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Health care delivery in the U.S. is a mess. We lead the world by far
in spending, but trail other developed countries in most health outcomes.
Our health care is disjointed, not coordinated, and seems
to be designed to maximize profits for insurers and health care
providers. These two groups usually seem to be in conflict about
which should get most of the money. While individual patients may
receive outstanding care, especially when it can be delivered profitably,
the population as a whole does not. Is the system not working,
or is it working too well to do the wrong thing? After all, “every
system is perfectly designed to get the results that it gets”.
In this book, Dr. Freeman argues that the problem is that our
healthcare system is not designed primarily to improve health. He
presents extensive evidence about the design of our health care
system and the results that it gets. He examines the imbalance
of high-tech care with primary care, the way our doctors are educated,
how new discoveries are presented to the public, and the
role of profit in distorting the design of U.S. healthcare. He suggests
how a new system could be designed based on the values
of achieving the best health for all of our people.
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“Health, Medicine and Justice is not your typical health care book. It challenges the very goals underlying the U.S. health care system: “We are getting what our system is designed to get—profit and wealth for those who control it, rather than health for the people of the nation.” If you think this idea is too controversial, this book is full of facts that make the case.” —Thomas Bodenheimer, M.D., University of California – San Francisco
Uncommon sense on health care - a book review, The Kansas City Star, March 29, 2015
“Joshua Freeman is chief of family medicine at the University of Kansas Hospital and an inveterate blogger. He started his “Medicine and Social Justice” blog in 2008 calling for universal health care coverage and has returned repeatedly to the subject. That’s because even though the Affordable Care Act makes coverage available to many people, Freeman doesn’t think it goes far enough. And while politicians dare not speak its name, Freeman isn’t shy about what he thinks we need: A single-payer, Canadian-style system covering everyone.Freeman recently gave me an advance copy of his new book, “Health, Medicine and Justice: Designing a Fair and Equitable Healthcare System,” laying out his arguments. It’s a fine primer on the tangled web of special interests and ultimately futile regulation that passes for a health care system in this country. (Truth in punditry: Freeman cites my reporting in his chapter on the role of profit in health care.)
Freeman provides telling anecdotes: His experience treating uninsured patients whose chronic illnesses were out of control because they couldn’t afford care. His discovery in New Orleans of a safety-net clinic sponsored by Qatar — which means America, the richest nation on Earth, accepts foreign aid to care for its poor. He’s also good at taking points often made by others and making connections. Yes, we know we spend more on health care than other wealthy
nations and despite that, our people aren’t particularly healthy. But the U.S. also spends less on social services, he observes, the kinds of things
that elevate people from the poverty that degraded their health in the first place.
But the poor don’t have political clout. Health care providers and insurers do. So that’s where the money goes. “We have a health care system that is designed to make profit rather than health,” Freeman says.
According to Freeman, a single-payer system — basically, Medicare for all — would go a long way toward putting the focus back on patients. It would eliminate the crazy quilt of insurance plans that drive up administrative costs. And it would set more equal and rational payments for medical
services. Providers could still compete, Freeman says, but it would be on the basis of quality or personal style.
Perhaps Freeman’s most compelling argument is that a system covering everyone would unite us all, rich and poor. We would all have an equal
stake in making sure providers were adequately paid and delivered high-quality care, and that everyone had access to that care.
But Freeman sees health care as a basic human right. That’s still a subject for debate in the United States.” — by Alan Bavley
“The US health care system is broken,” Joshua Freemen tells us in the opening line of his powerful critique, Health, Medicine and Justice: Designing a Fair and Equitable Healthcare System. He spends the next 300 pages masterfully and persuasively documenting this charge. His voice is disappointed more than it is angry or shrill. Freeman is a practicing family physician and the chairman of the Department of Family Medicine at the University of Kansas School of Medicine. It is his system and he wants to see it perform as it should, to work in a more equitable fashion, and to produce results that the country is paying for but not getting. His command of fact is impressive and his tone caring and therapeutic. He tells us about everything from comparative health systems in Europe to profit motives in the Board Room. Dr. Freeman concludes that a single
payer health system is the solution to better and more equitable healthcare in America. It is “political will,” he tells us, “that will fix the broken system.”
—Fitzhugh Mullan, M.D., Murdock Head Professor of Medicine and Health Policy, Professor of Pediatrics The George Washington University
“In his book, Health, Medicine and Justice, Joshua Freeman not only explains the unique features of the U.S. health care system that result in significantly higher costs but only mediocrity in performance, he also discusses the issues against a background of health care justice. This leads to the compelling conclusion that, being all in this together, we can apply principles of health care justice to ensure higher quality health care for everyone, at a level of spending that the nation can afford.”
—Don McCanne, M.D., Senior Health Policy Fellow, Physicians For a National Health Program (PNHP)
“This is an informative and entertaining overview of the current status and deficiencies of the US healthcare system. It will serve as a useful text for anyone just beginning their inquiry into how the system works, or for someone wanting a refresher course on the influences of social policy and values on the outcomes of the unique approaches to providing healthcare prevalent in the US.”
—Robert Graham, M.D., former CEO, American Academy of Family Physicians
“Whether simplifying the arcane methods of financing graduate medical education, or clarifying the inaccuracies and conflicts of interest in the way that medical schools report their production of primary care doctors, Dr Freeman provides insight into the bases for our out-of-balance health care workforce. In an engaging and understandable style, he not only identifies the underlying issues but also points to some opportunities for righting the health care system’s deficiencies; and makes a strong argument for why we should do so. If you don’t care about social justice and don’t want to risk caring more, don’t read this book.”
—Christine C. Matson M.D., Glenn Mitchell Chair in Generalist Medicine Chair, Department of Family and Community Medicine, Eastern Virginia Medical School
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Contact: Joshua Freeman, M.D.Cell Phone:
Email: jfreeman3@gmail.com
Health, Medicine and Justice
Designing a Fair and Equitable Healthcare System
By Joshua Freeman, M.D.
Published in 2015 by Copernicus Healthcare • 315
pages • ISBN PB: 978-0-9887996-8-4 • $18.95
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