For decades we have heard that the US healthcare system is in crisis — a Public Healthcare Crisis where population disease burden, poverty, and other social determinants of health have policy makers and healthcare administrators scrambling for solutions.

However, we would like to suggest that there is another crisis looming — a crisis that threatens the basic foundation of medicine where patient well-being is no longer the primary objective: the Medical Care Crisis.

This book is written to bring awareness to the Medical Care Crisis in America. By doing so, it is not meant to discount the importance of the current Public Healthcare Crisis. We indeed are experiencing a Public Healthcare Crisis characterized by population disease burden, inadequate housing, poverty, poor lifestyle choices, inactivity, food deserts, and other crippling social determinants of health.

The Public Healthcare Crisis is one to be addressed by policy makers, public health scientists, epidemiologists, and economists. However, the Medical Care Crisis, perhaps related to disproportionate focus on the Public Healthcare Crisis, is one of environmental imbalance among the four core components of medical care — doctors, payors, hospitals, and universities/innovators.

The authors of this book have nearly 100 collective years of experience in medical care — practicing medicine, leading multi-hospital health systems, creating and leading large physician medical groups, starting and leading medical schools, and relating with private and governmental payors. The book is written from the perspective of medical care in the state of South Carolina, where the authors have worked for the past 30 years. We believe the examples we use from our state are applicable to all of America.