In Critical Condition, Pulitzer Prize winners Donald L. Barlett and James B. Steele attempt to delve into a topic that many Americans say is one of the top three issues in the country today. The subtitle of the book acts as a good summary on its own: “How health care in America became big business and bad medicine”.

The inside cover states that: “More than 100 million people with inadequate or no medical coverage…Dirty examination and operating rooms in doctor’s offices and hospitals…Health care executives pulling in millions in bonuses for denying treatment to the sick…This may sound like the predicament of a third world nation, but this is America’s health care reality today.”

The authors did a thorough job researching many different aspects of what is wrong or ailing in the American health care industry. The term health care industry is one aspect they spend quite some time on, with the opinion that health care should not be viewed as an industry.

The basic view of Barlett and Steele is that the “free market” has destroyed or ruined America’s health care and the attempt to run health care as an industry, similar to the auto or manufacturing industries, is one of the leading causes for the problems in America’s healthcare. They advocate for the Federal Government to provide a single payer health care system similar to Canada and other, as the authors state many times, civilized nations.

Placing this premise aside the authors do reveal many problems with the American approach to healthcare including: hospitals overcharging the uninsured and patients paying cash, insurance companies receiving discounted rates from hospitals, pharmaceutical companies advertising directly to the general public rather than to Dr.’s in private journals, rampant fraud, pharmaceutical and insurance company lobbyists influence in Washington politics, Doctors being disempowered by insurance companies, Big Pharm. Industry being too powerful for the FDA to effectively regulate etc…

Each issue or fault is given its own chapter with the following titles:

1. A Second-Rate System
2. Wall Street Medicine
3. Anatomy of a Systems Failure
4. The Labyrinth of Care
5. Madison Avenue Medicine
6. The Remedy
7. Epilogue: Medicine in the Media

In general the book serves as a good primer on the very important issue of Healthcare in America. However, the authors in their zeal to prove that “free market” economics has ruined health care failed to share what, if anything, is working well in the American approach to health care. They list some solutions or remedies as they call them; however, they only devote 12 pages to the remedies after using 227 pages to list the problems.

The main remedy the authors propose is, as previously mentioned, that the government should provide a single payer system, and this singular unbalanced focus, is one of the drawbacks of an otherwise good book. No mention is made of other possible solutions without completely socializing health care as so many other countries have. From the authors’ perspective, the single payer solution is the only solution, and that lack of openness to other sides of this issue is why the review is three stars out of five.

As an example of another solution, we could look at the Taoist approach to health, and how healthcare was delivered in two “golden age” dynasties in ancient China: the Han (206 BCE-220CE) & Tang (618 CE-907 CE) dynasties. The Taoist practitioner’s role, especially during these two dynasties, was/is to first and foremost prevent ailments of body, mind and spirit. The practitioner would charge a fee, or accept a donation for the classes/lessons and consultations on prevention; however, if the student became ill anytime during the lessons, the Taoist was obligated to treat the student for free.

This philosophical mandate, and others, served as a natural way to prevent many of the problems Barlett and Steele discuss in Critical Condition. There is an old Taoist proverb that would serve modern day physicians well: “the highest healer teaches people how not to get sick, the lowest level healer focuses on those who are already sick”.

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