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Book and Media Reviews
October 22 2008

Without Your Consent: The Hijacking of American Health Care

JAMA. 2008;300(16):1943-1950. doi:10.1001/jama.2008.520

Dissatisfaction with the US health care system is running high in many quarters. A 2006 study found that 23% of surveyed US primary care physicians were very or somewhat dissatisfied with their overall experience with medical practice, with significantly higher rates of dissatisfaction regarding time spent per patient and income from medical practice.1 That same year, a patient survey revealed that 59% of those polled rated the US health system as “fair” or “poor,” and half of adults were “not too” or “not at all” satisfied with their health care costs.2 Health care proposals by presidential candidates from the Republican and Democratic parties differ widely in some respects, but all agree that costs are a central problem. Existing cost-control strategies, however, are a source of concern for physicians and other clinicians. One of the most consistently proposed cost-saving measures is cutting clinician payment rates. The Bush administration's latest proposed budget included steep Medicare payment cuts, and the formula that determines the payment update factor for the Medicare physician fee schedule will result in negative updates unless amended. Constant cost pressures add to the already high job demands of physicians. In Without Your Consent: The Hijacking of American Health Care, Michael Newton raises the alarm that these concerns are “hijacking” US health care.