There is little debate that health care in the United States is in need of reform. But where should those improvements begin? With insurers? Drug makers? The doctors themselves? In Big Med, David Dranove and Lawton Robert Burns argue that we’re overlooking the most ubiquitous cause of our costly and underperforming system: megaproviders, the expansive health care organizations that have become the face of American medicine. Your local hospital is likely part of one. Your doctors, too. And the megaproviders are bad news for your health and your wallet.

Drawing on decades of combined expertise in health care consolidation, Dranove and Burns trace Big Med’s emergence in the 1990s, followed by its swift rise amid false promises of scale economies and organizational collaboration. In the decades since, megaproviders have gobbled up market share and turned independent physicians into salaried employees of big bureaucracies, while delivering on none of their early promises. For patients this means higher costs and lesser care. Meanwhile, physicians report increasingly low morale, making it all but impossible for most systems to implement meaningful reforms.

In Big Med, Dranove and Burns combine their respective skills in economics and management to provide a nuanced explanation of how the provision of health care has been corrupted and submerged under consolidation. They offer practical recommendations for improving competition policies that would reform megaproviders to actually achieve the efficiencies and quality improvements they have long promised.
This is an essential read for understanding the current state of the health care system in America—and the steps urgently needed to create an environment of better care for all of us.

In this penetrating analysis, Bradford Gray tackles the thorny issues surrounding the question of to whom and for what our physicians and hospitals are accountable. This book provides a careful evaluation of the mechanisms of accountability that have developed along with a growing profit orientation of health care, and it alerts us to keep a sharp eye focused on who is looking out for the interests of the patient.

Based on years of observation at a large state university, Wannabe U tracks the dispiriting consequences of trading in traditional educational values for loyalty to the market. Aping their boardroom idols, the new corporate administrators at such universities wander from job to job and reductively view the students there as future workers in need of training. Obsessed with measurable successes, they stress auditing and accountability, which leads to policies of surveillance and control dubiously cloaked in the guise of scientific administration. In this eye-opening exposé of the modern university, Tuchman paints a candid portrait of the corporatization of higher education and its impact on students and faculty. 

Like the best campus novelists, Tuchman entertains with her acidly witty observations of backstage power dynamics and faculty politics, but ultimately Wannabe U is a hard-hitting account of how higher education’s misguided pursuit of success fails us all.