A cutting indictment of US healthcare

This book takes a look at how the US healthcare system evolved to its present form.

Cover of ‘A spirit of charity’, by Mike King

Presented as the history of five large public hospitals in the United States, this book provides an interesting insight into the wider American healthcare system and the politics, events and ideologies that have shaped it from the late 19th century to the present day.

Author Mike King is an experienced journalist and pulls no punches in his description of the failings of the US$3 trillion healthcare operation in the United States. As medical ethicist Arthur Caplan explains in his foreword, King debunks two “moral myths” that fly in the face of the facts: one is that the United States has the best healthcare system in the world, and the other is that every American receives the same quality of care regardless of their wealth.

Through his stories of these major government-owned and operated urban hospitals that serve as the provider of last resort to the poor and uninsured (Grady Memorial Hospital in Atlanta, Parkland Memorial Hospital in Dallas, Jackson Memorial Hospital in Miami, the John H Stroger Hospital of Cook County, and Charity Hospital of New Orleans), King explains why US healthcare funding is so complicated and why there is such disparity of access and variability in quality. He also highlights interesting aspects of the system, such as the importance of public hospitals as training grounds for the nation’s medics, why they are centres of excellence for trauma care, and the crisis in mental healthcare for the poor.

How the American approach to health as an earnt privilege, the history of racial segregation, and constant wrangling between federal and state, and Republican and Democrat, politicians have shaped healthcare provision is fascinating. But these themes are so frequently repeated that, by about halfway through the book, any element of surprise is long gone.

This book can be rather dry, and although a few case studies add a little colour, more quotes or interviews would have introduced other voices and interest. A six-page section contains pictures of the hospitals and a few historical photographs, while one diagram illustrates the proportion of uninsured individuals across the states. But that is it in terms of illustrations.

Steve Bremer


‘A spirit of charity’, by Mike King. Pp 345. Price £20. Maryland: Secant Publishing: 2016. ISBN 978 1 944962 06 7

Last updated
The Pharmaceutical Journal, PJ, November 2016, Vol 297, No 7895;297(7895):DOI:10.1211/PJ.2016.20201835

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