How Health Care in America Became Big Business--and Bad Medicine
Reviewer: Dr. James M. Wynne "www.corpmedinfo.com (Brisbane, Australia)

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)