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Books.FINAL:FINAL 2 8/21/08 11:04 PM Page 15 Aging is an intricately complex thing. It is rather like the old gospel song: "The knee bone's connected to the thigh bone, the thigh bone's connected to the hip bone," and so on. Gerontology, Satariano writes, "is a multidisciplinary field that focuses on the biology, psychology, and sociology of aging." How people age and what the outcome of that process is depends on issues such as gender, race and ethnicity, physical environment, networks of interpersonal relations, health behavior, and psychology. Women live longer, but are not as healthy. Why? Minorities have significantly worse health problems than whites. Why? Seniors who stay in their homes do better than those in care facilities. Why? To answer these questions, Satariano proposes an "ecological model," that argues that the "differences in levels of health and well-being in populations are due to a dynamic interplay among biologic, behavioral, and environmental factors, a broad interplay of multilevel factors that unfolds over the life of individuals, families, neighborhoods, and communities." The book examines subjects like disease, cognition, depression, and accidents, among others, breaking each general topic area into the "dynamic interplay" model. The book also suggests practical solutions to problems like housing and transportation. Satariano, for instance, says that a partnership between public health professionals and communities can tackle problems like seniors' access to food, safe parks, and local support services. A central theme in Satariano's book is his argument that "aging is not associated uniformly with the risk of disease, disability, and death." Extending people's life span is not enough, he says. The idea is not just to live longer, but to live better. The Epidemiology of Aging is extremely thorough but easily accessible to the average reader. The model it proposes helps organize the various overlapping fields of study in a way that gives a reader an overall picture without losing the details. No one can avoid getting old, but the quality of our lives as we age is something over which we have some control. This book is a helpful roadmap to all of our futures. —conn hallinan J U LY | A U G U S T 2 0 0 8 Health Care at Risk: A Critique of the ConsumerDriven Movement By Timothy Stoltzfus Jost; Duke University Press, 265 pp. h, consumer-driven healthcare. Doesn't that sound like an egalitarian and empowering way for individuals to gain control over their medical future? Well, not so fast, argues Timothy Stoltzfus Jost in Health Care at Risk. In fact, "consumer-driven healthcare" (CDHC) is a pretty name for an ugly impulse, the desire to make healthcare a product for individuals to purchase, instead of a social obligation and a human right. Now it is more than just an impulse. Jost uncovers a true movement behind the consumer-driven concept, with conservative think tanks teaming up with activists, lobbyists, and academics. Their healthcare proposals come wrapped in neat marketing, are based on a philosophy of radical libertarianiasm, and have the direct impact of protecting the profits of the corporate healthcare sector. In other words, CDHC advocates have created a mirror image of the guaranteed healthcare reform movement. They may lack the broad public support that our movement of patients and nurses enjoys, but CDHC advocates have access to incredible financial and political resources. Unlike single-payer activists, the CDHC supporters want an end to government regulation of the insurance and hospital industries and generally want an end to public health insurance like Medicare. They're free market advocates of the highest order, hoping for everyday Americans to either sink or swim in a deregulated healthcare market. Ultimately they believe that completely deregulating healthcare will lead to a more efficient system, and maximize the freedom of patients (if not, necessarily, provide them all with an equal level of care). Ironically, both the consumer-driven advocates and the guaranteed healthcare advocates start from the same A W W W. C A L N U R S E S . O R G premise: the system of employer-provided healthcare is dead or dying, and this phenomenon is sparking our healthcare crisis. They part ways after this shared belief. Guaranteed healthcare activists see the end of this system as the beginning of national, nonprofit health coverage. The CDHC movement sees something very different: leverage for the health savings accounts (HSAs) that form the central plank of the health proposals, of both President Bush and Sen. John McCain, and beyond that, a remade health system. HSAs are an insidiously brilliant proposal. By allowing individuals to open tax-free accounts for medical spending, HSAs both subsidize the individual insurance market and encourage individuals to see healthcare as a primarily individual responsibility. But HSAs are, at best, false empowerment. Individuals are empowered to face, alone and without government protections, a cartel of the most powerful, profitable, and politicallysavvy corporations in history, and try to extract out of them an appropriate level of healthcare. And do it while they're sick. Good luck with that. It won't work, and it can't work. HSAs, and the entire consumer-driven agenda, won't work because it is fundamentally un-American. Our nation was founded on a belief in mutual protection that has led Social Security, Medicare, and Medicaid to be among our most popular programs, alongside police, fire departments, and libraries. Moreover, these proposals can't work because they don't target a root problem of our healthcare crisis, which is its shocking inequality. The wealthiest among us already have access to incredible healthcare resources. The middle class and the working class don't, and this is our crisis. At the end of the day, the consumer-driven healthcare advocates can't solve this problem, and most don't care to try. Ultimately, the consumerdriven healthcare movement is the diversion along the path to genuine healthcare reform, and a way for the private insurance industry to protect its profits. Eventually this nation will make healthcare coverage nonprofit and universal— a system succeeding in nearly every other industrialized democracy. And when we do, the consumer-driven movement will fade away. It's really a question of how long they REGISTERED NURSE 15