Too Big to Succeed: Profiteering in American Medicine

Russell J. Andrews, MD, DEd

Publisher: iUniverse Pages: 175 Price: (paperback) $16.95 ISBN: 9781475971286 Reviewed: September, 2013 Author Website: Visit »

Too Big to Succeed exposes the way profiteering has driven costs in American medicine to unsustainable levels while eroding the quality of care. With an insider’s eye, the author, a neurosurgeon, examines how our system turns physicians into money-oriented profiteers and how profiteering has supplanted medical outcomes.

Expanding on the theme of Dr. Atul Gawande’s seminal 2009 New Yorker essay, The Cost Conundrum: What a Texas Town Can Teach Us About Health Care, in example after disturbing, documented example of what he calls ”the symptoms” of “profit-centered” health care, Dr. Russell J. Andrews devastatingly shows how profit motive has “highjacked” American medicine and made it “an economic rather than humanitarian enterprise.”

One particularly chilling example is lumbar spine surgery, for which Americans spend $2 billion dollars a year. Complex fusion surgery, “of questionable long term benefit” for many and for which life-threatening complications are more than twice as frequent as simple decompression surgery, nonetheless increased “fifteenfold” from 2002 to 2007. Why? “Not surprisingly,” Andrews notes, hospital charges were about $81,000 versus $24,000 and surgeon’s fees “five to ten times” more. His diagnosis: When health care is a commodity and profits the driving force, disaster is inevitable.

Prognosis: “Until we in the United States acknowledge that [universal] health care is part of a civilized society,” the costs and quality of health care will continue to diverge and “ultimately will bankrupt the United States financially, medically, and socially.”

Prescription: Reconfigure the system so that physicians are motivated to consider the patient’s medical outcome first and change the culture to return to the goals of the Hippocratic Oath.

Andrews’ insightful solution, like his well-documented, nation-wide examples showing how widespread the problem is, goes further, wider and deeper to attack the real cause than many others have. His compelling, well-reasoned, paradigm-shifting examination is an engaging and, yes, easy (!) read, essential for every health care consumer.

BlueInk Heads-Up: Highly recommended for health-care consumers, practitioners, policy wonks, politicians. Fans of Dr. Atul Gawande’s books and articles on American health care will also appreciate Dr. Andrews’ work.

Also available in hardcover and ebook.

Author's Current Residence
Los Gatos, California
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