I have been privileged to enjoy a uniquely varied professional career as a medical practitioner, consultant, educator and researcher, an officer or trustee in national societies and health care institutions, a medical journal editor and, most recently, a member of a state medical licensing and regulatory board. All of this experience has convinced me that American health care, despite its scientific and clinical achievements, is failing to meet some of its most important obligations to society. I believe that certain major reforms are urgently needed, and that the public and the profession, when they understand the facts, will want these reforms.

This book describes what has been happening to our health care system, explains why I am persuaded it must change substantially, and suggests the direction these changes should take. It is a personal manifesto, I suppose, but it is also intended to be a fact-based, readable assessment of one of our greatest domestic problems. If I have done my job, this book should be a useful resource for the many coming debates on health care policy.