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The Present Illness: American Health Care and Its Afflictions
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.

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The Present Illness: American Health Care and Its Afflictions
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.

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The Present Illness: American Health Care and Its Afflictions

The Present Illness: American Health Care and Its Afflictions

by Martin F. Shapiro
The Present Illness: American Health Care and Its Afflictions

The Present Illness: American Health Care and Its Afflictions

by Martin F. Shapiro

Overview

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.

Product Details

ISBN-13: 9781421445656
Publisher: Johns Hopkins University Press
Publication date: 01/31/2023
Pages: 496
Product dimensions: 6.00(w) x 9.00(h) x 1.15(d)
Age Range: 18 Years

About the Author

Martin F. Shapiro, MD, PhD, MPH (NEW YORK, NY), is a physician, health services researcher, and a professor of medicine at Weill Cornell Medical College and Distinguished Professor Emeritus of Medicine and Public Health at the University of California, Los Angeles, where he was chief of the Division of General Internal Medicine and Health Services Research for 25 years. He is the author of Getting Doctored: Critical Reflections on Becoming a Physician.

Table of Contents

Prologue. The Present Illness
Chapter 1. The Best of Times? A Tale of Two Health Care Narratives
Chapter 2. A Heart in a Heartless World: What Patients Want and Need
Chapter 3. Doctors and Dollars: Antecedents, Actions, and Consequences
Chapter 4. Procedural Proficiency or Human Connection? Attitudes, Aptitudes, and Opportunities
Chapter 5. Idealism on Life Support: Missed Opportunities in Medical Student Education
Chapter 6. Errors of (com)Mission: Misdirected Priorities in Education, Practice, and Research
Chapter 7. Making a Killing: Corporate Providers of Medical Care
Chapter 8. Biomedical Scientists and Their Truths: Disinterested Investigation or Prioritized Self-Interest?
Chapter 9. "Doing Everything for Money": The Producers of Health Care Products
Chapter 10. Human Rights and Wrong Turns: Some Problems with Health Care Financing, American Style
Chapter 11. Protagonists, Pitfalls, and Lessons from Abroad: The Tortuous Path to Health Care for All
Chapter 12. Rectitude or Revenue? American Health Care in the Marketplace
Chapter 13. Atomization and Its Discontents: The Consciousness and Connectedness of Participants in Health Care
Chapter 14. Malevolent Messaging: Toxic Interactions in Health Care
Chapter 15. Healing American Health Care: To Palliate, to Cure, or Both?
Epilogue. Lessons Learned
Acknowledgments
Appendix. Quixotic Proposals for Treating American Health Care's Afflictions
Index

What People are Saying About This

Robert M. Kaplan

Mountains of monographs document problems with selected components of our ailing healthcare system. The Present Illness uniquely recognizes the special interests of doctors, hospitals, insurance companies, politicians, pharmaceutical companies, researchers, regulators, and patients. As a revered professor, doctor, and historian, Shapiro masterfully brings deep understanding and fresh insights.

Jonathan Metzl

In The Present Illness, Martin Shapiro brilliantly re-diagnoses the age-old question, what is life worth? Told with deep compassion and vivid insight, Shapiro exposes how health care—the care for others and for ourselves—functions as a crucible though which societies such as the United States try and often fail to live up to their professed ideals. Equal parts history, dialogue, diagnosis, and lesson, this book powerfully and originally explores the politics and economics of American health, healthcare, and health education...and their discontents. Required reading for anyone who seeks to know more about how we got sick; and wants to imagine how on earth we can begin to get better.

From the Publisher

In The Present Illness, Martin Shapiro brilliantly re-diagnoses the age-old question, what is life worth? Told with deep compassion and vivid insight, Shapiro exposes how health care—the care for others and for ourselves—functions as a crucible though which societies such as the United States try and often fail to live up to their professed ideals. Equal parts history, dialogue, diagnosis, and lesson, this book powerfully and originally explores the politics and economics of American health, health care, and health education . . . and their discontents. Required reading for anyone who seeks to know more about how we got sick and wants to imagine how on earth we can begin to get better.
—Jonathan Metzl, Vanderbilt University, author of Dying of Whiteness

This is a powerful assessment of the state of medicine in contemporary US society and a compelling call to action. Shapiro's combination of research evidence, historical, sociological, and humanistic insights, and personal stories illustrate the issues involved in providing optimal medical care with a depth and nuance that I have not seen before on this broad topic.
—Paul D. Cleary, Dean Emeritus, Yale School of Public Health

Mountains of monographs document problems with selected components of our ailing healthcare system. The Present Illness uniquely recognizes the special interests of doctors, hospitals, insurance companies, politicians, pharmaceutical companies, researchers, regulators, and patients. As a revered professor, doctor, and historian, Shapiro masterfully brings deep understanding and fresh insights.
—Robert M. Kaplan, Stanford University, and former Associate Director, National Institutes of Health

Paul D. Cleary

This is a powerful assessment of the state of medicine in contemporary US society and a compelling call to action. Shapiro's combination of research evidence, historical, sociological, and humanistic insights, and personal stories illustrate the issues involved in providing optimal medical care with a depth and nuance that I have not seen before on this broad topic.

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