117
S
peaker Bennett sat down in his chair, winded. He had spent fifteen minutes pulling the books from his private collection off the shelves in a fit of rage. He was surrounded by a sea of manuscripts and political textbooks. Barely calm, he started performing the political calculus necessary to get his party back on track. He determined that trying to take some measure of credit for Drummond’s plan was his best outcome. He picked up the telephone.
“Get Chris Drummond on the phone. Tell him House Speaker Bennett wants a meet.”
END OF BOOK ONE
CAST OF CHARACTERS
Chris Drummond
—Chairman of the team
Barbara Drummond
—Wife of Chris Drummond
Sarah Drummond
—Daughter of Chris and Barbara Drummond
Hank Bennett
—Speaker of the United States House of Representatives
Tom Haines
—Chair of House Committee on Ways and Means and the super committee
Thomas Jackson—
Former president of the United States
Andy Cannon
—President of the United States
John Sebastian
—Secretary of the Treasury of the United States
Timoteo
—Hank Bennett’s bodyguard
Skip Davis
—CEO of Global Paramilitary Group
Suzanne Bass
—White House Chief of Staff
Glenn Woodall
—Director of the Office of Management and Budget
Deng Hongwei
—Minister of Finance of China
Brian McFarland
—Managing Partner, Northwest Region, Anderson Consulting
Kenneth Schuler, PhD
—Professor of Health Care Economics at Harvard University
Jason Mitchell
—Press Secretary to President Cannon
Clive Donald
—Billionaire industrialist, sponsor of the contest
Dr. Janet Duncan
—Director of Health and Human Services
Arnie Donovan
—Chief of Staff to Dr. Janet Duncan
Mick Schilling
—Deputy Director of the Central Intelligence Agency
Al Matson
—Senior vice president at Clive Donald’s company
Wesley Meeks
—Mole in Clive Donald’s organization
Jay Zuckerman—
the Director of Central Intelligence
Zhu Jinfu
—President of China
Jack Dain
—Linguist and member of Drummond’s team
Natalya Baturina
—Industrial psychologist and member of Drummond’s team
Pan Jiang
—Statistician and member of Drummond’s team
Sheryl Vogel
—Finance expert and member of Drummond’s team
Peter Lowsley
—Professor of Health Care Economics and member of Drummond’s team
Rakesh Gupta
—Programmer, technologist, and member of Drummond’s team
Mohammad
—Concierge of Isle Airy
Ahlam
—Mohammad’s assistant
Cala
—Cook of Isle Airy
Fahad
—Caretaker of Isle Airy
Patricia Lewis
—CEO of Unified Health Insurance Partners
Paul Soros
—CEO of American Hospital Operators, Inc.
Blaine Windsor
—Canadian Ministry of Health
Gail Hutchinson
—CEO of Biological Sciences, Inc.
Jake Swain
—CEO of Octagon Group
Leon Márquez—
Director of Homeland Security
Wu Jintong
—Chinese Special Forces
Li Tong
—Premier of China
Zhou Peng
—Senior General of China’s Central Military Commission
Dr. Lisa Brewer—
Hospitalist at Johns Hopkins Medical Center
A NOTE FROM THE
AUTHOR
T
his is a work of fiction. To make the story intelligent and credible, I’ve drawn upon real-world sources, including the body of published medical literature. Where appropriate, I’ve documented my citations. The US health care system has succeeded in its aim to deliver the most technologically advanced diagnosis and treatment in the world, without regard to absolute cost. An outcome that is logical given the financial incentives embedded within the industry’s practices. If we continue down this pathway, we’ll bankrupt the United States. The future aim must be a health care system that is affordable and financed on a pay-as-we-go basis. I invite you to critique the reforms I’ve proposed by posting your comments on my blog at
scottcglennie.com
.
Links:
Organisation for Economic Co-operation and Development:
http://www.oecd.org/
President Obama’s Health Care News:
http://www.whitehouse.gov/healthreform
Congressman Paul Ryan’s Balanced Budget:
http://paulryan.house.gov/issues/issue/?IssueID=100100#.UiuR_sYskuc
US Debt Clock:
http://www.usdebtclock.org/
Citations:
The dialogue in Chapter 6 and throughout the story regarding health care statistics published by the Organisation for Economic Co-operation and Development, OECD, was obtained from its website. OECD’s stated mission is “to promote policies that will improve the economic and social well-being of people around the world.” Found online at
http://stats.oecd.org/index.aspx?DataSetCode=HEALTH_STAT
The International Accounting Standards Board referenced in Chapter 6 is the independent standard-setting body of the IFRS Foundation. This is a real organization. The author’s representation that the IASB issued a new accounting pronouncement for governmental accounting, measurement, and disclosure of sovereign debt is fictitious. Their website is
http://www.ifrs.org/The-organisation/Pages/IFRS-Foundation-and-the-IASB.aspx
The dialog in Chapter 7 and throughout the story regarding public debt originates from the Federal Reserve Statistical Release. The federal government’s balance sheet figures are disclosed in Table L105. The author has manipulated the numbers to suit his purpose. Found on-line at
http://www.federalreserve.gov/releases/z1/current/z1.pdf
The dialogue in Chapter 7 and throughout the story regarding the Office of Management and Budget originates from the Fiscal Year 2013 Budget of the US Government, Table S-5 Proposed Budget by Category. The author has manipulated the numbers to suit his purpose. Found online at
http://www.whitehouse.gov/sites/default/files/omb/budget/fy2013/assets/tables.pdf
The dialogue in Chapter 7 and throughout the story regarding unfunded entitlements originates from the 2013 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds, page 228. The author has manipulated the numbers to suit his purpose. Available online at
http://downloads.cms.gov/files/TR2013.pdf
The dialogue in Chapter 9 regarding the risks of China’s holding of US treasuries originates from the Congressional Research Service Report entitled “China’s Holdings of US
Securities: Implications for the US Economy.” A copy of the report is available online at
www.fas.org/sgp/crs/row/RL34314.pdf
The dialogue in Chapter 9 regarding the health care challenges faced by China’s health care system originates from an article found online at
http://knowledge.wharton.upenn.edu/article.cfm?articleid=3296
The discussion in Chapter 10 regarding the Wolfson Economics Prize was adapted by the author from an article found online at
http://www.policyexchange.org.uk/component/zoo/item/wolfson-economics-prize
The dialogue in Chapter 21 regarding espionage was adapted by the author from an article found online at
http://www.theguardian.com/world/2013/jun/22/edward-snowden-us-china
The discussion in Chapter 28 regarding suicide reports in China was adapted by the author from articles found online at
http://www.crisis.org.cn/UploadFile/ResearchMaterial/PublishMaterial/03.A086E.MRP.Risk%20factors%20for%20suicide%20in%20China1.pdf
http://www.china.org.cn/china/2012-02/07/content_24568339.htm
The dialogue in Chapter 31 regarding converting sound waves into energy was adapted by the author from an article found online at
http://www.engadget.com/2011/09/20/researchers-convert-soundwaves-into-electromagnetic-energy-sile/
The dialogue in Chapter 34 regarding Mikhail Gorbachev and the fall of the Soviet Union was adapted by the author from an article found online at
http://www.spokesman.com/stories/2012/oct/07/putin-faces-economic-challenges/
The dialogue in Chapter 36 was adapted by the author from an article written by Dr. Michael Chernew, a professor of health care policy at Harvard Medical School. Dr. Chernew’s conclusion was the US can no longer afford the persistent gap between per capita health care spending growth and income growth, as measured by GDP. The author changed the conclusion and ascribed the published paper to a fictitious Harvard professor. Found online at
http://www. i n q u i r yjournalonline.org/doi/pdf/10.5034/inquiryjrnl_47.04.285
The ratio of US health care spending to Canadian health care spending referenced in Chapter 36 is materially correct with respect to historical costs. It was extrapolated from data published by the Organisation for Economic Co-operation and Development. Refer to the tabs “health
expenditure and financing, health expenditure since 2000.” Found online at
http://stats.oecd.org/index.aspx?DataSetCode=HEALTH_STAT
The author’s description of pathological narcissism in Chapter 37 was adapted from an article found online at
http://middlekingdomlife.com/guide/narcissistic-types-chinese-women.htm
The description of Chinese cyber espionage in Chapter 43 originates from an article published by
FORTUNE
magazine. Found online at
http://money.cnn.com/2013/07/08/technology/mandia-china-hackers.pr.fortune/index.html
The estimate of unfunded health care expenditures exceeding $700 billion referenced in Chapter 46 was calculated by summing the annual Medicare and Medicaid expenditures paid by transfers from the General Fund. The data was obtained from the Office of Management and Budget, Fiscal Year 2013 Budget of the US Government, Table S-5 Proposed Budget by Category. The author increased the number by $200 billion to reflect his estimate of the additional financial resources that will be necessary to fund the expansion of Medicaid coverage under The Affordable Care Act. Refer to Tables V.G1, V.G2, and V.G3. Found online at
http://www.whitehouse.gov/sites/default/files/omb/budget/fy2013/assets/tables.pdf
The dialogue in Chapter 46 pertaining to widely accepted reasons why US health care expenditures exceed other countries was adapted by the author from the CRS Report for Congress entitled “US Health Care Spending: Comparison with Other OECD Countries.” Found online at
http://assets.opencrs.com/rpts/RL34175_20070917.pdf
The dialogue in Chapter 46 pertaining to widely accepted reasons why US health care expenditures exceed other countries came from the author’s familiarity with the industry. The author holds a master’s degree in health policy and administration and is a certified public accountant. Also refer to a discussion of the component costs of national health care expenditures published by the American Hospital Association entitled “Assessment of Cost Trends and Price Differentials for US Hospitals,” March 2011, page 8. Found online at
http://aharesourcecenter.wordpress.com/tag/hospital-expenditures/
The dialogue in Chapter 46 regarding
Disruptive Innovation
is based on the author’s adaptation of the theories and ideas developed by Clayton M. Christensen, a professor at the Harvard Business School. He has written numerous books and articles on the subject of reinventing business models. Found online at
http://blogs.hbr.org/2008/11/harvard-business-ideacast-122/
Mentioned in Chapter 48, public-private partnerships are “special purpose vehicles” created by the government and private business to develop and operate joint ventures. Found online at
http://en.wikipedia.org/wiki/Public%E2%80%93private_partnership
The dialogue in Chapter 48 regarding The Toxic Asset Relief Program (TARP), a program created in October 2008 by Congress and President Bush to respond to the mortgage debt and real estate crisis, originates from the deficiencies documented in the Congressional Oversight Report. Found online at
http://www.gpo.gov/fdsys/pkg/CHRG-112shrg64832/pdf/CHRG-112shrg64832.pdf
In Chapter 48, the author discusses the concept of Accountable Care Organizations (ACOs). The story takes place in the near future which requires the author to make forecasts regarding the US health care system’s experiences with ACOs and The Affordable Care Act (Obamacare). The author predicts high ACO startup costs will be a deficiency of the model. Refer to the attached link to an article published in the
Wall Street Journal
for a discussion of ACOs. Found on line at
http://online.wsj.com/article/SB10001424052970204720204577128901714576054.html
The dialog in Chapters 51 and 53 pertaining to high private health plan administrative overhead was adapted by the author from numerous articles found online. Refer
to “Assessment of Cost Trends and Price Differences for US Hospitals” found on page 8 of the following link.
www.aha.org/content/11/11costtrendspricediffreport.pdf
http://newsatjama.jama.com/2013/04/24/jama-forum-are-health-insurers-administrative-costs-too-high-or-too-low/
http://www.healthleadersmedia.com/HOM-238650-4625/BCBSA-study-shows-low-health-plan-administrative-costs##
The dialogue in Chapter 54 regarding thirty percent of all health care services add minimal value is from the following citation: Fischer ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, Pinder EL, The implications of regional variations in Medicare spending, Part 1 & 2, Ann Internal Medicine. 2003;138: 273–298.