Americans currently spend $2 trillion a year on health care, nearly 15.3% of GDP, and the total is projected to reach $4 trillion by 2016. That's more per capita than any other nation in the world, and yet it doesn't seem to be enough. 46 million Americans do not have health insurance at all, and many of the rest of us struggle with high premiums and a sense of inadequate coverage that forces us to choose between the best care versus "covered care." Meanwhile, more and more employers are dropping health plans every year, the large corporate health insurance providers are showing signs of financial trouble, and Medicare is projected to go bankrupt by 2017.

In the face of these grim statistics, author John H. Hammergren, CEO of Fortune 18 health care company McKesson Corporation, argues optimistically that "this is the beginning of a new era for health care." In SKIN IN THE GAME: How Putting Yourself First Today Will Revolutionize Health Care Tomorrow (March 14, 2008; Wiley; $27.95; Cloth) John Hammergren (with Phil Harkins) shows us that the roots of today's health care crisis can be traced to the industry's evolution in the US over 200 years, explains its current state, and offers a picture of the great strides that can be made within just a few years. According to Hammergren, "the American health care system is in a fragmented state, split between mega-hospital systems, giant pharmaceutical companies, billion-dollar insurance providers, and multiple layers of government bureaucracy. Where all these entities operate separately from one another, health care is plagued by errors, inefficiency, inconsistent quality and a poor customer experience." However, the high-tech productivity and quality boom experienced by other industries is finally catching on in health care, making a fully digital, higher quality / lower cost and integrated system possible for the first time. The book's title also reflects the commitment needed from all parties in the business of U.S. health care to bring about lasting transformation.

Technology will give patients the capability to take control of their own health. If you exchanged the word patient for customer you would see that, in one aspect at least, health care is unlike any other industry in the country. After all, in what other industry would the customer put up with no options for service? In what other industry would customers not care how much they are charged or how well the quality of that provider's service compares to that of other providers? Hammergren asserts that if we are going to change health care for the better, we need to turn all of our assumptions around and put the customer - patient first. Right now, customer - patients are treated like children or invalids who are incapable of thinking for themselves; who are given few choices, if any; and who are kept deliberately in the dark regarding the data needed to make rational economic decisions. Soon patients will have ready access to information that allows them to make fact-based choices about when and where to seek care. Putting the patient in the center is where health care reform needs to start and technology such as electronic medical records, evidence-based medicine, robotic surgery and convenient retail-like clinics allow for better patient care and service.

In the grand scheme of things, the American health care system is an amazing story, a scientific marvel, one of the most incredible accomplishments of any civilization. But if you're sick and need care, it doesn't matter how far health care has come in its history, you just care about the last two feet - the distance between you and your doctor as you sit across from each other and discuss your condition and how to treat it. In SKIN IN THE GAME, Hammergren show that the current health care system (with its tremendous advantages and notable detriments) is starting to work in new ways that will generate a revolutionary leap in quality, safety, personalized care and efficiency.