Lives at Risk by John C Goodman, Gerald R Musgrave & Devon Herrick, Rowman & Littlefied, Publisher, Lanham, Maryland, © 2004, ISBN pending, 255 pp, $25, Prepublication Copy Reviewed.

Review by Del Meyer, MD

Goodman, Musgrave & Herrick have written a large number of policy reports and newsletters on health care. Their extensive treatise on the Twenty Myths of National Health Insurance was reviewed at one "Myth" per month in MedicalTuesday from April 2002 to Dec 2003, Now comes the definitive work on Single-Payer National Health Insurance Around the World – How National Health Insurance Fails Patients.

The authors note in their introduction that as we move further into the twenty-first century, it is clear that we are living with a number of institutions that were not designed for the Information Age. One of these institutions is health care.

Virtually everyone agrees that our health care system needs reform. But what kind of reform? Some on the right would like to see us return to the type of system prior to Medicare. Some on the left would like to see us copy one of the government-run systems established over the past century in a large number of countries around the world. This system of health care goes by various names such as socialized medicine, national health insurance and in the United States as the proposed single-payer health insurance. The Physicians for a National Health Program, claiming 8,000 physicians and medical student members (one percent of all physicians in the United States), contends that "single-payer national health insurance would resolved virtually all of the major problems facing America’s health care system today."

The authors believe that this alternative will not work. They feel that most commentaries on health policy tend to ignore three very important facts about modern health systems: 1) We could potentially spend our entire gross domestic product (GDP) on health care in useful ways. 2) We would likely want to increase the portion of our income that we are spending on health care in the future. 3) We have suppressed normal market forces in dealing with one and two.

These facts are not disputed but readily acknowledged by all health policy analysts. The first two are not unique to health care, but true of many other goods and services. When combined with the third characteristic, however, they have devastating implications.

Physicians deal with this on a daily basis. Essentially every patient who thinks that socialized or single-payer medicine is the answer feels that any impediment to unlimited testing would be removed. But this is removing all market forces from the equation. If 100 million Americans would increase the dozen or so blood tests that they medically need to the 900 blood tests that are available, that one maneuver would equal $1.5 trillion, the entire health care costs in this country. If 10 million Americans would want the 1,100 tests that can now be done on our genes to determine predisposition to a number of diseases, that alone would add another $10 trillion dollars to our health care costs. (To see how absence of market forces become ludicrous, just think: If every American would want to be screened genetically, that would add up to $300 trillion or ten times our total GDP. Imagine instead of health care being 15 percent of our GDP it would be 1000 percent of our GDP! One patient said we can afford 1000 percent of our income for health! When I ran this by a teacher, she said, "Why can’t something be 1000 percent of the total?" Yes our education system is also in need of reform.)

Evidence presented in Lives at Risk shows that patients in single-payer countries routinely face a reduction in the quality of health care, especially for the sick; lack of access to doctors; lack of access to new medical technology; and unreasonable waiting periods.

In New Zealand, 20 percent of people wanting health care are on a waiting list. In the United States, 14 percent are without insurance. Although the numbers are larger in the United States, the percentages are less. Thus more people proportionately are without health care in a socialized environment.

Lives at Risk is a further extension and definitive analysis of single-payer health care systems and shows that national single-payer health care systems have not delivered on the promise of a right to health care.

To read the reviews of the first twenty chapters, go to and click on the issues between April 2002 and December 2003. To read the pending reviews of Part II and Part III, you may want to subscribe to MedicalTuesday and read them on a monthly basis at .

Be sure to order a copy of this definitive work at