Obamacare is Unsustainable:

Full Review by Nick Estes, JD

I t's been five years since passage of the Affordable Care Act and over 30 million people have obtained health insurance coverage—most for the first time. The national uninsured rate has declined from a peak of eighteen percent to eleven percent. Low-income individuals have benefited from the expansion of Medicaid (in about half the states) and from the premium subsidies for private coverage purchased on the new health insurance exchanges. Obamacare brought major reforms to our health insurance system: carriers can't deny people because of pre-existing conditions, annual and lifetime caps on benefits are not allowed, and young adults can stay on their parents' policies until age twenty-six. The ACA, together with a reviving economy, even seems to have bent the cost curve down somewhat.

So what's not to like?

Plenty, according to Dr. John Geyman in How Obamacare Is Unsustainable: Why We Need a Single-Payer Solution for All Americans. Dr. Geyman makes a compelling and well-written case that America could do much better for its citizens.

First, 30 million people are still uninsured under the ACA. This would be unimaginable in other advanced countries. And there is little hope that many more of these individuals will become insured. Many of them are lowincome individuals who are just above the income cut-off for Medicaid, but feel they can't afford the coverage offered on the exchanges—even with a federal subsidy—and are willing to take their chances with a tax penalty—or with a sudden serious illness.

Moreover, even for those with insurance, Dr. Geyman emphasizes that an "epidemic of underinsurance" has developed. Many employer-sponsored health plans (some adopted to meet ACA requirements), as well as individual plans, including many purchased on the new state exchanges, have higher and higher deductibles and co-pays. For example, most people are buying "silver" plans on their exchange, which only cover seventy percent of the enrollee's medical bills. Many are buying "bronze" plans, which cover sixty percent. Obviously, a family could easily be financially devastated by having to pay thirty or forty percent of the cost of treatment for a really serious illness.

Moreover, health care remains twice as expensive per capita in the United States as the average of other advanced countries, while health outcomes are not any better, and are frequently worse. Obamacare is only expected to cause marginal improvement in that unconscionable statistic.

According to the Dr. Geyman, the basic problem with the ACA is that it is built on our current system of private health insurance, which costs a fortune in administration and profits, while adding essentially nothing of value to American health care. The incredible political power of the health care industry, and especially the health insurance industry, forced the politicians, from President Obama on down, to exclude any consideration of a "single-payer" system like Medicare, in which citizens pay taxes rather than insurance premiums, and a government agency, rather than private companies, pay the health care providers.

I was startled to learn from Dr. Geyman that the excess administrative costs attributable to our system of private health insurance (both at the insurance carriers and at hospitals and physician offices) currently are almost $600 billion per year—over three percent of our nation's gross domestic product. That's almost twenty percent of our total health care costs. The administrative costs of Medicare, by contrast, are about three percent.

For all this money, there is no evidence that the health insurance companies provide any useful service that couldn't be provided just as well by a government agency like the Centers for Medicare and Medicaid Services at much lower cost.

There are two functions of health insurance. First, the insurance function. Someone must collect funds on a regular basis from a large pool, and then use those funds to cover at least some of the health care costs of individuals when they occur, recognizing that some people every year will need far more health care than others. A government agency can provide this risk-smoothing function as well as hundreds of private companies, as Medicare does now for our highest-risk population. Second, there is the administrative function: managing the collection of premiums and the payment of health care costs to the providers, minus co-pays and deductibles. To keep payment costs down, the insurance companies bargain with providers and limit access in various ways, so they can guarantee providers Reviews and reflections 60 The Pharos/Autumn 2015 certain volumes of business in exchange for lower rates.

The core problem with this system is that it takes huge costs to administer a system that requires each company and provider to determine which costs are covered—and that will depend on the patient's particular plan, on which entity provided the service, what type of service was provided, and under what circumstances. In the meantime, the company has every incentive to find ways to maximize the costs borne by the provider and the patient, and minimize what it must pay. These limitations on coverage cause people to skip preventive, non-emergency care, and wait until they are really sick and have to go to the emergency room at great expense.

Dr. Geyman argues very persuasively that it is high time we recognized that provision of medical care is not primarily a "business" best left to the private market, because everyone deserves good care regardless of their income level. Most advanced countries combine a system of mostly private providers with a form of universal national health insurance ultimately supported by income and payroll taxes. Canada is an example. (The United Kingdom is unusual in providing most care through a national health service that actually employs the physicians.)

This book is a very informative, clearly written, comprehensive indictment of our present health care system, five years into Obamacare. Personally, however, I doubt that the system is as "unsustainable" as Dr. Geyman thinks. American politics is remarkably adept at resisting changes that threaten the incomes of powerful interests. Thirty years ago, when health care spending was less than ten percent of GDP, everyone would have said that a spending level that consumed eighteen percent of our GDP surely would never be allowed. Today we think that surely Americans will wake up and adopt national health insurance as health care spending approaches and then exceeds twenty percent of our income. I'm not holding my breath.

—Reviewed by Nick Estes, JD, former health policy analyst for New Mexico Voices for Children.
His address is: 1315 Lobo Place NE Albuquerque, New Mexico 87106 E-mail:


A significant book that should be read by everyone who uses healthcare
May 4, 2015—By Victoria Randall

This is an excellent book, especially for anyone who is under the impression that the Affordable Care Act provides the solution to our outdated and dysfunctional healthcare system. Dr Geyman clearly explains the pros and cons of the ACA in a fair and even handed way.

He discusses the goals of the ACA: to provide greater access to healthcare, to contain costs and to improve quality, and measures them against the reality now that we are five years into the program. He points out the ways in which the ACA has helped some, and the ways it has failed the majority. He explores the reasons why the ACA cannot be sustained; one of the most compelling, in my opinion, is that unless we can take the burden of healthcare costs off of companies, we will fall far behind in economic competition with the rest of the world. You would think that most companies would have realized this by now, but strangely it hasn’t happened. We are headed for status as a third rate power.

He has a solution, which has been widely discussed and which the majority of American people support : single payer healthcare. This would be healthcare that is publically funded but privately delivered. In other words, our combined taxes would pay for everyone’s healthcare, eliminating deductibles, co-pays and other causes of bankruptcy.

My only area of disagreement with Dr Geyman is his casual assumption that abortion is a necessary component of healthcare. Abortion is not healthcare; it is the opposite. It is an unnecessary and elective procedure, since it is widely known that abortion is never necessary to save the life of the mother. Americans who are in the womb have as much right to protection as those of us who have made it out. Including abortion as part of Medicare expanded for everyone would add another barrier to its acceptance, since it is unlikely that Christians and other people who value life would agree to their taxes funding it.

Aside from that issue, the book is exceptional: clear and important. It only remains to be seen when our leaders will develop the will to implement the system that every other civilized nation has had for years.

Geyman illustrates key points with simple and effective charts and graphs
April 13, 2015—By Stephanie Chandler

History provides perspective. Status reports adds the immediate past and currency to a discussion. Debate on possibilities can and often does lead to a call to action. With a reading of Dr. John Geyman’s book, How Obamacare is Unsustainable: Why We Need a Single-Payer Solution for All Americans, you might find another reason to participate in the 2016 US election process.

A prolific author on the US healthcare system and its effects throughout our overall economy, Geyman provides his reader with extensive documentation to his content. For anyone who wants a comprehensive bibliography as the next national election cycle continues to spin at warp speed, the bib alone at the end of each chapter makes the book a ‘must have’.

Geyman illustrates key points with simple and effective charts and graphs. One eye opener and a take way for the reader can be found in Table 9.1, Chapter 9. When patients with symptoms that often are reported as other, more serious diagnoses than warranted, patients become vulnerable. If health care records drive our eligibility for health care coverage in our current system, misleading and/or inaccurate information about our health status leads to denials of coverage.

Book Review by Stephen Brandi
May 15, 2015—by Stephen Brandli -

If you haven’t read local resident and physician Dr. John Geyman’s book, HOW OBAMACARE IS UNSUSTAINABLE, Why We Need a Single-Payer Solution for All Americans, you should. While you may not agree with every assertion Dr. Geyman makes in the book, you probably agree that (1) our healthcare system is broken, (2) the politicians are unlikely to agree on a good solution to it, and therefore (3) the only way it will change is if we all get educated about it. And if you are like me, our healthcare system is relatively opaque to you. Dr. Geyman gives a compelling explanation of what is wrong with the system and why.

As the book title foretells, Dr. Geyman makes two broad assertions in this book: that the Affordable Care Act (ACA, otherwise known as “Obamacare”) is not a sustainable solution, and that the proper solution is for the government to pay for all healthcare utilizing non-profit healthcare providers (the so-called “single payer” system).

In the first part of book’s two parts, Dr. Geyman identifies many problems with our current healthcare system, which of course includes the ACA. However, it is not clear from the book whether the ACA has caused these problems or simply failed to fix preexisting problems. Dr. Geyman identifies some ways in which the ACA has helped, e.g. additional enrollment of the uninsured, and some ways in which the ACA has hurt, e.g. made things more complicated. But the book gives the impression that the main problems with our healthcare system predate the ACA and that the ACA has failed to fix them.

The second part of the book argues that the only possible solution to the problem is a “single payer” system. In a single payer system, the government sets the standards of care, e.g. what tests should be run in any given situation, sets the prices for that care, and then pays for it. All consumers get the same benefits. Healthcare providers then compete for the consumer’s business. However, they are paid only for the care that the government decides is necessary and only the prices that the government sets. Medicare has similar features today.

Dr. Geyman also advocates for a return to the non-profit healthcare provider model. According to Dr. Geyman, when he began practicing decades ago, doctors and hospitals cared more about patient service than profit. Over time, healthcare has become a business. Dr. Geyman believes that the profit motive is destroying healthcare in this country.

I believe our healthcare system is the most pressing problem in this country and is getting worse. The first half of Dr. Geyman’s book is very helpful in understanding why our system is failing. Dr. Geyman’s opinion on the appropriate cure, which involves removing healthcare from our market-based economy, is debatable. I, for one, am skeptical that a single-payer system is the only possible solution. But even if you are a staunch capitalist, it is worth reading this book to understand the problem. Dr. Geyman’s arguments are hard to ignore.

An Effective Prescription for Our Failing Health-Care System
Friday, 10 April, 2015 09:24 By Samuel Metz, Truthout | Book Review by Samuel Metz, M.D.

The Affordable Care Act is a sitting duck. Working with private insurance companies, hospital chains and Big Pharma, Congress superimposed arcane regulations on an already Byzantine system of financing health care.

Dr. John Geyman cannot resist this target. His new book, How Obamacare is Unsustainable, confirms that the Affordable Care Act (ACA) is not the pathway to a better health-care system. It is one of the biggest impediments.

The structure of this critique reflects Geyman's organized mind. The first of three parts reviews the unhappy history of American health-care reform. The second assesses our health-care landscape five years into the ACA. The last presents a solution: a national single-payer health plan.

History first. Geyman notes that President Obama, from whom the ACA derives its nickname, doomed the reform from its inception.

By inviting the insurance industry, hospital chains and pharmaceutical companies to set the agenda, Obama adopted a strategy similar to his unsuccessful predecessor, President Clinton, in the early 1990s.

This time, these key components of the "medical-industrial complex" fought first with outside industries, then with patient interest groups, and finally with each other. Organized medicine joined the fray. It was not pretty.

"Health-care 'reform' through the ACA," says Geyman, "was framed and hijacked by corporate stakeholders, themselves in large part responsible for system problems of health care and dedicated to perpetuating their self-interests in an unfettered health-care marketplace."

Not surprisingly, the needs of this privileged complex were addressed by the resulting legislation. The needs of patients were not.

Geyman refines the definition of patient interests. He mentions, with some contempt, the four "pillars of patients' rights" promoted by Florida's governor, Rick Scott: Choice, competition, accountability and personal responsibility. These "pillars," notes Geyman, support a political, not a health-care, agenda.

Geyman even refines the "Triple Aim" of Dr. Donald Berwick. He replaces "improving the experience of care, improving the health of populations, and reducing per capita costs of health care" with "access, cost and quality."

Note the key addition of "access." The best care is immaterial without access. And the biggest impediment to access is lack of money, even for the insured, given rising copays and deductibles.

By Geyman's criteria, the ACA fails. Governor Scott and Dr. Berwick would agree.

What next? "It is futile to embark on unproven or disproven incremental tweaks to our present system while ignoring health policy and experience around the world," warns Geyman. Every other industrialized country provides better care to more people for less money. What can they teach us?

Geyman answers: A national health-care plan, with single-payer financing and not-for-profit delivery. This suggestion is not new; Geyman and others have advocated this alternative for decades. Evidence validates this: In every population, single payer provides better care to more people for less money than private insurance.

Some dismiss single payer as "Un-American." Geyman disagrees. Single payer "is completely in step with traditional American values, including efficiency, choice, value, equity and integrity. These values . . . are echoed by both major political parties." Single payer is as American as . . . well, Medicare, America's largest single-payer-like system.

A note on style. Geyman, professor emeritus at the University of Washington School of Medicine, clearly suffered greatly listening to tedious monologues from academics exploiting captive audiences. In contrast, Geyman's readers get respect. Each chapter begins with intended points, then offers colorful and immaculately documented examples, and concludes with a conclusion. Refreshing.

By the final chapter, few readers will remain unconvinced, fewer still will lack comprehension, and none will have lost interest. Given a topic renowned for incomprehensible diatribes (i.e. health-care reform), this is a respectable achievement.

One deficiency. Every other industrialized country provides universal care at less cost than we do. But Geyman fails to note that only a handful use the single-payer financing, not-for-profit delivery format that he advocates. This does not invalidate his thesis, but some readers may miss learning other options.

Nonetheless, Geyman's national health plan is credible. America's need for reform received validation from a surprising source. Mark Bertolini, CEO of Aetna, said of his industry, "The system doesn't work; it's broke today. The end of insurance companies, the way we've run the business in the past, is here."

How Obamacare is Unsustainable confirms not only Mr. Bertolini's despair of the pre-ACA health-care system, but the despair of patients who learn the ACA leaves our system just as broken.

Dr. Geyman's text is a blueprint for repair.

Book Review: “ How Obamacare is Unsustainable”
Review by Sarah K. Weinberg, MD

Dr. Geyman, Professor Emeritus of Family Medicine at the University of Washington School of Medicine, has recently published his tenth book about the need for real reform of the U.S. health care non-system. This book examines the effects of the Patient Protection and Affordable Care Act of 2010 (ACA) after its first five

The book is divided into three parts. The first part, “Historical Background”, briefly reviews the failed attempts in the 20th century to enact some form of national health insurance, and then reviews how the practice of medicine has changed over the same time period. He gives special emphasis to the corporatization of medical practice, which started in the 1970s following the establishment of Medicare and Medicaid, and exploded with the managed care emphasis of the 1990s. The net result was a sea change in values underlying the health care system from service orientation to a business ethic of profit-seeking. The ACA resulted from the diversion of reform to a bill written by and for “the big four” corporate interests: insurance, pharmaceutical, hospital, and organized medicine.

The second part, “Five-Year Experience with Obamacare” reviews the promises made during the writing of the ACA as compared with the realities five the ACA in four key areas: access to care, control of costs of health care, affordability of care for patients, and quality of health care provided. Although there are some good points, the ACA has underperformed in all four of these areas..

The third part, “The Single-Payer Alternative: National Health Insurance” is an excellent description of what a single-payer national health insurance program should look like. Dr. Geyman lists major arguments for such a system, barriers to getting there, and political prospects for overcoming the barriers.

The book is well written, making it relatively easy to read and digest the tremendous amount of information contained in its pages. Physicians, nearly all of whom
express frustration with the way our health care system functions and the evolution of their roles from honored independent professionals to paid technical employees, should all read this book. The same is true for other people working in the health care delivery system. For the general public, one must already be quite interested in health care system reform to enjoy all the detail.

This presentation about the ACA at five years after passage will remain a valuable reference work for several years to come. Another book will certainly be warranted in 2020 when the ACA is ten years old, and let’s hope that Dr. Geyman will do it for us!

(We have a few copies available for a donation of $15 – contact us if you want one. The book is also available through Amazon and regular bookstores.)

John Geyman has been a prolific writer of books describing the major deficiencies in health care in the United States, but "How Obamacare Is Unsustainable" is set apart from the others for a couple of important reasons. He explains what has been wrong with our five year experiment in reform and what we can do about it, and, especially pertinent, it is timed to coincide with a moment in history in which there will be an intense national dialogue recognizing the health care failures of the past and present, with a demand for political solutions as we enter the season of the 2016 presidential election.

Just today, Sen. Burr, Sen. Hatch and Rep. Upton released a nine page report being characterized as the Republican response to Obamacare (though Speaker Boehner has requested another, likely similar proposal from a House team that includes Rep. Upton). Unfortunately, the Burr/Hatch/Upton response is highly partisan and thus gets most of the policy wrong. Although the Affordable Care Act was conceived as a non-partisan solution, it too became partisan as the politics shifted from a largely right-wing concept advanced by Democrats (non-partisan) to an exclusively Democrat-endorsed proposal (highly partisan). In the turmoil, the result ended up being the most expensive model of reform, yet it contained terribly flawed policies that fall intolerably short of universality, affordability, accessibility, efficiency and equity. Both the Democrats and the Republicans are wrong.

As we enter the pending national dialogue on reform we need to move the rhetoric from partisan sniping to informed discussions of policy. We know where Congress lies in the highly-polarized partisan divide, but what about the nation?
According to a January 2015 Gallup poll, 42% of voters are Independents, 29% are Republicans, and 28% are Democrats. Thus a plurality is non-partisan.

According to that same Gallup poll, 45% of Independents support getting their insurance "through an expanded, universal form of Medicare." To no surprise, 79% of Democrats also support universal Medicare, but, of great importance, 23% of Republicans do as well. When people understand policy, the partisan polarization diminishes.

At this time in history, it is imperative that all solutions be on the table, including those that give up on comprehensive reform (Burr/Hatch/Upton), those that perpetuate unacceptable mediocrity (the Affordable Care Act), and those that would actually achieve the goals that a large majority of Americans support (single payer, improved Medicare for all).

This is why John Geyman's book is so timely. It is a book on optimal policy. It can be contrasted with today's partisan release on the Republican answer to Obamacare. Their nine page proposal can be accessed at the following link:

Partisan politics has not served us well with the Democrats giving us overpriced and mediocre reform and the Republicans proposing to further expose patients to the perverse dysfunctions of the market. Maybe Independents can help us stamp out partisanship and instead become serious about doing what is right for the nation.

Right now we have a chance to change history. We should make widely available John Geyman's book based on sound, effective policy - just what the nation desperately needs.

—David Gimlett, M.D.


Health Care Wars: How Market Ideology and Corporate PowerAre Killing Americans (2012 CHC)

Full Review by Don McCanne, M.D.

We have been told from time immemorial in this country that free markets, unfettered by government interference, are the fix for any of our problems. The notion that a competitive private marketplace gives us more information, choice, efficiency and value has been repeated so often for so long that it has become a meme (a self-replicating idea that is perpetuated regardless of its merits). Although this idea has become as American as apple pie and might work in some sectors of the economy, it does not work that way in health care.

The shared prosperity that followed World War II gave rise to the American dream that brought new hope and opportunities for much of our population. But over the last 30 years, under a relentless attack by conservatives and willing Democrats, this dream is disappearing.

This book takes an evidence-based approach to assess and describe the track record of health care markets as they actually work. As you will see, it is a story of profiteering, greed and waste with very little accountability. I hope that this book is useful in informing the public, policymakers and politicians of the real problems with markets. We will need a strong and powerful unified grassroots movement to push our leaders toward real reform.

It has long been recognized that health care does not follow the rules of free markets, yet the United States continues to rely on a fragmented, dysfunctional financing system that fails to adequately correct for these market deficiencies. In Health Care Wars, John Geyman shows us how this has been a disaster, while providing us with hope through the prospect of our empowerment as both patients and taxpayers.

The Cancer Generation: Baby boomers facing a perfect storm (2012 CHC)

October 23, 2009

Book Review —by A.R. Strobeck Jr.

"The Cancer Generation: Baby Boomers Facing a Perfect Storm," by John Geyman, M.D. Common Courage Press, 2009. Softcover, 303 pp., $18.95.

In "The Cancer Generation," Dr. John Geyman, physician and professor emeritus of family medicine at the University of Washington, focuses on the baby boomer generation in the United States and the virtual tsunami of cancer cases that is expected to hit this 79.5-million-member demographic as more of its members move into their "golden years."

Geyman says he aims to examine "the changing landscape of cancer in the U.S., including the extent to which the marketplace fails patients with cancer care." He takes a hard look at how well the present state of cancer care - particularly the financing of medical services - measures up to the task of providing quality, compassionate care to those who need it.

While he draws upon the latest academic research and the book is heavily footnoted, the material is presented in a popular, accessible way, including with the abundant use of tables and graphs.

The picture he draws is not pretty. The author believes that the outlook for cancer care is bleak, largely due to the unregulated "free market" economic policies that have come to dictate both access to, and delivery of, health care in the U.S. These policies have given rise to an astronomical increase in the costs of cancer care, with treatment costs are now rising by 20 percent each year. The rising costs are putting effective care out of reach of millions.

This problem is expected to worsen, the author says, noting that the Institute of Medicine projects the number of cancer cases will double between 2000 and 2050. Meanwhile, the annual cost of treating cancer is projected to reach $1.1 trillion by 2023, more than five times what we spend today.

As a result, the aging of the U.S. population "will lead to an increasing cancer burden, both for individuals and their families as well as for the health care system itself."

Geyman acknowledges that treatments for cancer have improved, and today's care can be effective in many cases. He points to the dramatic increase in the survival rate among children diagnosed with cancer, for example.

But lack of health insurance, or poor quality insurance, prevents people from getting access to and obtaining proper care. The chief culprit here, he says, is the private health insurance industry, which is more concerned with increasing its profits than in assuring access to care.

More generally, however, he believes that our present market-driven health care system cannot meet the coming surge in cancer cases without drastic changes in its structure, access, delivery and methods of financing.

Geyman sees a blind faith in technology in the U.S. as fueling an explosion of new technologies, even though there is much uncertainty as to the safety and efficacy of these innovations. Unfortunately, he asserts, due to the high stakes that come with cancer, patients facing it are "especially vulnerable to accepting treatment at whatever the risks or costs." Thus the marketplace is "setting cancer policy by default," i.e. most of our health care dollars are going into treatment and far too little into prevention.

Cancer survivors face special challenges, he writes. They are less likely to be employed. They face three kinds of barriers to care thrown in their way by private insurance: availability, affordability and adequacy. And if these barriers are not enough, private insurance companies sometimes will go to even greater lengths to deny coverage to those afflicted.

Survivors lucky enough to have insurance face much higher co-payments. In addition, insurance firms try to cap coverage or otherwise place limits on the amount of treatment. As a result, a cancer diagnosis is often a prelude to financial crisis and bankruptcy.

Cancer survivors without insurance often find it difficult to see a doctor or to have a regular source of care. Geyman notes that it is no wonder that uninsured and Medicaid patients often have cancer at a more advanced stage when it is diagnosed. In addition, most cancer survivors often have serious co-morbidities such as heart disease or diabetes, which also go untreated at a disproportionately higher rate.

Geyman argues that everyone needs accessibility to doctors if the mortality rate of cancer is to be reduced. Unfortunately, the policies of the private health insurance industry are heading in the opposite direction, leading to uncontrolled inflation of costs; growing unaffordability of premiums; decreasing levels of coverage; a bloated bureaucracy, contributing to the waste of 31 cents of every U.S. health care dollar on administrative costs; a shrinking market of only 59 percent of employers now offering health insurance; ineffective state and federal regulation; and growing insecurity and hardship in the general population.

Racial disparities also continue to take a heavy toll: for example, cancer mortality rates are 35 percent higher for African Americans than whites.

What's his prescription for a cure? As step No. 1, Geyman recommends establishing a public health insurance system such as single-payer Medicare for All. Such a system would provide health care services "based on medical need, not ability to pay, " and would "eliminate much of the inefficiency and waste of the private insurance industry and actually cost employers and individuals less than we are already paying for insurance and health care."

He outlines additional measures like establishing a national, evidence-based clinical effectiveness program; more funding for cancer research; and the strengthening of the nation's cancer workforce, especially in primary care and geriatric oncology.

Finally, Geyman reminds us of the ethical issues surrounding cancer care, citing Dr. Martin Luther King Jr., when he said, "Of all forms of inequality, injustice in health care is the most shocking and most inhuman.... Although social change cannot come overnight, we must always work as though it were a possibility in the morning."

Reading and acting on this book will help bring about that better day.

A.R. Strobeck Jr. worked for many years in health care administration. He resides in Chicago.
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Breaking Point: How the primary care crisis endangers the lives of Americans” (2011 CHC)

Pointing the way forward for primary care - Review by A.R. Strobeck Jr.

Dr. John Geyman has written another tour de force on a health care topic. This time he examines the “silent crisis” which is rapidly unfolding in health care delivery: the unraveling and decline of the primary care structure.

Recognizing the flaws and limitations of the Affordable Care Act, and noting the decades-long decline in the number of primary care providers, Geyman asks: Going forward, how will patients and their families obtain medical care that is “affordable, readily accessible, continuity-based, and comprehensive”?

Assuming the ACA passes constitutional muster, millions of additional Americans will have new, limited coverage from either subsidized private insurers or Medicaid, but “Insurance without a physician — how much of a gain is that?”

Geyman divides his analysis into two parts. In Part I, he looks at the many dimensions of the crisis and its impacts on the system, particularly on patients and their families. In Part 2, he examines various policy alternatives, including lessons from other countries, and finally proposes “a comprehensive agenda for rebuilding primary care.”

Geyman believes the problem is such a challenge that its solution requires a long view, possibly over one or two generations. Successfully dealing with this problem would involve “a complete reorientation of the goals of health care, the roles of physicians and other health professionals” as well as fundamental changes in the way health care is financed. He warns that failure to do so will hasten an implosion “for much of our population, and potentially become a growing force that could bankrupt the nation.”

Geyman notes that less than one-third of U.S. physicians are practicing primary care, and “their numbers are falling fast.” Less than 20 percent of graduating U.S. medical students are selecting fields in primary care and only 7 percent are choosing family medicine. Largely because of the financial pressures associated with going to medical school, notably the heavy burden of student debt, many students are turning to specialties that they believe will be more lucrative.

At the same time, many primary care doctors have stopped seeing patients in the hospital and now confine their practice to their offices, where they are poorly reimbursed by third-party insurers. They are also experiencing higher levels of dissatisfaction with their work. Meanwhile, government policy appears to be out of touch with the magnitude of the crisis.

Yet studies show “consistent cost savings across the board in regions with most primary care physicians,” including fewer emergency room visits and hospitalizations, and a consistent increase in the quality of care in areas with a larger density of primary care doctors.

Patients are confronting greater financial barriers in accessing health care, including rising premiums and higher co-payments, deductibles and co-insurance. As for the uninsured, they are lucky to find any physician who will see them.

Patients are victimized in other ways, too. In their quest for ever greater profit, financing companies have even discovered “a highly profitable business in medical credit cards.” Interest rates can rise to 26.99 percent for G.E.’s Care Credit, and most people who obtain these cards have limited resources to begin with. They “are vulnerable to various abuses by hospitals and other providers who push these cards without transparent disclosure of their risks.”

In Part 2 of his work, Geyman looks at various policy alternatives, using key yardsticks such as accessibility, continuity of primary care, prevention, and financial neutrality in medical decision-making.

The author cites three basic policy alternatives: (1) Cede primary care to non-physicians such as nurse practitioners and physician assistants, (2) Continue our specialist dominated physician workforce; (3) Build a generalist physician workforce with primary care teams and a generalist-specialist mix of 50-50.

Geyman believes that the third choice is the obviously best course and he focuses on this solution. He views the building of a strong generalist base as the only way out of our national health care crisis.

He explains that this approach has worked well in the few areas where it has been tried, including at The Group Health Cooperative of Puget Sound, Rocky Mountain Health Plans, and the Mesa County Physicians Independent Practice Association.

At the same time, he remarks: “We cannot get to real health care reform without rebuilding our primary care infrastructure, and we can’t get that done without other fundamental system reforms — they are completely interdependent.”

Geyman takes a look at what other countries have done and how some of their experiences might be applied in the United States. He finds that we are clearly at a disadvantage: “All other countries around the world meet the challenges of access, quality, and fairness for comprehensive health care at costs that are affordable and sustainable.”

The author observes that while there is no such thing as a perfect health care system, we have much to learn from other advanced countries if we remove our ideological blinders and “give up our unfounded attitude of American exceptionalism.” We also have to give up the myths that we have the best health care and our health problems are unique to us.

Geyman looks to Ontario, Canada’s, system for an example of organized health care as “a model worth organizing and fighting for.” The Family Health Team model there has expanded the capacity of primary care through interdisciplinary teams and resolved many hitherto nettlesome problems.

The teams include family physicians, nurse practitioners, pharmacists, social workers and health educators. They provide 24/7 care, handle most of the care themselves, and are coordinators of care provided by specialists as well as from other community resources. The teams now serve 2 million people and show every sign of success.

Geyman outlines 10 “primary building blocks for rebuilding primary care in the U.S.,” including evidence-based coverage, revised physician payment, new goals and paradigm, re-design of primary care, general medical education, emphasis on ethics, expanded research, increased regulation, and malpractice liability reform. But at the foundation of the entire structure is universal coverage through a single-payer national health insurance plan, a sine qua non for the overhaul’s success.

The author views American society as divided into two Americas: “a buoyant, bailed-out Wall Street and a depressed Main Street.” i.e. it’s the 1 percent vs. the 99 percent. He discusses how corporate America has profited at the expense of sick and vulnerable Americans, and notes that even with the ACA, there is a “continuing emphasis of our market-based culture and medical-industrial complex” to turn “quick profits with little regard for the public interest.”

But Dr. Geyman has pointed a way forward.

A.R. Strobeck Jr. holds a masters in health planning and policy from the University of Illinois at Chicago as well as a masters in history from Northern Illinois University. He worked as a research associate for over 10 years for an association of health care executives.

Dr. John Geyman's new book on primary care: 'Breaking Point'
Review by: Wendell Potter / Firedog Lake

Just last week, the 34-nation Organization for Economic Cooperation Development (OECD) released the results of its most recent study of the health care systems in the 40 counties considered to be “developed.” It came as no surprise to see that the U.S. health care system — if we can even call it a system — is still by far the most expensive on the planet.

We spend two-and-a-half times more on health care per person than the OECD average. The average expenditure per person in the U.S. is $7,960. The OECD average, by comparison, is just $3,233. Yet we rank 29th in the number of hospital beds per person and 29th in the average length of a stay in the hospital. We have high rates of avoidable hospital admissions for people with asthma, lung disease, diabetes, hypertension and other common illnesses, and we lag behind many other countries on other measures of quality and accessibility.

And when it comes to access to physicians, we’re considerably closer to the bottom than the top. We rank 26th in the number of physicians, especially primary care doctors, per 1,000 people.

All of the bad news for the U.S. in the OECD report is troubling if not shocking, but that last data point — that 25 countries have more physicians per capita than we do — even caught me by surprise.

But after reading Dr. John Geyman’s latest book, "Breaking Point—How the Primary Care Crisis Endangers the Lives of Americans," I now understand why and how we have sunk so low. Not only does Geyman explain what has happened to our primary care infrastructure over the past several decades, he makes the most compelling case I’ve read anywhere about the urgency of rebuilding it. He also suggests ways we can do it.

If you’re not acquainted with Geyman, you should be. He is one of the wisest and most prolific writers about health care in America. "Breaking Point" is his 12th book and follows another must-read: "Hijacked: The Road to Single Payer in the Aftermath of Stolen Health Care Reform."

As you can tell by the title of that book, Geyman is not a big fan of the Affordable Care Act, a.k.a. "Obamacare." While he notes that the reform law will expand access over the next several years, “it will not make a dent in the primary care crisis.”

In fact, he goes on, “the 32 million Americans who gain some kind of insurance coverage between now and 2019 will find it more difficult than ever to find a primary care physician. Insurance without a physician — how much of a gain is that?"

A former Republican country doctor, Geyman writes that when he graduated from medical school in 1960, there already was a growing shortage of general practitioners, but not nearly as severe as today. In 1960, 18 percent of U.S. doctors were in general practice. By 2000, the number had fallen to 12 percent, and it continues to spiral downward because of the many disincentives in the U.S. for medical students to go into primary care.

Those disincentives have led to primary care physicians becoming an endangered species.

“Specialization, subspecialization and sub-subspecialization are increasingly taking over the physician workforce,” he writes. “The reasons for these changes have much to do with money and the business of medicine. The decline in generalist medicine and primary care is inexorable with present policies in health care, and present trends signal a disaster unfolding.”

That disaster is indeed unfolding, although you’d hardly know it from the politicians and pundits who are more interested in ideology and the gamesmanship of reform than truly addressing the problems with workable solutions. And while the far-reaching reforms that are needed have so far been beyond the ability of lawmakers to enact—also having to do with money and the business of medicine—the disaster that is unfolding is increasingly being felt by American families.

Because of increases in population and the dwindling supply of general practitioners, more and more Americans are unable to find a personal primary care physician for themselves or their family. As a result, Geyman writes, their care has become increasingly expensive and fragmented.

Why does primary care matter? Geyman lists several reasons. Patients with regular access to primary care doctors receive more preventive services, and they have fewer preventable emergency room visits and hospital admissions. Because they get to know their patients well over time, primary care doctors order fewer tests than specialists, and they help protect their patients from inappropriate, unnecessary and expensive over-utilization of specialist services.

Having primary care leads to earlier diagnosis and treatment of illnesses, enhancing quality and outcomes of care. Primary care doctors are also ideally suited to coordinate care for patients who need multiple specialists. And studies have shown that patients with an ongoing relationship with a primary care doctor are more compliant with treatment.

Geyman believes, and I agree, that primary care must be at the heart of a transformed U.S. health care system — and it ultimately will be transformed because the status quo is not sustainable. And, like me, he is an optimist — transformation not only is possible, it is inevitable.

Toward the end of "Breaking Point," Geyman provides us with “ten lessons for primary care and health policy” that every reform advocate and every lawmaker truly interested in reform should read. Only someone with Geyman’s knowledge as a physician in private practice for decades and a renowned scholar of health care systems around the world could develop what essentially is a roadmap out of our unfolding disaster.

The last of those ten lessons is especially important for advocates who were disheartened and disillusioned when Congress passed the Affordable Care Act because of its shortcomings and the fact that it gives the insurance industry a renewed lease on life. Lesson #10: “The fight for sustainable and accountable health care can be a long one, but it can be won in the end by those prepared to keep at it.”

"Breaking Point" is worth reading not only to get a better understanding of the value of primary care but also Geyman’s wise counsel, reality-based optimism and challenge for us to stay in the fight and never give up. “We can all make a difference if we choose to do so,” he concludes. “Let’s go for it!”

Indeed. It’s time for all of us to rally, especially with the fate of the Senate and White House at stake.

Excellent discussion of the future of primary care medicine Review by John A. Leraas on April 7, 2014

Primary care medicine, otherwise know as family practice, has changed so as to become in some respects unrecognizable in the forty years since I entered practice. The family doctor who knew you is a threatened species. With the incentives currently built into the medical care system that part of medicine will likely vanish.

Breaking Point is about primary care as family practice (pediatrics and obstetrics are actually specialties). It is about the struggle the family doctor has to survive in the current environment. The situation is not pretty and few are better prepared to discuss it than John Geyman, MD. He does a masterful job. He writes well and is very understandable.

I believe in Family Medicine. I practiced it for forty years. I hope it survives. I also doubt it will.
I retired sixteen months ago as much for survival as a human being as for fiscal reasons. Over the years one develops a relationship with his/her patient. This is critical in helping that patient when he or she needs a physician the most. When is that? When he or she is in the hospital. Now in most communities primary care physicians aren't given inpatient privileges to treat patients. Often I was not informed of my patient's admission. It is difficult to be effective as a physician when cut out of the system.
This is just one example; Dr. Geyman presents others, some fiscal, some psychological, some existential. Many have left primary care and by report, not so many are entering.

I thank Dr. Geyman for this book.

—John A. Leraas, MD

Hijacked: The Road to Single Payer
in the Aftermath of Stolen Health Care Reform (2010 CCP)

“You think the battle for real health care reform is over? John Geyman says ‘Not on your life!’ And, by the way, your life is what’s at stake. This former Republican country doctor and long-time respected scholar, editor, and advocate for reform that puts the patient, not the industry, first, has issued an informed, convincing, and passionate account of why the battle has just begun, and how we, the people, can win.”

—Bill Moyers, author of Moyers on Democracy

Do Not Resuscitate: Why the health insurance industry is dying, and how we must replace it (2008 CCP)

by CassiodorusFollow, Daily Kos

This is a book review of John Geyman's book Do Not Resuscitate: Why the Health Insurance Industry Is Dying, and How We Must Replace It.  Here I argue that the rereading of this book is especially timely as Congress nears the last stages of preparation for a vote upon "health insurance reform" nears.  We need to remember, now of all times, that the fight for health care for all is nowhere near over

Before the current debate ostensibly leading up to the passage of Obama's celebrated "health insurance reform" bill, John Geyman, M.D., emeritus professor of the University of Washington School of Medicine, (and who also has a prominent blog on the Physicians for a National Health Plan website), wrote a book detailing his critique of the chaos in American health care and his recommendation that it be replaced with a single-payer health care system.  Do Not Resuscitate is that book.  Yes, I am aware that DrSteveB reviewed this book back in January, but his review covered a large number of books, gave only a brief summary, and got only 46 comments.  The other diary on this book here at Orange only received eight comments.  Dr. Geyman's book, then, deserves a rereading.

Geyman's indictment of the current system is threefold, as stated in his preface.  1) "The industry today profits by avoiding coverage of sick people, leaving them uninsured or underinsured while passing along coverage of the sick to increasingly beleaguered public safety net programs."  Thus we cannot trust payment for health services to for-profit entities.  2) "the costs of health care continue to climb," so you won't be able to afford it.  And, lastly, 3) "With 47 million Americans uninsured, the number of uninsured is soaring, and cost containment is still nowhere on the horizon. (xvi)"

"Health insurance reform" tries to solve the problem of the uninsured through a false equivalence: forcing everyone to buy junk policies with inadequate subsidies is not "providing health care to everyone."  This is why it's important to pay attention to this argument, now.  Do you really expect much from a bill crafted upon the acceptance of a lie?

This book, to be sure, is out of date: its preface is dated May 2008.  And so one has to do a bit of extrapolation in order to update its premises so as to produce a critique of the "health insurance reform" as it stands today.  Here I will try my best to do that extrapolation.

Chapter 1 of this book details the history of health care.  Geyman's history is one which goes "from spreading risk to avoiding risk and maximizing profits," (7) as the insurance industry expanded from the role in (mainly) providing insurance through employers, which is the role it had after World War II.  Geyman's main complaints here are that the insurance industry currently has "limited oversight" (14-15) and that it is rotten through with "consolidation," thus providing insurers with political power over the economic process. (15)

Chapter 2 is a summary of the three biggest profitmongers in the health insurance industry, with occasional glances at their predatory practices.  The big three are Wellpoint, which cherry-picks its customers, United Health Group, (which sells scanty policies to healthy college students), and Aetna, which has cut back on its actual coverage of the sick of late.  Here's a sample quote:

Wall Street maintains an especially close watch on MLRs (medical loss ratios). When a fourth-quarter 2006 MLR came in at 81.1 percent, down from 81.3 percent in the third quarter but higher than the 2005 level of 79.9 percent, for example, Wellpoint felt compelled to reassure investors that its premium pricing would outpace medical costs.  (30)

For those who don't know: "medical loss ratio" is the percentage of expenditure upon medical cases which actually goes to medicine, as opposed to administration and profits.  If they tell you that the actual profit rate of the health insurance business is "below 5%," well that's just creative accounting.  Ask to see the medical loss ratios.  

Chapter 3, "From 'Cherry Picking' to 'Denial Management,'" is about how the insurance companies profit off of malicious practices.  Geyman gives a list of these, and they include:

  1. practices that limit access, and these are summarized in terms of underwriting guidelines to deny coverage.  When coverage is required via "health insurance reform," these will become guidelines to deny care.
  2. practices restricting choice, which allow insurers to dump expensive forms of health care while channeling care to facilities owned by the insurance companies themselves.
  3. practices limiting the value of coverage, i.e. junk insurance, which doesn't really cover you but at least you get to say "yes" when the secretary asks you if you have insurance.
  4. practices that reveal the industry's lack of integrity -- this category covers a wide variety of forms of lying and fraud, including:

a) inadequate disclosure
b) inappropriate disclosure
c) deceptive marketing
d) conflicts of interest
e) devious dealings with physicians
f) profiteering through insider stock sales
g) outright fraud

So, yeah, there's a lot of sh#t goin' down.

Chapter 4 is titled "Myths and Mirrors: How the Industry Perpetuates Itself."  This is a myth-debunking chapter, in which untrue assumptions about the industry are rebutted.  The fundamental problems revealed in this debunking are those of a for-profit insurance system attempting to "cut costs" by denying people access to care, thus increasing mortality rates and overloading emergency room use.  We are also told that the government funds about 60% of health care costs; this is, then, an attempt to refute the "free market" ideology which keeps the insurers in business.
Chapter 5 claims that the health insurance industry is "An Imploding Industry On A Death March."  The problem with such phrasing is that it's hard to tell precisely who is going to die -- us, or the insurance companies?  I think it's us who die.  But if you kill enough peasants they will start to revolt, and form lynch mobs.  We shall see.  At any rate, here are Geyman's reasons for saying this:
1.  Growing health care costs
2.  Growing unaffordability of premiums and health care
3.  Decreasing levels of insurance coverage
4.  Fragmentation and inefficiency

Generally speaking, we've been over these reasons before.  Moving on:
1.  Shrinking markets
Most insurance has been employer-funded, although here we are told that the shift away from employer-funded health insurance has been "dramatic."  (100)  Generally speaking, the reduced levels of employer-funded health insurance have been compensated by -- nothing.  Page 101 tells us: "A 2006 study by the Commonwealth Fund found that 89 percent of Americans who explored getting individual coverage between 2003 and 2005 never purchased a plan."  People just can't afford it.  No wonder the companies are so desperate to get that mandate in place!
2.  Subsidized markets are also vulnerable -- what happens is that the corporations abuse the public plans (Medicare, Medicaid) and then fall prey to lawsuits.
3.  Ineffective State and Federal Regulation -- we've been over this before.
4.  Growing Economic Insecurity and Hardship, Even for the Insured -- here, Geyman touches upon the economic downturn, in a relatively early stage as of the time of writing of this book.  But I'd like to depart from script, here, and explore this suggestion a bit further.  

On p. 112 Geyman starts to make his summary argument: "Why We Must Discard Private Multi-Payer Financing" for health care.

Chapter 6 discusses incremental reform.  "A recent RAND study found that government subsidies which cut health insurance premium costs by one-half would reduce the number of uninsured by only 3 percent."  (133)  High risk pools are "largely ineffective."  Association health plans are "not-for-profit false fronts for their own for-profit marketing."  (133) Disease management programs are granted this conclusion, again via a RAND study: "there is little evidence that these programs can actually save money or improve health outcomes over the long term." (133)  Pay for Performance plans and more efficient use of information technology will not "do the trick."  

All of Geyman's citations of evidence should have delivered a stern warning to the people in Congress writing 2,000 page bills meddling with "health insurance reform."  Congress is simply not going to be able to "reform" the existing system in any workable way, because it's based on the maintenance of profit-making corporations which increase margins through the denial of care, and because the government is simply not going to find enough money from some other source to pay for the rising costs of health insurance (assuming that regulation requires the companies to pay for an increased incidence of care).  Obama's insistence that reform be "revenue-neutral" ups the ante even further.  Which do you like worse: high premiums, or high taxes?  Thus "health insurance reform" is likely to be a variant on the a failure, i.e. a failure.  Geyman concludes:

We are almost certain to see increasingly unaffordable insurance premiums with less coverage, growing ranks of the uninsured and underinsured, further fragmentation of risk pools, erosion of safety net programs, and increased morbidity, preventable hospitalizations, and deaths.  (138)

Chapter 7 is about "The Industry's Rearguard Actions."  This is a discussion of what the insurance industry was (at the time of writing) trying to do to prevent reform.

Chapter 8 addresses single payer: what would it look like?  here are its main assets:

• Evidence-based coverage: make sure drug and medical device industries offer cost-effective solutions to medical problems
• Reimbursement reform: make sure pay for primary physicians is equitable
• Strengthening of primary care: more primary care physicians
• Quality improvement: better care for all
• Transition from For-Profit to Not-For-Profit System: get the profit-mongers out from between you and your doctor
• Rebuild the Capacity of Government: Get the anti-government people out of government
• Malpractice liability reform: huge "jury awards that are devoted to paying for medical costs incurred by malpractice will be eliminated under NHI, since the government will pay physicians and hospitals that perform the corrective care."  (202)

So who would be the winners, who would be the losers, with a single-payer system?  The winners would be the businesses, the working class, the physicians, and the medical community.  The losers would be the health insurance industry and the drug and medical device industries.

Geyman concludes by arguing that single payer reform is possible now.  His argument here is not entirely persuasive -- it does not appear as if the single-payer advocates are sufficiently organized politically to withstand the financial onslaught of the health insurance industry.  Indeed, in her most recent pitch to the single-payer people, Jane Hamsher said this:
The weakness of single payer clout was evidenced this year when none of the 88 cosponsors of H.R. 676 worked collectively to get a CBO score.  Withholding even a handful of votes from the war supplemental, or the stimulus bill, or cap and trade could have made that happen.

Instead, Democrats like Charles Rangel and Henry Waxman withdrew as cosponsors.  After collecting donations from single payer supporters for years, once their votes counted they were nowhere to be found.  Joe Baca, Eddie Bernice Johnson, David Scott stepped forward and said  they will not even vote for it if it came up for a vote.  And Andre Carson, Linda and Loretta Sanchez, Betty Sutton and Jim Moran wouldn’t commit.
Why did they feel they could do that?  Because they felt safe in the knowledge that there would be no political consequences.  And there were none.

In future election cycles, then, we must be prepared to kick Congress' and Obama's butt to make sure single-payer reform is "on the table."  Otherwise we face a long, dreary band-aid period on the way to minimally-effective reform, with not a whole lot of hope against rising premiums, ineffective subsidies, cherry-picking companies, the gutting of Medicare and Medicaid, the persistence of the category of the uninsured, and so on.  

And just to press the point home, I don't buy ANY of this crap about how Congress will only consider "health insurance reform" fifteen years from now, so we better make sure the bad bill passes "or else."  There are too many people being ripped off by the existing system now, far more than there were in 1994, and there will continue to be too many people ripped off by the existing system next year, whether the bad bill passes or no.  

As for the "public option," and the current bill?  The debate on the "health insurance reform" endgame is covered better over on firedoglake than it is here.  I suppose the most proactive discussions today are about the expansion of Medicare to 55 and up.  That could be the preview of an ultimate expansion of Medicare to everyone.  The rest of it, as Geyman would argue, is a mixed bag, but mostly crap.