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In Excellent Health: Setting the Record Straight on America's Health Care (Hoover Institution Press Publication (Hardcover))
In Excellent Health offers an alternative view of the much maligned state of health care in America, using facts and peer-reviewed data to challenge the statistics often cited as evidence that medical care in the United States is substandard and poor in value relative to that of other countries. The author proposes a complete plan for reform in three critical areas of the health care puzzle—tax structure, private insurance markets, and government health insurance programs—designed to maintain choice and access to excellence and facilitate competition.
360 pages, Hardcover
First published December 1, 2011
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Displaying 1 - 6 of 6 reviews
August 4, 2017
This book brings to healthcare economics the fundamental viewpoint which has proven so successful in clinical medicine: evidence-based analysis. The author, Dr. Scott Atlas, cites a plethora of clinical studies to show that the health outcomes of medical care in the US are generally superior to those of other developed countries with single-payer healthcare systems. Dr. Atlas explains why life expectancy and infant mortality are poor metrics for judging healthcare, because they are so dependent on factors quite separate from the healthcare system. The book is slightly dated, having been written as the (ironically named) Patient Protection and Affordable Care Act was first being implemented. Even that, however, has an advantageous aspect, because it allows the reader to see how Dr. Atlas' predictions comport with the reality we now are witnessing of Obamacare's implosion. The book is not exciting; data-heavy analysis seldom is. However it is a valuable source of information for anyone who wants to understand American healthcare and health insurance at a level more than that of slogans and demonizing.
November 10, 2025
I was reminded of this book by its author being in the headlines in a major way this year. Scott Atlas recently joined the Trump Administration as the President's top pandemic advisor. Despite having no training or academic qualifications in epidemiology or public health, the Atlas White House is implementing a "masks don't work," "herd mentality" strategy that actual infectious disease scientists believe will unnecessarily kill, hospitalize, and cause permanent heart and lung damage to millions of Americans. I originally gave this book a high rating because the arguments appeared to be entirely empirical, data-based and rooted in citations to medical journals. Now that I am aware that this author is a partisan quack, due to his zeal for misinformation that confirms his prejudices instead of an objective analysis, every claim he makes in this book unfortunately has to be taken with skepticism.*
This book made a big impression on me in college, partly because I read it shortly after my final exam in Introductory Statistics. The impact of confounding variables is a vastly overlooked component of public policy. When comparing one healthcare system to another, the most important variable to track when measuring policy effectiveness is the state of the population being cared for. To use an analogy, when we compare Lebron James to Michael Jordan in the "greatest of all time" discussion, people point to the Jordan having twice as many championships as Lebron as an argument for why he is a better player. However, basketball is a team sport, and Lebron had limited control over the roster of teammates he had to work with. We should only evaluate Lebron by his individual statistical performance**, not whether he was fortunate enough to be on a team with a front office that could consistently sign & trade for exceptional teammates.
Similarly, the crux of this book is a crucial distinction between health care (i.e. the overall health of the population being treated), as opposed to medical care (the effectiveness of doctors, hospitals, pharmacies and insurance companies at remedying health problems). Most advocates for healthcare reforms that supplant the private sector with increased government-provided care (such as a Public Option or "Medicare for All") believe that American healthcare system is extremely expensive while being inferior to care in other developed nations. A key talking point at the time this book was written was from the Michael Moore documentary Sicko, which pointed to America's low life expectancy and relatively high infant mortality rate in comparison to other nations.
Scott Atlas points to the confounding variables in the population that doctors have no control over (such as higher rates of obesity, gun violence, drug abuse, and car accidents) as explaining the discrepancy between Americans and Europeans. When he runs a statistical regression that isolates the medical care that doctors have control over, Americans have the highest life expectancy and lowest infant mortality rates in the world. Atlas also brings to bear the extensive evidence of American superiority in patient access to the best surgeons and medical care technology in the world, particularly for cardiology and oncology.
American healthcare is also not as expensive as commonly perceived when we adjust for per-capita GDP: Americans buy more healthcare in part because we are richer on average than people in other countries. When we also factor in the extensive waiting lists that socialized systems use to ration medical care, and the pain and suffering this causes to patients, America's medical care is not so expensive after all, and perhaps drastic measures are unwarranted.
Europeans are healthier in spite of their inferior medical care systems, whereas American medical providers are the best in the world in spite of the overweight, risk-loving, and violent patient population they are tasked with treating. I'm sure Scott Atlas is making similar points in his analysis of America's reponse to Covid-19: America's medical care providers are the best in the world at rescuing Americans who are infected with Covid, despite having a patient population with significantly higher rates of the preexisting conditions (and noncompliance with social distancing guidelines) that can make Covid a lethal proposition.
While this book is vital for appreciating the advantages of America's system of mostly-privatized medical care, Mr. Atlas is not the end-all-be-all on the topic. He and other free-market advocates acknowledge the need for reforms, and his praise needs to be tempered by the very-real price gouging, fraud, and lack of transparency that are endemic to the corporatist status quo. However, this book is a bracing corrective to biased perceptions about the ability of a competitive private sector to care for the sick and injured. - September 2020
*(I always regret such instances, where a book makes compelling contrarian claims, but it is not widely-read enough where other experts will publish rebuttals or alternate takes for my consideration. The closest thing I found in this case is this long-form podcast interview with Mr. Atlas about the book.)
** ...which surpasses Jordan's... Lebron James is the GOAT... so I guess Atlas is arguing that America is the Lebron James of healthcare once we factor out the Jerry Krause variable
This book made a big impression on me in college, partly because I read it shortly after my final exam in Introductory Statistics. The impact of confounding variables is a vastly overlooked component of public policy. When comparing one healthcare system to another, the most important variable to track when measuring policy effectiveness is the state of the population being cared for. To use an analogy, when we compare Lebron James to Michael Jordan in the "greatest of all time" discussion, people point to the Jordan having twice as many championships as Lebron as an argument for why he is a better player. However, basketball is a team sport, and Lebron had limited control over the roster of teammates he had to work with. We should only evaluate Lebron by his individual statistical performance**, not whether he was fortunate enough to be on a team with a front office that could consistently sign & trade for exceptional teammates.
Similarly, the crux of this book is a crucial distinction between health care (i.e. the overall health of the population being treated), as opposed to medical care (the effectiveness of doctors, hospitals, pharmacies and insurance companies at remedying health problems). Most advocates for healthcare reforms that supplant the private sector with increased government-provided care (such as a Public Option or "Medicare for All") believe that American healthcare system is extremely expensive while being inferior to care in other developed nations. A key talking point at the time this book was written was from the Michael Moore documentary Sicko, which pointed to America's low life expectancy and relatively high infant mortality rate in comparison to other nations.
Scott Atlas points to the confounding variables in the population that doctors have no control over (such as higher rates of obesity, gun violence, drug abuse, and car accidents) as explaining the discrepancy between Americans and Europeans. When he runs a statistical regression that isolates the medical care that doctors have control over, Americans have the highest life expectancy and lowest infant mortality rates in the world. Atlas also brings to bear the extensive evidence of American superiority in patient access to the best surgeons and medical care technology in the world, particularly for cardiology and oncology.
American healthcare is also not as expensive as commonly perceived when we adjust for per-capita GDP: Americans buy more healthcare in part because we are richer on average than people in other countries. When we also factor in the extensive waiting lists that socialized systems use to ration medical care, and the pain and suffering this causes to patients, America's medical care is not so expensive after all, and perhaps drastic measures are unwarranted.
Europeans are healthier in spite of their inferior medical care systems, whereas American medical providers are the best in the world in spite of the overweight, risk-loving, and violent patient population they are tasked with treating. I'm sure Scott Atlas is making similar points in his analysis of America's reponse to Covid-19: America's medical care providers are the best in the world at rescuing Americans who are infected with Covid, despite having a patient population with significantly higher rates of the preexisting conditions (and noncompliance with social distancing guidelines) that can make Covid a lethal proposition.
While this book is vital for appreciating the advantages of America's system of mostly-privatized medical care, Mr. Atlas is not the end-all-be-all on the topic. He and other free-market advocates acknowledge the need for reforms, and his praise needs to be tempered by the very-real price gouging, fraud, and lack of transparency that are endemic to the corporatist status quo. However, this book is a bracing corrective to biased perceptions about the ability of a competitive private sector to care for the sick and injured. - September 2020
*(I always regret such instances, where a book makes compelling contrarian claims, but it is not widely-read enough where other experts will publish rebuttals or alternate takes for my consideration. The closest thing I found in this case is this long-form podcast interview with Mr. Atlas about the book.)
** ...which surpasses Jordan's... Lebron James is the GOAT... so I guess Atlas is arguing that America is the Lebron James of healthcare once we factor out the Jerry Krause variable
May 15, 2022
Availability of state-of-the-art medical technology, timely access to specialists, the most effective screening, the shortest wait times for life-changing surgeries, the newest, most effective drugs for more accurate, safer diagnosis and for the most advanced treatment are all superior in the United States. These statements are facts, facts based on data about all Americans as a population rather than selected groups, facts demonstrated in the peer-reviewed medical and scientific literature.
I purchased Scott Atas' In Excellent Health (IEH) to gain some familiarity with and knowledge of something I admittedly know very little about but feel like every adult in America needs to at least be conversant in: healthcare. I wasn't disappointed.
Although I was confused by some of the publication details on the Amazon page, thinking this book was released in 2020 (in actuality, it was published in 2010), it was still incredibly informative and eye-opening.
The subtitle, 'Setting the Record Straight on America's Health Care', may give some indication about the objective of the book. In essence, it's an attempt to refute some common misconceptions about American healthcare and, well, 'set the record straight' as to what the realities of the situation actually are.
At the time of writing, Obamacare was a hot topic, and so IEH was meant to counter some of the popular misinformation circulating about America's healthcare faults. Most importantly, it was being (and still is being) said in many places that America is ranked among the worst in such areas as infant mortality and life expectancy. The first few chapters of IEH are dedicated to showing why the popular studies suggesting these abysmal rankings are actually severely flawed in their sources and methods, as well as showing from more reliable studies that these metrics of health are incredibly complicated to measure and compare between different countries.
The middle chapters of the book tackle the question about just how good American healthcare actually is, looking at its performance in areas such as specific disease treatment, technological and pharmacological advancements, access to treat, etc. In every arena, America is either superior or among the best when considered against other western countries.
The final chapter is more focused on Atlas' specific suggestions for how to improve America's already excellent system, in contradistinction to the (then-new) Obamacare policies. Atlas' approach is to reduce, rather than increase, the government's involvement in healthcare, wanting to expose the industry to more free market forces instead.
Overall, I thought IEH was excellent (no pun intended) in many regards.
Even the author admits it's a very dry read--it's difficult to make healthcare a riveting topic. IEH is essentially a compilation of tons and tons of studies, and I expected that going into it. In spite of that, I actually found it really enjoyable, simply because I wanted to learn about the topic so badly. Not all of my questions were answered, but I can't imagine this being a bad place to start. It's chock full of endnotes citing the studies used and other books for further reading.
I suppose someone may look at the author's personal political leanings and think he's cooked or cherry-picked the data to skew the results in his favor for whatever reason. Those who think that way are more than welcome to dive into the sea of references in the Notes section and vivisect Atlas' conclusions. I don't want to blindly believe just anybody, but the author's credentials don't immediately strike me as someone who would be an outright liar or charlatan. At the very least, IEH provides an excellent argument for one potential side of the issues discussed, one that is well-sourced and -argued. As I continue to look into this subject more, I at least have a decent place to measure opposing arguments from.
Perhaps the most significant mark against IEH is the final chapter. All the rest of the information is fairly easy to understand for the layman with just a little familiarity with statistics and medical terminology (and I'm no expert in either). But the last chapter gets into the weeds pretty quickly on healthcare policy, governmental and political jargon, and time-relative information. By this last phrase, I mean that (at the time of writing this review) it's been over a decade (12 years) since the political events being referenced. This isn't really a bad thing, but I think it hinders the usefulness of IEH in that it ties it down a little to the period in which it was written. Of course, the rest of the information is also at LEAST 12 years old, but the general studies and findings about healthcare trends around the world previously cited at least give some more timeless insights, even if more recent data could be found. I just thought getting tangled up in the specific politics of the Obama era in the last chapter reduced IEH's recommendability a little.
In the end, IEH is a book I WOULD recommend, with that last caveat in mind.
I purchased Scott Atas' In Excellent Health (IEH) to gain some familiarity with and knowledge of something I admittedly know very little about but feel like every adult in America needs to at least be conversant in: healthcare. I wasn't disappointed.
Although I was confused by some of the publication details on the Amazon page, thinking this book was released in 2020 (in actuality, it was published in 2010), it was still incredibly informative and eye-opening.
The subtitle, 'Setting the Record Straight on America's Health Care', may give some indication about the objective of the book. In essence, it's an attempt to refute some common misconceptions about American healthcare and, well, 'set the record straight' as to what the realities of the situation actually are.
At the time of writing, Obamacare was a hot topic, and so IEH was meant to counter some of the popular misinformation circulating about America's healthcare faults. Most importantly, it was being (and still is being) said in many places that America is ranked among the worst in such areas as infant mortality and life expectancy. The first few chapters of IEH are dedicated to showing why the popular studies suggesting these abysmal rankings are actually severely flawed in their sources and methods, as well as showing from more reliable studies that these metrics of health are incredibly complicated to measure and compare between different countries.
The middle chapters of the book tackle the question about just how good American healthcare actually is, looking at its performance in areas such as specific disease treatment, technological and pharmacological advancements, access to treat, etc. In every arena, America is either superior or among the best when considered against other western countries.
The final chapter is more focused on Atlas' specific suggestions for how to improve America's already excellent system, in contradistinction to the (then-new) Obamacare policies. Atlas' approach is to reduce, rather than increase, the government's involvement in healthcare, wanting to expose the industry to more free market forces instead.
Overall, I thought IEH was excellent (no pun intended) in many regards.
Even the author admits it's a very dry read--it's difficult to make healthcare a riveting topic. IEH is essentially a compilation of tons and tons of studies, and I expected that going into it. In spite of that, I actually found it really enjoyable, simply because I wanted to learn about the topic so badly. Not all of my questions were answered, but I can't imagine this being a bad place to start. It's chock full of endnotes citing the studies used and other books for further reading.
I suppose someone may look at the author's personal political leanings and think he's cooked or cherry-picked the data to skew the results in his favor for whatever reason. Those who think that way are more than welcome to dive into the sea of references in the Notes section and vivisect Atlas' conclusions. I don't want to blindly believe just anybody, but the author's credentials don't immediately strike me as someone who would be an outright liar or charlatan. At the very least, IEH provides an excellent argument for one potential side of the issues discussed, one that is well-sourced and -argued. As I continue to look into this subject more, I at least have a decent place to measure opposing arguments from.
Perhaps the most significant mark against IEH is the final chapter. All the rest of the information is fairly easy to understand for the layman with just a little familiarity with statistics and medical terminology (and I'm no expert in either). But the last chapter gets into the weeds pretty quickly on healthcare policy, governmental and political jargon, and time-relative information. By this last phrase, I mean that (at the time of writing this review) it's been over a decade (12 years) since the political events being referenced. This isn't really a bad thing, but I think it hinders the usefulness of IEH in that it ties it down a little to the period in which it was written. Of course, the rest of the information is also at LEAST 12 years old, but the general studies and findings about healthcare trends around the world previously cited at least give some more timeless insights, even if more recent data could be found. I just thought getting tangled up in the specific politics of the Obama era in the last chapter reduced IEH's recommendability a little.
In the end, IEH is a book I WOULD recommend, with that last caveat in mind.
June 20, 2013
I think this is an excellent book full of useful (and well-footnoted) information that belies a lot of the impressions of the US health care system overall that we are given in medical school or in newspapers. The tendentious tone is a little frustrating, and he often beats a dead horse with some arguments while covering other issues in just a couple of paragraphs, but definitely worth reading. I'm surprised there were fewer critical reviews in major papers / magazines.
May 12, 2012
This is a great exposé on the misperceptions about US healthcare due to the way WHO and other health organizations deal with the healthcare issue
September 5, 2018
Brilliant! Extremely well researched, and completely tears away at the lies we are being continually fed about the US health care system.
Displaying 1 - 6 of 6 reviews