Publishers Weekly
August 2018
In this trenchant and accessible diagnosis of the ills plaguing American healthcare, Fine, a family physician and former director of the Rhode Island Department of Health, argues that America has “a healthcare market, not a healthcare system”—and everyone is worse off because of it. Fine persuasively demonstrates that the profit motive built into the patchwork of federal, state, and local programs that pass for healthcare in the U.S. leads to ballooning costs, gross inefficiency, and treatment for the privileged few instead of cost-effective prevention for the many. He cites community healthcare programs in places like Mound Bayou, Miss., and Huntingdon County, N.J., as examples of how health systems designed to address the needs of the small areas in which they are situated, as identified by members of those communities, can improve health outcomes just as much, if not more, than advances in medicine. Indeed, the book touts the importance of education, healthy food, and primary care centers embedded in dense community networks over specialized medical care, mounting a sustained critique of pharmaceutical companies who shill for drugs that people don’t need. America isn’t Finland, Fine admits, but the Finnish province of North Karelia had a mortality rate similar to that of the U.S. until changes were made in its healthcare system, after which heart disease rates fell by 80% and life expectancy grew by six years. This book is an informative, insightful introduction to a complex topic.
