How can we save primary care from collapse and improve health care outcomes? Primary care in the United States faces an existential crisis. Its value is unchallenged: policy experts argue that the primary care sector is critical to the quality and equity of the health care system. On the other hand, studies show that primary care is underfunded, providers are struggling with burnout, and an increasing number of patients lack access to this essential care. In Wonderful and Broken , Troyen A. Brennan offers a timely exploration into the precarious state of primary care in the American health system today. Drawing on years of field research and firsthand accounts from clinicians, this book paints a picture of both the current struggles and emerging solutions that define the primary care landscape. With health care costs rising and clinician burnout at an all-time high, Brennan examines whether value-based care can truly rescue primary care from the brink of collapse. At the heart of this book are the compelling stories of doctors, nurses, and care teams who are forging a new path, championing preventive care, and prioritizing patient relationships. From the efforts of government policies to the involvement of venture capitalists, the book unveils the multifaceted approaches being employed to shift health care from a fee-for-service model to one centered around value, quality outcomes, and equitable access. But will these efforts be enough? Brennan does not shy away from the hard questions, offering both a critique of past failures and hope for a more equitable future. Essential reading for policymakers, health care professionals, and anyone concerned about the future of American health care, Wonderful and Broken illuminates the pivotal role primary care must play in achieving sustainable and effective reform. Vivid, incisive, and urgent. This is essential reading on why American health care is failing―and how rebuilding primary care can fix it. ―Atul Gawande, MD, MPH, author of Being Mortal: Medicine and What Matters in the End Brennan's book is brilliant. He has full grasp of what makes primary care wonderful and how it is broken. He offers a clear and realistic vision of how primary care should evolve and even thrive―and the steps that key stakeholders should take to make that possible. ―Thomas H. Lee, MD, Chief Medical Officer, Press Ganey Brennan skillfully highlights the persistent tension between the well-established benefits of primary care―for both individuals and the broader health care system―and a system that too often hinders the realization of those benefits. He calls on us to move beyond these entrenched barriers and to build a health care system that truly places patients and primary care at its center. ―R. Shawn Martin, Executive Vice President/CEO, American Academy of Family Physicians Wonderful and Broken is a must-read for anyone who wants to understand why our health system is so dysfunctional and what can be done to fix it. With data and compelling storytelling, Brennan illustrates how we are only limited by our willingness to spend resources differently in order to reduce overall health care costs while extending lives and improving health. ―Russell S. Phillips, MD, Harvard Medical School Center for Primary Care Wonderful and Broken captures primary care's reality perfectly. As a practicing family physician, I recognize Dr. Brennan's descriptions all too well. I'm grateful for his nationwide exploration of primary care models, and I share his optimism that primary care can still be rediscovered to lift the US from the basement of health outcomes among developed nations. ―Robert L. Phillips Jr., MD, MSPH, American Board of Family Medicine Few, if any, health care experts can claim the enormous breadth of experience that Troy Brennan can. He tackles how to turn around our health care system with careful attention to the evidence, a scholar's sense of balance, and a commitment to honesty. An instant 'must read' for anyone who cares about finding our way to better health care. ―Donald Berwick, MD, MPP, Institute for Healthcare Improvement; praise for The Transformation of American Health Insurance Troyen Brennan is uniquely qualified to write a book explaining how American health care policy has evolved and where it might be going, having been at various times in his career a clinician and physician administrator, and an executive in health insurance, pharmacy benefit management, and retail pharmacy companies. You are sure to learn things about health policy you didn't know. This book has my strongest recommendation. ―Joseph P. Newhouse, Harvard University; praise for The Transformation of American Health Insurance Blending insights from a career in the top echelons of medicine, business, and academia, Brennan's book is a must-read, exposing how US health insurance has produced a bloated healthcare system and why Medicare for All is not a liberal pipedream but a lifeboat