Understanding Health Policy: A Clinical Approach. Third edition. By Thomas S. Bodenheimer and Kevin Grumbach. 222 pp. New York, Lange Medical, McGraw-Hill, 2002. $34.95 (paper). ISBN 0–07-137815–4.

The latest edition of Bodenheimer and Grumbach’s fine textbook on health policy is as refreshing and valuable as the original volume published in 1998. Although its stated goal has become even more daunting—to explain how the American health care system works—the book’s performance continues to be exceedingly commendable. The third edition has been updated to include discussions of quality of care, the demise of managed care, and an accounting of the conflicting forces that are shaping health care today. The authors have retained the clinical vignettes that illustrate so many of the dilemmas that clinicians face on a daily basis. The vignettes, which cover topics ranging from care for the uninsured to organ transplant waiting lists, are complemented by text that illuminates the underlying history and structures that have made the problems of access, equity, justice, and quality so enigmatic in American health care.

Several chapters are worth special mention. You will be hard pressed to find a more lucid explanation of the morass of health care payment structures than the chapter titled “Paying for Health Care.” The chapter titled “Access to Health Care” explains the problem of the uninsured and summarizes the evidence on the value of health insurance, while reminding us that health is also a product of race, socioeconomic status, and class. The chapter “Quality of Health Care” brings the reader up-to-date on the crusade for safer, high-quality health care, including a timely discussion of malpractice and tort reform.

The authors are refreshingly unapologetic in their advocacy for the importance of primary care in a just and affordable health care system. Even though this book is geared primarily toward medical students and other health profession students, one cannot help but wonder whether all health care would not be a better place if everyone would read this enlightening and well-written text. Among textbooks on health policy, few are as clear, concise, and comprehensive. I look forward to the day when this book is added to the list of medical students’ “bibles”: Harrison’s Textbook of Internal Medicine, Cecil’s Textbook of Medicine, the Washington Manual of Medical Therapeutics, and Bodenheimer-Grumbach’s Understanding Health Policy.

Finally, after reading Understanding Health Policy, I was left pondering the dirty secret in medicine and health care today—it’s all about money. Whether the problem is adequate coverage for the uninsured, long-term care, quality of care, or rationing—the issue is money. How often has a student said, “I just want to go out and practice good medicine,” only to find that medical practice is really about business, insurance, overhead, and cost control? We must confront our economic realities, educate ourselves and our students about these realities, and take responsibility for our part in this debacle of a health care system. Our patients, our profession, and our nation demand it.