Crisis In U.S. Health Care

The problems of U.S. health care are of intense public interest today. The debate over where to go next to rein in costs and improve access to quality health care has become bitterly partisan, with distorted rhetoric largely uninformed by history, evidence, or health policy science. Based on present trends, our expensive dysfunctional system threatens patients, families, the government, and taxpayers with future bankruptcy.

This book takes a 60-year view of our health care system, from 1956 to 2016, from the perspective of a family physician who has lived through these years as a practitioner in two rural communities, a professor and administrator of family medicine in medical schools, a journal editor for 30 years, and a researcher and writer on health care for more than four decades.

There has been a complete transformation of health care and medical practice over that time from physicians in solo or small group practice and community hospitals to an enormous, largely corporatized industry that has left behind many of the traditions of personalized health care. This is an objective, non-partisan look at the major trends changing U.S. health care over these years, and points out some of the highs—and lows—of these changes, which may surprise some readers. It also compares the three basic alternatives for health care reform currently being debated.