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Oxymorons: The Myth of a US Health Care System

BMJ 2002; 324 doi: (Published 20 April 2002) Cite this as: BMJ 2002;324:982
  1. David Woods (, president of Healthcare Media International
  1. Philadelphia

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    Jossey-Bass, $35, pp 272

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    Three factors militate against changing America's $1.3 trillion non-system of health care, says economist J D Kleinke. The first is chaos, which he believes is a rule, not an aberration, in the delivery of medicine. The second is behavioural inertia among the dozens of layers of healthcare administration. And the third is what he calls the “twaddle echo” factor, which is what executives, pundits, consultants, and other thought leaders in health care think at any given time will solve the first two problems.

    The main problem, says Kleinke, is …

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