The U.S. does not have a health system. Instead we have market for health-related goods and services, a market in which the few profit from the public’s ill-health. Health Care Revolt looks around the world for examples of health care systems that are effective and affordable, pictures such a system for the U.S., and creates a practical playbook for a political revolution in health care that will allow the nation to protect health while strengthening democracy. Dr. Fine writes with the wisdom of a clinician, the savvy of a state public health commissioner, the precision of a scholar, and the energy and commitment of a community organizer. “This is a revolutionary book. The author incites readers to embark on an audacious revolution to convert the American medical market into the American health care system.” —T.P. Gariepy, Stonehill College/CHOICE connect “Michael Fine is one of the true heroes of primary care over several decades.” —Dr. Doug Henley, CEO and executive vice president of the American Academy of Family Physicians “As Rhode Island’s director of health, Dr. Fine brought a vision of a humane, local, integrated health care system that focused as much on health as on disease and treatment.” —U.S. Senator Sheldon Whitehouse “Michael Fine has given us an extraordinary biopic on health care in America based on the authority of his forty-year career as writer, community organizer, family physician, and public health official.” —Fitzhugh Mullan, MD Michael Fine, MD, is a writer, community organizer, and family physician. He is the chief health strategist for the City of Central Falls, RI, and Senior Clinical and Population Health Services Officer for Blackstone Valley Community Health Care, Inc., and recipient of many awards and prizes for his pioneering work bringing together public health and primary medical care. He was director of the Rhode Island Department of Health, 2011–2015. Bernard Lown is professor emeritus of cardiology at the Harvard School of Public Health and the developer of the direct current defibrillator. As a peace activist he cofounded the International Physicians for the Prevention of Nuclear War, an organization that won the Nobel Peace Prize in 1985. He is the author of The Lost Art of Healing: Practicing Compassion in Medicine and Prescription for Survival: A Doctor’s Journey to End Nuclear Madness . Ariel Lown Lewiton is a writer and editor based in New York. Her essays, stories, and criticism have appeared in the Los Angeles Review of Books , the National , Vice , the Paris Review Daily , Tin House online, and elsewhere. She has an MFA from the University of Iowa’s Nonfiction Writing Program and is a contributing editor at Guernica magazine. Health Care Revolt How to Organize, Build a Health Care System, and Resuscitate Democracy — All at the Same Time By Michael Fine PM Press Copyright © 2018 Michael Fine All rights reserved. ISBN: 978-1-62963-581-1 Contents Acknowledgments, Foreword Bernard Lown, MD, and Ariel Lown Lewiton, Introduction We Are Missing the Point: We've Got a Market, Not a Health Care System, Chapter One What Are We Doing Wrong?, Chapter Two We Have a Market, Not a Health Care System, Chapter Three What Matters for Health, Chapter Four So What's Up with Obamacare? Did It Matter?, Chapter Five Embers and Sparks: A Tale of Two or Three Cities, a Couple of States, Two or Three Countries, and a Rural Place or Two, Chapter Six What Our Health Care System Could and Should Look Like If We Want This Democracy to Hold, Chapter Seven How Can We Get from Here to There? How to Create a Political Revolution in Health, Chapter Eight Why Clinicians Must Revolt, Chapter Nine Health Care and Democracy, Bibliography, About the Author, Index, CHAPTER 1 What Are We Doing Wrong? We spend $3.2 trillion per year on health care, twice as much as the average industrialized country, and three to four times as much as countries with the best public health in the world. But our public health outcomes that rank us no better than forty-third in the world. That's like picking up two dollars worth of eggs, getting charged four dollars at the checkout counter, and then getting home to find out half your eggs are broken. For $3.2 trillion a year, we should have the longest life expectancy in the world, but we are ranked thirteenth among the thirteen industrialized democracies and forty-third in the world. For $3.2 trillion a year, we should have the lowest infant mortality in the world, but we are ranked thirteenth among the thirteen industrialized democracies and thirty-seventh in the world. And for $3.2 trillion a year, we should have no measurable health disparities among population groups who differ only by skin color, language, or geography. In the little state of Rhode Island, which is only forty miles long and twenty miles wide, some population groups have infant mortality rates that are twice as high as others. Some places