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Medical Writings |7 October 2008

Without Your Consent: The Hijacking of American Health Care

Michael K. Gusmano, PhD

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Author, Article, and Disclosure Information
  • From State University of New York, Downstate Medical Center, Brooklyn, New York.

Structured abstracts of information on newly published books, computer programs, selected Web sites, and other material are provided in this portion of Medical Writings.
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Structured abstracts of information on newly published books, computer programs, selected Web sites, and other material are provided in this portion of Medical Writings.
Newton MJ. 272 pages. New Canaan, CT: Paribus Publishing; 2007. $24.99. ISBN 1933705086. Order at www.withoutyourconsent.com.
Field of medicine: Medical ethics.
Format: Hardcover book.
Audience: Medical professionals, policymakers, and academics with an interest in health policy, medical ethics, or medical sociology.
Purpose: To illustrate how the failure of the United States to confront health care costs openly leads to loss of autonomy by both physicians and patients.
Content: The first section presents a diagnosis of the problem. The next sections explain why efforts to control costs by hospitals, managed care organizations, and the government undermine physician and patient autonomy and discuss the need for trust in the physician–patient relationship. The final section articulates the author's concerns about the deprofessionalization of medicine and his hopes for the future.
Highlights: Critics of the U.S. health care system argue that U.S. physicians enjoy less clinical autonomy than physicians in many other countries because the United States does not have a budget mechanism to control health spending. Without an institutional mechanism for controlling aggregate spending, third-party payers attempt to limit spending by denying payment for “unnecessary” procedures, denying coverage for poor risks, or using various techniques to pass costs along to physicians and patients. The book provides a powerful firsthand account of how these efforts limit the ability of physicians to act as fiduciary agents for their patients. The...
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Gusmano MK. Without Your Consent: The Hijacking of American Health Care. Ann Intern Med. 2008;149:520. doi: https://doi.org/10.7326/0003-4819-149-7-200810070-00026

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Published: Ann Intern Med. 2008;149(7):520.

DOI: 10.7326/0003-4819-149-7-200810070-00026

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2008 American College of Physicians
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704

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