October 3, 1977

Doing Better and Feeling Worse: Health in the United States

Author Affiliations

Case Western Reserve University School of Medicine Cleveland


by John H. Knowles, 278 pp, $9.95, paper $3.95, New York, Norton, 1977.

JAMA. 1977;238(14):1569. doi:10.1001/jama.1977.03280150139054

The product of a Nelson Rockefeller think tank known as The Commission on Critical Choices for Americans, this book samples the opinions of the Eastern medical establishment on the problems of our health care system. Of the 20 authors, all but three work in Boston, New York, or Washington, four have appointments at Harvard, and three are officials of major philanthropic foundations based in New York.

In general, the contributors are exceptionally well informed, and they write interestingly and often authoritatively. Points on which most of the contributors agree are the following: (1) Despite some notable problems having to do with cost, lack of coordination, and social injustice, American medicine is doing well, both for itself and for the public. (2) Some changes can be made, using incentives rather than penalties, without abandoning pluralism or going so far as total government medicine. (3) We probably cannot dispense with "half-way" technology