Book excerpt: The United States spends greatly more per person on health care than any other country but the evidence shows that care is often poor and inappropriate. Despite expenditures of 1.7 trillion dollars in 2003, and growing substantially each year, services remain fragmented and poorly coordinated, and more than 46 million people are uninsured. Why can't America, with its vast array of resources, sophisticated technologies, superior medical research and educational institutions, and talented health care professionals, produce higher quality care and better outcomes? In The Truth about Health Care, David Mechanic explains how health care in America has evolved in ways that favor a myriad of economic, professional, and political interests over those of patients. While money has always had a place in medical care, "big money" and the quest for profits has become dominant, making meaningful reforms difficult to achieve. Mechanic acknowledges that railing against these influences, which are here to stay, can achieve only so much. Instead, he asks whether it is possible to convert what is best about health care in America into a well functioning system that better serves the entire population. Bringing decades of experience as an active health policy participant, researcher, teacher, and consultant to the public and private sectors, Mechanic examines the strengths and weaknesses of our system and how it has evolved. He pays special attention to areas often neglected in policy discussions, such as the loss of public trust in medicine, the tragic state of long-term care, and the relationship of mental health to health care. For anyone who has been frustrated by uncoordinated health networks, insurance denials, and other obstacles to obtaining appropriate care, this book will provide a refreshing and frank look at the system's current and future dilemmas. Mechanic's thoughtful roadmap describes how health plans, healthcare professionals, policymakers, and consumer groups can work together to improve access, quality, fairness, and health outcomes in America. About the Author: