cover of Shredding the Social Contract



Mind Boggling Complexity is Sorted Out

Shredding the Social Contract: The Privatization of Medicare ©2006 John Geyman, M.D.

© 2008 Beth Helstien

My husband still regrets losing his doctor when Dr. Geyman retired from practice at the Inter Island Medical Center. In addition to being a fine doctor, Professor Emeritus of Family Medicine at the University of Washington School of Medicine, where he was chairman, a member of the National Academy of Sciences Institute of Medicine, he is a prolific author.

Trying to understand what to do about Medicare is daunting and not for the faint-hearted. Dr. Geyman introduces the reader to a boggling number of agencies involved in health care and an even more overwhelming set of acronyms for various plans, policies, and mechanism of measurement of health care services. More significant than the mere terminology for understanding the Medicare morass is the complexity and severity of the problem. 

The book sets the context of the Medicare problem as the clash between private interests (and profits) and the public good. The initial chapter is an historical overview of the conflict between democratic values and the interests of corporations in America.  The conclusion: privatization of Medicare is the single most important threat to the program. The argument that free markets deliver health care with greater efficiency or less cost than government is debunked.
The book documents the numerous ways in which private plans and corporate interests actually cost Medicare more than government-sponsored insurance. Geyman has done his research, and he documents his points with reference to hundreds of sources in more than seven hundred footnotes. Privatization of Medicare undermines the health of older Americans and the stability of the program, and privatization should be ended before Medicare is destroyed.  It means insurance companies make the decisions about Medicare coverage. Issues at stake include:

Public policy decisions are taken out of the realm of democracy, where Geyman argues they belong, and placed in the hands of corporations seeking to maximize profits.

His sources include public opinion research that points to the fact that regardless of political rhetoric, most Americans support some sort of national health insurance plan. (It’s fascinating that the candidates running for office are more fearful of how the media will attack them if the support a solution that corporate interests—including much of the media—disfavors, rather than offering what voters actually want.) 

The price of America’s social contract to provide health care to the elderly is now more than a third of the national budget, and Medicare’s cost—and its portion of our national budget—is rising fast. Medicare’s problems demand solution. Paying for health care for seniors—and providing health care to all Americans—won’t be easy.  Readers who want to understand the vastly complicated issues at stake will find a wealth of information in Geyman’s book; it’s worth the work.

Shredding the Social Contract, like all books reviewed here, may be found at the San Juan Island Library.

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