A review of all of the problems with Maynard’s s review would require more ink than the original, so I will confine my comments to clarifying what Herzlinger actually advocates. As in all other areas of society, she sees progress coming from the bottom up, not the top down, with empowered consumers and entrepreneurial providers creating profitable arrangements, structures, and institutions that will improve quality and convenience while decreasing actual prices and costs. (Costs are larger than just the dollar price, as any person who has waited for, or simply been denied, care because of budget constraints in socialized medical systems knows.)

Progress has been slower than Herzlinger originally expected when she wrote Market-Driven Health Care in 1997, largely because of the efforts of established interests, both those that profit from delivering the status quo (such as hospitals that go to the government to block competition) and academics and policy mavens who earn their keep by providing justification for centralized systems. This book, like her others, makes bold claims, moves swiftly, and offers solutions to reform U.S. health care.

Although I do not support individual mandates, the book and author deserved better treatment. Such treatment could have started by assigning the review to someone who understands U.S. health care, not just the European view of it.

Sally C. Pipes
Pacific Research Institute, San Francisco, California