Health Affairs Reviews Buz Cooper's Book
The review, written by University of Texas professor William M. Sage, MD, JD, characterizes the book as "the capstone to an illustrious career in academic medicine."
Cooper, MD, who died last year of cancer, was a major figure at the University of Pennsylvania where, in the 1970s, he founded Penn's Cancer Center and later became a nationally-renowned health policy expert at Penn's Leonard Davis Institute of Health Economics.
Poverty as cost driver
Written in the last two years of his life and published just months after his death last year, Cooper's book is a data-rich argument that poverty rather than waste and physician inefficiency is the primary driver of the country's runaway health care costs.
"Once one accepts that a combination of social and professional determinants drives health care expenditures, Cooper's book offers surprising insights. One is the difference between Medicare spending, which largely reflects high utilization and the demographics of aging, and private spending, which is more a function of price than of volume. Another is the historical trend of spending on richer compared to poorer patients. According to Cooper, the amount spent on health care for the poor was only 60 percent of that spent for the rich in the late 1960s but grew to 150 percent by 2010, with the crossover point in the mid-1980s. Only a small amount of that shift reflects population aging or the epidemic of chronic disease. More is attributable to the passage and expansion of Medicare and Medicaid (including their prohibition on racial discrimination)."
"In other words, US health care in the post-Medicare era is a major redistributor of society’s resources from the rich to the poor."