In this short audiobook, R.W. Murphy makes the argument that the US healthcare delivery system is irreparably broken as the result of a perfectly inelastic demand curve for healthcare goods and services. In essence, he indicates that Americans will buy the same number of units regardless of price and that is destroying the system. He points to all the retail level cost control initiatives to date as failing to address wholesale pricing pressures. His premise is that underlying wholesale cost increases have hardly been affected at all. Any cost reductions at the retail level resulting from tough utilization management have been no more than temporary "stair step" efforts that get quickly absorbed. He offers both historical perspective and going-forward options for structural change. He refers to the need to make the demand curve more price responsive as an "American Healthcare Imperative" because the inevitable alternative is serious damage to American society in its absence. He indicates that failing to act is no longer an option.

R.W. Murphy has been involved in healthcare cost control since 1980. He started his career as a home office underwriter for a major US healthcare insurance company. In 1990 he became a consultant for an international firm and in 1995 formed his owned consulting company. He has been involved in virtually every cost control initiative in the last 40 years - and by his own admission, has the scars to prove it. 

The book has been made deliberately short. It can be listened to in less than an hour. The author indicates that his intent has been to make Americans think about the necessity for structural change - not give them an actual road map for it. As such, he remains relatively nonpartisan regarding the options. He also is clear that he has spent less time in doing statistical research than using his professional experience to show relationships. He tells the listener to not be caught up in absolute numbers but to instead examine the historical and projected trends.

The Introduction has been written under an alias by a professional healthcare administrator in West Palm Beach, Florida. By remaining anonymous, he offers candid opinions with which peer administrators might not agree. His comments come from perspective gained via vast experience on the provider side of the industry. In addition, his politics are significantly right of the author's. As such, his views provide germane counterpoint.

As more a red-flag than a how-to book, it should be listened to by every person who believes that healthcare policy will be an important differentiating factor in the 2020 US election.