Critical Condition: How Health Care in America Became Big Business--and Bad Medicine (Paperback)

by Donald L. Barlett (Author), James B. Steele (Author)
Key Phrases: free market medicine, Critical Condition, Wall Street, United States (more...)

Editorial Reviews

From Publishers Weekly
Bestselling investigative journalists Barlett and Steele (America: What Went Wrong?) deliver a devastating indictment, supported by excellent research, of a health-care system that they say is failing to provide first-rate services to its citizens, 44 million of whom are without insurance. According to these Pulitzer Prize–winning reporters, now with Time magazine, the U.S. compares poorly with other Westernized nations in delivering quality care and a healthy life expectancy, and preventing infant mortality. Per capita health-care spending continues to exceed the amount spent by many other countries, the authors say, because one out of every three U.S. dollars pays for administrative costs. The authors also present case histories of patients, some with life-threatening conditions, who were ignored by bureaucratic HMOs that put profit first. Barlett and Steele describe how health care first became driven by profits on Wall Street during the Reagan administration. Competing insurance plans, they say, led not to better choices for consumers, but to physicians who are prevented by insurers from prescribing needed treatments; a severe shortage of nurses; and unsafe hospitals where staff shortages and unsanitary conditions result from cost-cutting. The authors, who strongly advocate a single payer plan, successfully depict a health-care system in crisis.
Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved. --This text refers to an out of print or unavailable edition of this title.

From The New England Journal of Medicine
Love thy neighbor: an American paradox? The United States has one of the highest levels of church attendance in the world, but when it comes to health care, it seems that churchgoers find it difficult to love their neighbors in the way that secular Europeans take for granted. Critical Condition, a fine polemic, describes how health care in the United States is financially rewarding to insurers and providers but delivers poor-quality health care to many of its citizens. Although U.S. health care has been described as the "best system in the world" (and it is in parts), it is also a failure because of its inability to deliver good-quality care to the disadvantaged. However, this paradox is also the triumph of the system, since its component parts do what they are designed to do. Medicaid provides variable support for some of the poor. Medicare offers a finite package of care for the elderly, with patients in the eastern United States receiving 60 percent more care than those in the West. Veterans are cared for in a mini-National Health Service, which appears to have had some success in shifting cases from the hospital to primary care settings. The majority of U.S. workers are offered little choice in insurance plans by their employers, who, confronted by an escalation in costs, increasingly have recourse to higher levels of deductibles and copayments and are pruning benefit packages. Then there are the 43 million Americans with no health insurance. Over the life cycle, the American lottery can move people across these systems with significant consequences for their material well-being and health. In each of these health care systems, Americans face price discrimination and bankruptcy if they are unlucky in their genes and life events. In their book, Barlett and Steele describe these problems in graphic detail. They explain how, instead of cross-subsidizing the poor with revenues from people who are more affluent, providers charge them higher prices for the same services as those received by the more fortunate. This price discrimination is supported by vigorous pursuit of people who fail to pay their health care debts. American private-sector bureaucrats, like their public-sector counterparts in Europe, increasingly have recourse to "cookbook medicine," in which practice guidelines and protocols (all too often evidence-free) are imposed on practitioners. Given that medical practice exhibits established and significant variations and well-chronicled medical errors, together with a remarkable reluctance to measure success in improving the quality of life of patients, it is unsurprising that bureaucrats seek to establish quality standards in the health care industry. What is surprising is that their efforts in the United States and elsewhere remain feeble and are rarely "confused" by evidence of cost-effectiveness. But there again, this is no accident but, rather, the deliberate product of the incentive structures inherent in the U.S. health care system. These incentives protect the insurers and providers from contestability, muting price competition and ensuring that competition in quality is superficial and rarely informed by patient-outcome data. Barlett and Steele offer a nicely documented and well-written insight into all that is bad with the U.S. health care system. For skeptical Europeans on the receiving end of evidence-free health care reforms often inspired by unevaluated policies from the United States, this book is a welcome antidote. There are no simple solutions to complex problems inherent in health care systems worldwide, and the authors' advocacy of national insurance as the solution to the problems of equity and access that they document is unconvincing. First, insurers and providers thrive at the current health care feast and are unlikely to support reforms that redistribute their jobs and incomes. Second, tax-financed national insurance does not address the problems of inefficiency in the supply of health care as demonstrated by Europe. National insurance enables societies to love their neighbors, but as Adam Smith, the 18th-century Scottish economist, noted, capitalists always conspire to exploit the consumer, and nowhere is this more evident than in the health care sector. Will Barlett and Steele precipitate altruistic reform, unlike their many predecessors who have described the failings of U.S. health care? The recent presidential election makes this unlikely. Americans appear to prefer to practice their religion in isolation from their social policies. Alan K. Maynard
Copyright © 2005 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS. --This text refers to an out of print or unavailable edition of this title.

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Product Details

• Paperback: 288 pages
• Publisher: Broadway (October 11, 2005)
• Language: English
• ISBN-10: 0767910753
• ISBN-13: 978-0767910750
• Product Dimensions: 7.8 x 5.2 x 0.7 inches
• Shipping Weight: 7.2 ounces (View shipping rates and policies)
• Average Customer Review: 4.0 out of 5 stars See all reviews (26 customer reviews)
• Amazon.com Sales Rank: #364,095 in Books (See Bestsellers in Books)

Customer Reviews

Most Helpful Customer Reviews

70 of 74 people found the following review helpful:

5.0 out of 5 stars Please read this book!, October 15, 2004

By	M. J. Petrillo "Bookmark" (Boxfod, MA) - See all my reviews (REAL NAME)

This review is from: Critical Condition: How Health Care in America Became Big Business--and Bad Medicine (Hardcover)

It's funny that in this political season there is not much attention being paid to this book. Because this is exactly what the candidates should be paying attention to. As a life long conservative I could never have imagined rating this book highly, but it speaks the truth. The authors discuss the present day health care system, and where the present "market driven" emphasis has brought us as a nation. And truthfully, as we all know, it's not good. The authors lay out simple facts that we all know, but for some reason, strike us as incredible. For example, why is it that in the richest and most powerful nation that the world has ever known, is it necessary for parents to have to hold fundraisers and garage sales to finance the medical treatments that their children need to survive. We have all seen it, but have we ever actually thought about it? That's what this book does. It makes us look at what has become ordinary in this country, and ask why? What good is it to be the richest and most powerful country on Earth, if we can't take care of our children or our parents without having to go into bankruptcy, or holding a bake sale to finance necessary medical care. This is an eyeopening book about the sad state of our health care system. Plaese read this book and think about it. What makes a country great? Is it the flag, or the military? Or is it the way a country takes care of its people? Or the way the people take care of each other. It's funny, but I always would spout out the rethoric that we had the best health care on earth, but this book made me think. Do we? And I think we all know the answer; no. And why don't we? We should, shouldn't we?

38 of 39 people found the following review helpful:

4.0 out of 5 stars Good analysis of the history of market-based healthcare, November 11, 2004

By	chefdevergue (Spokane, WA United States) - See all my reviews (TOP 500 REVIEWER)

This review is from: Critical Condition: How Health Care in America Became Big Business--and Bad Medicine (Hardcover)

For those people who vaguely remember when healthcare & insurance was generally a manageable aspect of our lives (as opposed to being a source of stress & potential financial ruin), this book will explain very well how healthcare in US arrived at the point where it is today. For younger readers, this book will remind them that once upon a time, there was a country where insurance was fairly comprehensive & affordable, hospitals were oriented towards community rather than being part of a bottom-line-obsessed corporation, and pharmaceutical commercials were not littering the airwaves.

The authors do an excellent job of showing that the shift, on every level of healthcare, to a market-based economic model has achieved exactly the opposite of what the proponents of the free market claimed would happen. Instead of streamlining healthcare & making it as a whole more efficient and affordable, the shift to the free market has actually created a massive bureaucracy (which conservatives claim to loath) and a far less efficient healthcare system. Certainly it is not any more affordable. Anyone who is familiar with medical collections & with the stunning increase in bankruptcies over the last few years can attest to this. The authors underscore their arguments with a litany of horror stories of patients dying or suffering hugely at the hands of a hopelessly tangled system which emphasizes the bottom line over the welfare of the patient.

All of this is well and good, and mighty depressing. However, only a minimal amount of time is devoted to what might be done about it. The authors' suggestion --- the adoption of a single-payor system --- is fine as far as it goes, but they offer only a cursory examination of the benefits of such a system and do not delve into any of the criticisms of the same. Neither do they discuss other proposals such as tort reform, which is the Bush administration's answer seemingly to every healthcare crisis. In interviews, the authors have observed that capping jury awards would only make a tiny dent in the overall costs of insurance, and certainly tort reform has had mixed results at best, depending on which of the states that have passed tort reform legislation one examines. Yet the authors barely touch on it their text. At the very end of their book, the authors mention the fact that Big Business (aside from the healthcare industry) certainly has good reason to want a single-payor system, since healthcare costs cut deeply into THEIR profits, thus setting up a contest of sorts between two powerful for-profit entities. It is probably the fact that the combined power of multiple US industries outweighs the power of the insurance & healthcare industries that will ultimately force genuine changes in how this country manages healthcare, but the authors for whatever reason prefer not to explore this particular topic. This is unfortunate.

Overall, this book provides some good detail on issues we all need to know more about, but if you are looking for detailed solutions, you will need to look elsewhere.

22 of 22 people found the following review helpful:

4.0 out of 5 stars An empasis on market pressures, October 31, 2004

By	Dr. James M. Wynne "www.corpmedinfo.com" (Brisbane, Australia) - See all my reviews (REAL NAME)

As a doctor who has been tracking and documenting the development of corporate medicine and the application of market thinking and market processes in health care for over 10 years (...), from outside the USA, it was an absolute delight to find credible US authors who had actually identified the core problem as the market itself.

Almost every effort to correct problems in health care in the USA has been on the basis that market forces are applicable to all situations. Proposed solutions to health care problems caused by market forces have been attempts to make the system more market like and increase market pressures (e.g. managed care) so compounding the problem.

The book shows that health and aged care cannot be successfully commodified and traded in a marketplace; which is not to suggest that a socialist solution will provide answers. This is not about ideology but about people.

The other strenghth of the book is that it identifies the major role which Wall Street financiers play in driving market solutions into contexts where they are inapplicable. Bankers and market analysts attend board meetings to advise. They will not lend their financial support to corporations which fail to follow their market prescriptions. Success is dependent on this support.

Few analysts confront the hard fact that profit and care compete for the same limited dollar, and in the market context profit pressures are much stronger than care. The many documented failures in care (e.g. at Tenet Healhcare's Redding Hospital) and the massive fraud scandals involving the most successful companies in each sector are documented in this book.

I agree that the solution offered is only a step forward - but an important one. It does not eliminate market forces or market listed corporations. It continues to drive the system with a set of crude economic levers and competitive forces. It is probably the best they can do in the present US context while still remaining credible.

I cannot recommend this book highly enough because it comes closer to the heart of the modern problems in health care than any other analysis I have seen. It encourages US citizens to confront the core problems and decide whether health is a commodity to be traded commercially for profit or whether it is perhaps after all a Samaritan service - a cooperative endeavour by a community of citizens concerned for the welfare of others who have fallen on hard times? Are those who provide care specailised extensions of the community and its values or are they self interested instrumentalities driven by crude financial levers?

The decision reached also defines the sort of society the USA is.

Michael Wynne. (Australian doctor)