Stephen Davidson, Still Broken: Understanding the U.S. Health Care System

Extract

Still Broken comes at the best of times and the worst of times for books on United States health care policy. As a thorough, detailed and clear explication of the convoluted workings of the US health system, it is helpful and timely. Equally thoughtful are Davidson's recommendations for the direction reform must take. His excellent advice, however, did not make it into print until right after the passage of the sweeping Patient Protection and Affordable Care Act (PPACA) of 2010. Even so, readers will find this book a useful guide to a health care system on the brink of change and to reform debates that are far from over.

Davidson, professor of health policy and management at Boston University, states that the purpose of his book is to urge a consensus around the need for reforming the US health care system. He seeks to cut through the rhetorical bluster, interest group manoeuvring, and ideological rigidity surrounding health care reform, and promote agreement on central issues. Part 1, ‘Problems’, focuses on explaining the paradox of the US health system: the country spends far more than any other on health care, yet has millions of uninsured people and severe problems with access, quality and outcomes. Davidson summarises the extant literature to argue that the high cost of medical care and growing rates of un-insurance are inextricably connected. A chapter on ‘What we get for what we spend’ extols the benefits of medical advances while marshalling evidence of deteriorating quality, high numbers of medical errors, and low consumer/patient satisfaction with the health care system. Finally, Davidson argues that, beyond the familiar problems with access, cost and quality, the ‘delivery subsystem’—by which he primarily means the doctor–patient relationship—has itself eroded due to growing commercialism.