How forty years of neoliberal policy choices created an American health care system that prioritizes profit over people.
How can a nation with unmatched wealth and medical innovation also have the highest health care costs and the poorest health outcomes among its peers? In America's Wrong Turn, John E. McDonough offers a compelling explanation for this troubling puzzle of contemporary US life and shows that this reality did not arise by accident.
Beginning in the later twentieth century, a powerful political and economic philosophy began to reshape the United States and continues to mold the institutions that govern health care, insurance coverage, and population health. Across four decades, the rise of neoliberal thinking elevated privatization, deregulation, and profit maximization as guiding principles for public policy. McDonough illustrates how these ideas influenced medical care at every level, altering government roles, accelerating consolidation, encouraging the financialization of once-mission-driven sectors, and shifting the US health system's priorities away from patients and communities. The consequences of these changes include deepening inequality, eroded public health capacity, and a growing burden of medical debt.
Synthesizing history, policy analysis, and the lived realities of the American health system, McDonough reveals how a national commitment to economic freedom above all else set the stage for today's dysfunctional health care system. Despite today's crises, he also highlights emerging efforts that signal the possibility of a new direction, one based on fairness, accountability, and the restoration of health as a public value. America's Wrong Turn offers a framework for understanding how the United States arrived at this moment and what it will take to create a system worthy of the people it serves.
Industry Reviews
"Not since Paul Starr's Social Transformation of American Medicine has a book provided such historically sweeping insight into US health care's political-economic foundations. Through the lens of the neoliberal revolution, McDonough offers a fresh perspective on the American health system's crises in costs, access, and population health."-Austin Frakt, Vice President and Chief Research Officer, Joint Commission
"Our health system combines private bureaucracy, profiteering and burdens on patients and clinicians alike. John McDonough's unique contribution is to explain how the application of neoliberal principles to a social good produced a toxic blend of inefficiency and injustice. America's Wrong Turn combines a passionate and well-researched call for reform with a deep explanation of how wrongheaded ideology created our health care crisis."-Robert Kuttner, Coeditor, The American Prospect
"For physicians, nurses, and patients navigating today's broken system, John McDonough's America's Wrong Turn is essential reading. He provides a lucid, thorough account of how neoliberalism shaped the US health care non-system-its forms, functions, and failures. Relentlessly knowledgeable and searingly direct, McDonough cuts through the smokescreens of the last forty years. It is a masterpiece of health policy."-Donald M. Berwick, President Emeritus, Institute for Healthcare Improvement, and former Administrator, Centers for Medicare and Medicaid Services
