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More than Medicine

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More than Medicine

The Broken Promise of American Health

Harvard UP,

15 min read
10 take-aways
Audio & text

What's inside?

How the US can go from spending the most on health care (and getting the least) to spending less (and getting more).

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This slim, apolitical and important volume reads like a manifesto. Renowned medical scientist Robert M. Kaplan challenges leaders to make the United States’ health care system average. By the most important measures of health – life expectancy and quality of life – the US badly lags its peers and slides further behind each year. Kaplan prescribes dramatic changes in health care policy without a bigger budget. He argues for reallocation of the current budget, which today focuses on cures, technologies, procedures and medical “moonshots.” Kaplan pleads for a more commonsense, balanced approach – namely, an immediate increase in funds allocating 10% of the US budget to the societal, behavioral and environmental drivers of health. This would permit a more comprehensive, whole-person approach to wellness and health instead of fixing people after they break. This is an important read for policy makers and legislators as well as health care professionals and providers.


Americans spend far more on health care than people in other rich countries, yet receive much less.

The United States’ expenditure on health care greatly exceeds all other rich nations. The US ranks last or close to it among wealthy nations on the pivotal measures of infant mortality, life expectancy, survival to age 50 and life expectancy after 50. It would take more than a decade of effort and radical change to get the US health care system to match even the average quality of systems in other developed nations.

Even those with access to the best US health care gain little advantage over those in other rich nations. The US overemphasis on medicines and cures, combined with inattention to social, behavior-related and preventive health care factors, exact enormous costs but return comparatively little. This overemphasis denies Americans the quality of care in “Canada, Australia, Western Europe” and elsewhere at far lower costs.  

Policy makers should reconsider the system’s focus on cures, new treatments and technologies.

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About the Author

Robert M. Kaplan is director of research at the Stanford School of Medicine Clinical Excellence Research Center. He was president of the American Psychological Association Division of Health Psychology.

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