Beyond political posturing and industry quick-fixes, why is the
American health care system so difficult to reform?
Health care reform efforts are difficult to achieve and have been
historically undermined by their narrow scope. In The Present Illness,
Martin F. Shapiro, MD, PhD, MPH, weaves together history, sociology,
extensive research, and his own experiences as a physician to explore
the broad range of afflictions impairing US health care and explains why
we won't be able to fix the system without making significant changes
across society.
With a sharp eye and ready humor, Shapiro dissects the ways all groups
participating--clinicians and their organizations, medical schools and
their faculty, hospitals and clinical corporations, scientists and the
National Institutes of Health, insurers and manufacturers, governments
and their policies, and also patients and the public--shape and
reinforce a dysfunctional system. Shapiro identifies three major
problems stymieing reform: commodification of care; values,
expectations, unmet needs, attitudes, and personal limitations of
participants; and toxic relationships and communication among these
groups.
Shapiro lays out a sweeping agenda of concrete actions to address the
many factors contributing to the system's failings. Highlighting the
interconnectedness of both the problems and potential solutions, he
warns that piecemeal reform efforts will continue to be undermined by
those who believe they have something to gain from the status quo.
Although overhauling our health care system is daunting, Shapiro
nonetheless concludes that we must push forward with a far more
comprehensive effort in all sectors of health care and throughout
society to create a system that is humane, effective, and just.
