Views & Reviews

What is wrong with US health care

BMJ 2008; 336 doi: (Published 10 January 2008) Cite this as: BMJ 2008;336:99
  1. Douglas Kamerow, chief scientist, health, social, and economics research, RTI International, Washington, DC, and associate editor, BMJ
  1. dkamerow{at}

    The problems with the American healthcare system are brilliantly laid out in this new book. But overtreatment isn’t the whole story, and fixing the system is another matter, says Douglas Kamerow

    Yet another book about the healthcare “system” everyone loves to hate? Yes, indeed, but this is a good one. Journalist Shannon Brownlee systematically documents the problems of health care in America, deftly mixing statistics with telling anecdotes and quotations. Along the way she also profiles healthcare heroes and villains at greater length.

    If you ask doctors why health care costs so much in the United States, we’ll tell you that it is the for-profit medical system and litigious lawyers that are the problem. Drugs cost too much because of the rapacious drug companies. Administrative costs are too high and are multiplied by the vast number of health plans and insurance companies. And because we’re worried about lawsuits, we practise defensive medicine and order too many tests so we don’t miss anything.

    Brownlee enumerates and rejects most of these explanations. She uses overtreatment as her organising principle and the …

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