Big Med

de David Dranove, Lawton Robert Burns

"When it comes to healthcare, bigger isn't always better. The early-1990s rise of "megaproviders"-large, hospital-based healthcare systems that have become the norm in American medicine-brought promises of accessibility, cost savings, and excellence to the American healthcare experience. Today's megaproviders, following three decades of growth and consolidation, receive as much as two-thirds of healthcare spending in the United States. Big Med examines the rise of these megaproviders and their formative role in reducing American healthcare to its current shambles. As healthcare organizations have consolidated, they've increased their market power, and in doing so created a system in which the network sets the prices, insurance and pharmaceutical companies take the blame, and Americans suffer the costs. Drawing on seven decades of combined research in economics and sociology, Dranove and Burns consider the effects of this noncompetitive system on patients, doctors, and society more broadly. Physicians are forced to provide less attentive care to a larger number of patients; patients in turn pay more for lesser care. This leaves both parties alienated and disenchanted, and any motivations to improve the flawed system are stalled. Amid screeching public debate around the prospects and perils of Medicare-for-all, Big Med is a provocative, narrative-shifting account of who's really calling the shots-and causing harm-in American healthcare today"--