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.

This is an auto-narrated audiobook edition of this book.

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.

Catholic health care is about ethics but also "ethos" – not only what we shouldn't do but a vision for what we should do with love. The issues it faces don't just concern academic bioethicists – they concern every faithful Catholic doctor, nurse, practitioner, and even patient. Modern medical practitioners on the ground, day-in, day-out, wrestling with medical moral matters, witnessing what is happening in American medicine today, while also striving to witness to their Catholic faith in living out their medical vocation – these are the primary authors of this unique book, and these are the readers it hopes to serve.

Catholic Witness in Health Care integrates the theoretical presentation of Catholic medical ethics with real life practice. It begins with fundamental elements of Catholic care, touching upon Scripture, moral philosophy, theology, Christian anthropology, and pastoral care. The second part features Catholic clinicians illuminating authentic Catholic medical care in their various medical disciplines: gynecology and reproductive medicine, fertility, pediatrics, geriatrics, critical care, surgery, rehabilitation, psychology, and pharmacy. Part three offers unique perspectives concerning medical education, research, and practice, with an eye toward creating a cultural shift to an authentically Catholic medical ethos.

Readers of this book will learn essential elements upon which the ethics of Catholic medical practice is founded and gain insights into practicing medicine and caring for others in an authentically Catholic way.

The first critical book on “appropriate technology,” Developing to Scale shows how global health came to be understood as a problem to be solved with the right technical interventions.
 
In 1973, economist E. F. Schumacher published Small Is Beautiful, which introduced a mainstream audience to his theory of “appropriate technology”: the belief that international development projects in the Global South were most sustainable when they were small-scale, decentralized, and balanced between the traditional and the modern. His theory gained widespread appeal, as cuts to the foreign aid budget, the national interests of nations seeking greater independence, postcolonial activism, and the rise of the United States’ tech sector drove stakeholders across public and private institutions toward cheaper tools. In the ensuing decades, US foreign assistance shifted away from massive modernization projects, such as water treatment facilities, toward point-of-use technologies like village water pumps and oral rehydration salts. This transition toward the small scale had massive implications for the practice of global health.
 
Developing to Scale tells the history of appropriate technology in international health and development, relating the people, organizations, and events that shaped this consequential idea. Heidi Morefield examines how certain technologies have been defined as more or less “appropriate” for the Global South based on assumptions about gender, race, culture, and environment. Her study shows appropriate technology to be malleable, as different constituencies interpreted its ideas according to their own needs. She reveals how policymakers wielded this tool to both constrain aid to a scale that did not threaten Western interests and to scale the practice of global health through the development and distribution of technical interventions.

This is an auto-narrated audiobook version of this book.

The first critical book on “appropriate technology,” Developing to Scale shows how global health came to be understood as a problem to be solved with the right technical interventions.
 
In 1973, economist E. F. Schumacher published Small Is Beautiful, which introduced a mainstream audience to his theory of “appropriate technology”: the belief that international development projects in the Global South were most sustainable when they were small-scale, decentralized, and balanced between the traditional and the modern. His theory gained widespread appeal, as cuts to the foreign aid budget, the national interests of nations seeking greater independence, postcolonial activism, and the rise of the United States’ tech sector drove stakeholders across public and private institutions toward cheaper tools. In the ensuing decades, US foreign assistance shifted away from massive modernization projects, such as water treatment facilities, toward point-of-use technologies like village water pumps and oral rehydration salts. This transition toward the small scale had massive implications for the practice of global health.
 
Developing to Scale tells the history of appropriate technology in international health and development, relating the people, organizations, and events that shaped this consequential idea. Heidi Morefield examines how certain technologies have been defined as more or less “appropriate” for the Global South based on assumptions about gender, race, culture, and environment. Her study shows appropriate technology to be malleable, as different constituencies interpreted its ideas according to their own needs. She reveals how policymakers wielded this tool to both constrain aid to a scale that did not threaten Western interests and to scale the practice of global health through the development and distribution of technical interventions.

In the wake of the successful cloning of animals and the promises—or fears—of stem cell research, new discoveries in science and medicine need more than ever to be accompanied by careful moral reflection. Contending that concern over the ethical dimensions of these and other like issues are no longer just in the domain of those involved in medical practice, the third edition of Ethics of Health Care claims these are vital topics that should matter deeply to all citizens.

While stressing the Catholic tradition in health care ethics, Ethics of Health Care is ecumenical, incorporating a broader Christian tradition as well as humanistic approaches, and takes as common ground for mutual understanding the Universal Declaration of Human Rights of the United Nations. This new third edition is a response to the many developments in theology and the startlingly rapid changes in the arenas of medicine and health care over the past decade, from the dominance of managed care to increased surgery on an "outpatient" basis; from hospice care for the dying to the increasing use of drugs in the treatment of mental illness.

Revised and thoroughly up-to-date, this third edition continues with its valuable teaching aids, including case studies, study questions, chapter summaries, a bibliography, and complete index.

David M. Craig traveled across the United States to assess health care access, delivery and finance in this country. He interviewed religious hospital administrators and interfaith activists, learning how they balance the values of economic efficiency and community accountability. He met with conservatives, liberals, and moderates, reviewing their ideas for market reform or support for the Affordable Care Act. He discovered that health care in the US is not a private good or a public good. Decades of public policy and philanthropic service have made health care a shared social good.

Health Care as a Social Good: Religious Values and the American Democracy argues that as escalating health costs absorb more and more of family income and government budgets, we need to take stock of the full range of health care values to create a different and more affordable community-based health care system. Transformation of that system is a national priority but Americans have failed to find a way to work together that bypasses our differences. Craig insists that community engagement around the common religious conviction that healing is a shared responsibility can help us achieve this transformation—one that will not only help us realize a new and better system, but one that reflects the ideals of American democracy and the common good.

Health Extension: Community-Based Healthcare and the Future of Cooperative Extension explores innovation in extension health programs, engaged scholarship promoting research-based information in communities, and the evaluation and documentation of community programs and their impacts. This volume provides land-grant and university-based colleagues up-to-date information on using the Cooperative Extension System (CES) for community engagement in healthcare while also familiarizing those outside CES and the academy with a roadmap for improvement. The contributions of a diverse array of scholars challenge the status quo in extension programs by characterizing the introspection, understanding, creativity, partnerships, and leadership that will be required to improve lives and communities  in the twenty-first century. This perspective underscores the role of CES as foundational to the future of Health Extension and offers an alternative to approaches that utilize the CES as a model without the accompanying advantages of history, community embeddedness, and sustainability.

Exploring the moral foundations of the healing relationship, Edmund D. Pellegrino and David C. Thomasma offer the health care professional a highly readable Christian philosophy of medicine. This book examines the influence religious beliefs have on the kind of person the health professional should be, on the health care policies a society should adopt, and on what constitutes healing in its fullest sense.

Helping and Healing looks at the ways a religious perspective shapes the healing relationship and the ethics of that relationship. Pellegrino and Thomasma seek to clarify the role of religious belief in health care by providing a moral basis for such commitment as well as a balancing role for reason. This book establishes a common ground for believers and skeptics alike in their dedication to relieve suffering by showing that helping and healing require an involvement in the religious values of patients. It clearly argues that religion provides crucial insights into medical practice and morality that cannot be ignored, even in our morally heterogeneous society.

Central to the authors' message is the concept of patients' vulnerabilities and the need to help them recover not only from the disease but also from an existential assault on their personhood. They then show how this understanding can move caregivers to view their professions as vocations and thereby change the nature of health care from a business to a community of healing.

Physicians, nurses, administrators, clergy, theologians, and other health professionals and church leaders will find this volume helpful for their own reflections on the role of religion in the health care ministry and for making a religious commitment integral to their professional lives.

There is no shortage of criticisms of U.S. COVID-19 policy. This book argues that officials at the highest levels lied to the public or deliberately suppressed relevant information, shamelessly over-sold the efficacy of masks and vaccines, and enacted lock-down policies of unproven value that caused massive economic, educational, and psycho-social damage.

In How to Respond Better to the Next Pandemic Allen Buchanan argues that, contrary to widespread opinion, the primary cause of flawed COVID-19 policy was not defective leadership, but rather institutional failure. Decisions were made through processes that lacked the most basic safeguards against the large-institution “yes-man” and group-think phenomena and included virtually no provisions for holding decision makers accountable. More fundamentally, policy makers did not fulfill the crucial duty to provide plausible public justifications for their decisions. They disguised the fact that scientific opinion was divided on the appropriateness of the policies they endorsed and labeled those who disagreed with them as anti-scientific. In some cases, they responded to criticism, not by engaging it on the issues, but by branding their critics as quacks.

Medicine, Health Care, and Ethics adds to this rich tradition with a collection of contemporary essays that represent the very best efforts of current Catholic scholarship in the field of health care and medical ethics.

A qualitative and quantitative approach to the study of foreign patients’ utilization and assessment of health care in the United States.

What are the barriers preventing migrants from accessing and successfully using health care in their new home country? Do these barriers vary based on the migrants’ country of origin? And are they a problem for highly skilled migrants, who often have well-paid jobs and health insurance provided by their employers? Based on field research conducted in the Washington DC area, Navigating the Cultures of Health Care and Health Insurance brings together mixed methods, qualitative, and quantitative approaches to the study of foreign patients’ utilization and assessment of health care in the United States. Through interviews with both health care providers and patients, attitudes toward health insurance and medical treatment are compared for migrants from three countries with very different cultural backgrounds and health insurance systems: Germany, India, and Japan. 

A searing study of how modern reproductive politics shapes women's bodily agency

Pregnancy indisputably takes place within a woman's body. But as reproductive power finds its way into the hands of medical professionals, lobbyists, and policymakers, the geographies of pregnancy are shifting, and the boundaries need to be redrawn, argues Laura R. Woliver. The Political Geographies of Pregnancy is a vigorous analysis of the ways modern reproductive politics are shaped by long-standing debates on abortion and adoption, surrogacy arrangements, new reproductive technologies, medical surveillance, and the mapping of the human genome.

Across a politically charged backdrop of reproductive issues, Woliver exposes strategies that claim to uphold the best interests of children, families, and women but in reality complicate women's struggles to have control over their own bodies. Utilizing feminist standpoint theory and promoting a feminist ethic of care, Woliver looks at abortion politics, modern adoption laws that cater to male-headed families, regulations that allow the state to monitor pregnant women but not always provide care for them, and the power structures behind the seemingly benign world of egg-selling and surrogate parenting. She also considers the potentially staggering political implications of mapping the human genome, and the exclusion of women's perspectives in discussions about legislation and advancements in reproductive technologies.

The Rebirth of the Clinic begins with a bold assertion: the doctor-patient relationship is sick. Fortunately, as this engrossing book demonstrates, the damage is not irreparable. Today, patients voice their desires to be seen not just as bodies, but as whole people. Though not willing to give up scientific progress and all it has to offer, they sense the need for more. Patients want a form of medicine that can heal them in body and soul. This movement is reflected in medical school curricula, in which courses in spirituality and health care are taught alongside anatomy and physiology. But how can health care workers translate these concepts into practice? How can they strike an appropriate balance, integrating and affirming spirituality without abandoning centuries of science or unwittingly adopting pseudoscience?

Physician and philosopher Daniel Sulmasy is uniquely qualified to guide readers through this terrain. At the outset of this accessible, engaging volume, he explores the nature of illness and healing, focusing on health care's rich history as a spiritual practice and on the human dignity of the patient. Combining sound theological reflection with doses of healthy skepticism, he goes on to describe empirical research on the effects of spirituality on health, including scientific studies of the healing power of prayer, emphasizing that there are reasons beyond even promising research data to attend to the souls of patients. Finally, Sulmasy devotes special attention and compassion to the care of people at the end of life, incorporating the stories of several of his patients.

Throughout, the author never strays from the theme that, for physicians, attending to the spiritual needs of patients should not be a moral option, but a moral obligation. This book is an essential resource for scholars and students of medicine and medical ethics and especially medical students and health care professionals.

If you’re going to have a heart attack, an organ transplant, or a joint replacement, here’s the key to getting the very best medical care: be a white, straight, middle-class male. This book by a pioneering black surgeon takes on one of the few critically important topics that haven’t figured in the heated debate over health care reform—the largely hidden yet massive injustice of bias in medical treatment.

Growing up in Jim Crow–era Tennessee and training and teaching in overwhelmingly white medical institutions, Gus White witnessed firsthand how prejudice works in the world of medicine. And while race relations have changed dramatically, old ways of thinking die hard. In Seeing Patients White draws upon his experience in startlingly different worlds to make sense of the unconscious bias that riddles medical treatment, and to explore what it means for health care in a diverse twenty-first-century America.

White and coauthor David Chanoff use extensive research and interviews with leading physicians to show how subconscious stereotyping influences doctor–patient interactions, diagnosis, and treatment. Their book brings together insights from the worlds of social psychology, neuroscience, and clinical practice to define the issues clearly and, most importantly, to outline a concrete approach to fixing this fundamental inequity in the delivery of health care.

The Affordable Care Act (ACA), the sweeping health care reform enacted by the Obama Administration in 2010, continues to be a contentious policy at the center of highly polarized political debates. Both before and after the law’s passage, political elites on both sides of the issue attempted to sway public opinion through two traditional approaches: messaging and policymaking itself.  They operated under the assumption that the public’s personal experiences toward the law would make them more favorable. Yet these tried-and-true methods have had limited influence on public attitudes toward the ACA. Public opinion towards the ACA remained stable from 2010 to 2016, with more Americans opposing the law than supporting it. It was only after Donald Trump was elected in 2016 and the prospect of the law being repealed became a reality that public opinion swung in favor of the ACA. If traditional methods of influencing public opinion had little impact on attitudes towards the ACA, what did? In Stable Condition, political scientist Daniel J. Hopkins draws on survey data from 2009 to 2020 to assess how a variety of factors such as personal experience, political messaging, and partisanship did or did not affect public opinion on the ACA.
 
Hopkins finds that although personal experience with the ACA’s Medicaid expansion increased favorability among low-income Americans, it did not have a broader overall impact on public opinion. Personal experience with the Health Insurance Marketplace did not increase wider support for the ACA either. Due to the complex nature of the law, users of the Marketplace often did not realize they were benefiting from the ACA. Therefore, perceptions of the Marketplace were shaped by high-profile issues with the enrollment website and opposition to the individual mandate. These experiences ultimately offset one another, resulting in little discernable change in public opinion overall. Hopkins argues that political polarization was also responsible for elite’s limited influence and that public opinion on the ACA was largely determined by partisanship and political affiliation. Americans quickly aligned with their party’s stance on the law and were resistant to changing their beliefs despite the efforts of political elites. 
 
Stable Condition is an illuminating examination of the limits of elites’ influence and the forces that shaped public opinion about the Affordable Care Act.
 

A provocative chronicle of how US public health has strayed from its liberal roots.

The Covid-19 response was a crucible of politics and public health—a volatile combination that produced predictably bad results. As scientific expertise became entangled with political motivations, the public-health establishment found itself mired in political encampment.

It was, as Sandro Galea argues, a crisis of liberalism: a retreat from the principles of free speech, open debate, and the pursuit of knowledge through reasoned inquiry that should inform the work of public health.

Across fifty essays, Within Reason chronicles how public health became enmeshed in the insidious social trends that accelerated under Covid-19. Galea challenges this intellectual drift towards intolerance and absolutism while showing how similar regressions from reason undermined social progress during earlier eras. Within Reason builds an incisive case for a return to critical, open inquiry as a guiding principle for the future public health we want—and a future we must work to protect.