America’s Health Care System Is Overdue for a Check-Up:

My Review of Donald L. Barlett and James B. Steele’s Book Critical Condition: How Health Care in America Became Big Business – and Bad Medicine

Mason McIlnay was a kindergartner living in Salem, Oregon.  Leg aches began to plague him, and doctors soon discovered he had a serious childhood cancer called neuroblastoma.   Mason was very sick, and nothing saddens the heart more than hearing about a sick child.  He needed immediate treatment.  Unfortunately, Mason’s family falls among the masses of 43 million uninsured Americans, an estimate agreed upon by experts. 

Mason’s mother held the mother-of-all garage sales with the hopes of bringing in enough money to pay the tens of thousands of dollars they owed for his treatments.  She made enough profit to put a dent in the mountain of debt she had been carrying, but not enough to lift the entire weight off her tired shoulders. She must continue to make huge payments for years to come.  The McIlnay’s story is one of many heart-breaking stories found in Donald L. Barlett and James B. Steele’s latest book, Critical Condition: How Health Care in America Became Big Business – and Bad Medicine (Doubleday, 2004, 304 pgs.)   Barlett and Steele’s in-your-face accounts of despair force readers to consider how this supposedly great country could abandon so many needy and sick Americans.

Critical Condition is a reproachful analysis of America’s health care system and the damaging attempt to improve health care in America by using a market-based approach.  Barlett and Steele write, “What does it say about the richest country on earth that its citizens must depend on raffles and spaghetti dinners to pay the medical bills – a situation that exists in no other civilized country?”(12).  Critical Condition goes on to explain, America’s health care costs more than any other country’s: 15 percent of gross domestic product in 2003.  Yet, when comparing lifespan in terms of years of healthy living, Americans rank 29th among nations – between Slovenia and Portugal. “In sum, Americans pay for a Hummer but get a Ford Escort,” writes Barlett and Steele (13).  Sadly, the authors do not get around to offering a solution until the last fifteen pages of the book.   This latest collaboration by the authors demonstrates how America’s health care is failing miserably, but without much attention given to possible solutions, readers are left feeling hopeless.

Aptly included in the title, Critical Condition: How Health Care in America Became Big Business – and Bad Medicine, are the words “big business and bad medicine” – an unfortunate combination for American citizens.  In Critical Condition, Barlett and Steele explain that corporate decisions at a marketing company, for example, “may have economic consequences affecting the paychecks, dividends, or stock options of workers, executives and investors.”  However, “the same decisions in a health care company are matters of life and death” (154).  The book’s title effectively echoes this belief.

This bleak examination of America’s health care is the seventh book by the Pulitzer prize-winning investigative team.  These men have been working together for over thirty years: first at the Philadelphia Inquirer, then at Time magazine, and now at Vanity Fair (“About the Authors”).  They are the authors of the 1992 book America: What Went Wrong, an analysis of the apparent trend toward a middle class decline, which spent eight months on the New York Times bestseller list.  Describing Barlett and Steele’s approach in America: What Went Wrong, Remesh Ponnuru commented in the conservative National Review that the authors prefer “to tell economic history as a morality play, with venal politicians and greedy, short-sighted CEOs ganging up on working stiffs.”   Story-telling is an effective method of selling an idea, and seems to be a favored approach of the authors in many of their works.  Working together for so many years has obviously refined their teamwork and deepened their investigative ability.  

Without fail, Barlett and Steele provide gripping evidence of the truly critical condition of our health care system.   Barlett and Steele state, “Nearly one of every three dollars now spent on health care goes for administration” (170).  The book explains that American consumers pay more for fewer benefits while contending with a lack of choice in providers and prices.  Frustrated patients and physicians are dealing with billing chaos and confusion caused by the excessive number of health plans.  To increase profit, providers overcharge the uninsured and limit hospital stays with overly restrictive guidelines.  Pressured hospitals dangerously cut costs by cutting number of staff and supplies and reducing sterilization.  Undertrained and overworked nurses make frightening mistakes.  The media contributes to the problem as well, Barlett and Steel suggest, by urging people to undergo countless unnecessary tests and causing an overuse of the system, which drives up prices.  Pharmaceutical giants push off-label prescriptions (untested combinations of tested drugs like the infamous fenphen) and the FDA has suspiciously slow response times to side-affect concerns.  HMO and hospital chain CEO’s seem to care more about the bottom line and their own lavish lifestyles than they do about the lives of their fellow American citizens.  And all this madness is because, Barlett and Steele propose, in the end anyone who has any power in this crazy system ultimately chooses their pocketbook over morality.  “At best it’s a costly and wasteful system that siphons off precious health care dollars.  At worst, it causes injury and death” (159).  Page after page, chapter after chapter, the authors give shocking examples of the system’s complete failure.

  The authority with which Barlett and Steele present their case against a market approach to care comes from the depth to which they have researched this topic.  Critical Condition is full of facts and studies with seven pages of sources at the end.  Marie D. Jones writes in her review of the book for, “All of the shocking information in this tragic, but utterly critical book points to one thing.  We are on the verge of a major disaster here in the United States, a disaster that will cripple our economy and leave millions ill and without proper care.”  The plethora of facts is almost dizzying, and because so little conflicting evidence is presented, the many facts sway readers that what is being read is God’s truth.

Barlett and Steele provide plenty of true stories that demonstrate their view of the health care crisis, which goes a long way toward helping readers relate and perhaps even moving some to compassion.  For example, they share the story of Jack and Donna Brown.  Donna, a waitress, was uninsured but needed colon surgery.  Her hospital bill was a whopping $57,000 that she just could not pay.  The hospital sued, forcing the couple into bankruptcy.  Jack told a confidant, “We tried paying our medical bills… I worked very hard.  We lost a home because of this lawsuit” (22).  A very desperate situation indeed, and disturbing enough to show Barlett and Steele’s point that greedy hospitals care more about profit than actually helping patients.  The authors typically follow horrific stories such as this with carefully chosen supporting evidence of the problem at hand. 

  Critical Condition is written for not only politicians and physicians (though they should absolutely read it) but for average American health care consumers.  Their writing style is easy for those average citizens to understand and achieves the authors’ desired response: won over by the authors’ persuasiveness, rallied proponents are ready for change – although readers may not realize they have not been given all the information they need.  In conservative leaning Newsweek magazine, Robert J. Samuelson states that Barlett and Steele tend to “report matters so selectively – with so little attention to conflicting evidence or any larger context – that ordinary readers are misled.”  Surely the authors are not trying to mislead, but the selective nature with which they offer information fails to fully equip readers, like Marie D. Jones, who are attempting to shape informed opinions.

After taking in all this information, readers will be ready to hear a suggestion for change. Barlett and Steele advise a single payer system (read: universal health care coverage) to correct all of this.  Readers may find that this book pushes them to elect leaders who have health care reform as a top priority.  Reading Critical Condition will cause one to believe that conservatives and other opponents to universalized care simply do not realize that adopting universal coverage would not be a radical move for America: “We already have universal health care for everybody aged sixty-five and over: It’s called Medicare” (138).   According to the authors, universal coverage would not mean communist medicine either; rather it would bring American citizens up to par with the other industrial countries and their dedication to providing good health to all people.  Jocelyn Chao said it well, albeit through sarcasm, in her editorial on universal health care for The Onion, “What will they tell us next – that everyone deserves a free public education and the ‘right’ to a fair trial?”  Americans who believe all people are created equal may conclude that providing universal coverage to all is a very worthwhile goal for America. 

Barlett and Steele’s proposal in Critical Condition for universal health care coverage may sound appealing, but because it lacks needed details, the recommended plan seems intangible.  The short 15-page final chapter devoted to the authors’ solution, titled “Remedy,” falls short of expectations.  Bruce P. Hurter M.D. writes for Psychiatric Services, “Critical Condition is particularly strong in its presentation and documentation of the ‘costs’ of modern medicine,” but it “less clearly presents a framework for remedy” (Hurter).  Barlett and Steele mention other countries that benefit from single-payer systems, and an overview of how Canada, Sweden or Japan runs their health care programs could have provided some needed clarity.  A chapter devoted to examining a working universal health care system could have painted a picture for readers of how it might also work for America.  Had they included more support to their claims, Barlett and Steele could have pushed readers from thinking, “Hmm… sounds interesting,” to crying out, “What are we waiting for?”

Despite a weak close, Barlett and Steele have done an outstanding job at presenting their case against America’s Health Care system.  Critical Condition: How Health Care in America Became Big Business – and Bad Medicine thoroughly convinces readers of the grave shortcomings of the current system.  In the end, Critical Condition is a book full of frightening health care horror stories with no happy ending in sight.  Sweet Dreams.

Works Cited

“About the Authors.”  20 Feb. 2008.  <;.

Barlett, Donald L., and James B. Steele. Critical Condition: How Health Care in America Became Big Business – and Bad Medicine.  New York: Doubleday, 2004.

Chao, Jocelyn.  “I Don’t Want Health Care If Just Anyone Can Have It.”  The Onion  7 Mar. 2007.  10 Mar. 2008. <


Hurter, Bruce P.  Rev. of  Critical Condition: How Health Care in America Became Big Business – and Bad Medicine by Donald L. Barlett and James B. Steele. Psychiatric Services 57.2.  Feb. 2006: 8 pars.  20 Feb. 2008. <;.

Jones, Marie D.  Rev. of Critical Condition: How Health Care in America Became Big Business – and Bad Medicine by Donald L. Barlett and James B. Steele.  20 Feb. 2008.  <;.

Ponnuru, Ramesh. “Time’s Terrible Two: The perils of Barlett and Steele.”  National Review  17 Jul. 2000.  11 Mar. 2008.  <


Samuelson, Robert J.  “Confederacy of Dunces: Why the National Press So Often Gets the Story On The Economy All Wrong.”  Newsweek  24 Jan. 2008.  11 Mar 2008. <;.


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