The medical profession and healthcare in the United States are in trouble. Healthcare is unaffordable for a growing part of the population, 46 million Americans are uninsured, tens of millions are underinsured, quality of care is unpredictable, and these problems are getting worse, not better. All incremental attempts at reform have been ineffective, and the nation is confronting a crisis in healthcare costs, access, quality, and equity.

John Geyman, MD, a renowned expert in primary care and health policy, traces over the last forty years the sea change in US healthcare, which has engulfed the profession in a marketplace now controlled by corporate and business interests. The profession’s long history of service-based ethics and its social contract have been called into question as the business ethic of bottom-line profits has spread throughout the system. The deregulated healthcare marketplace, now one-sixth of the nation’s economy, has had damaging impacts on health of the public as well as the profession itself.

In Part I of the book, Geyman shows how medicine arose as a moral enterprise. Part II details the invasion of the business ethic, and in Part III, Geyman dissects the conflicts of interest medicine has with business, showing how patients get sold short. In the final section, Geyman shows that major reform is inevitable, and provides a roadmap for how professionals and laypeople together must renew medicine’s social contract and reclaim its moral legacy.

John Geyman, MD, the author of Falling Through the Safety Net: Americans Without Health Insurance, is a family physician. He is most recently the author of Shredding the Social Contract: The Privatization of Medicare. He lives outside of Seattle, Washington.