America's Wrong Turn: Us Health Care in the Neoliberal Era

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.

John E. McDonough is a professor of practice in the Department of Health Policy and Management at the Harvard T.H. Chan School of Public Health. He is the author of Inside National Health Reform and Experiencing Politics: A Legislator's Stories of Government and Health Care.