Fresh Medicine: How to Fix Reform and Build a Sustainable Health Care System

Beginning with the words "Health care in America is broken," and the claim that its underlying structure (insurance; uncoordinated providers) is obsolete, Tennessee governor Bredeson lays out a "new set of principles" to guide reform. While he supported President Obama's health care reform package, he now calls it "a stunning disappointment" and flags an inadequate funding mechanism and the act's failure to establish fiscal and quality control, which will lead to sky-rocketing costs. He proposes many improvement measures, including six well-considered "stepping stones," like the establishment of a trust account modeled on Social Security and financed by new taxes, and an independent audit of healthcare organizations, and would replace the recently-challenged mandate with a national voucher system. Prior to public service Bredesen founded and ran a managed-care company and, as governor, has been faced with overseeing TennCare, the State's controversial experimental program which, he writes, is an example of how a well-intentioned medical reform can spin "wildly out of control." Bredesen's belief in the value of direct experience led him to undertake this endeavor and he crystallizes that experience into a concise yet comprehensive effort. (Oct.)