This book investigates the historical development of the American health care system to explain why it remains a fragmented, unequal, and largely hidden public-private hybrid. Colleen M. Grogan, a professor at the University of Chicago, utilizes extensive historical research and policy analysis to argue that the U.S. government has consistently expanded its role in health care while simultaneously obscuring that involvement through private-sector intermediaries. The text provides a chronological framework that traces the evolution of these policies from the late 19th century through the implementation of the Affordable Care Act.

Experts recognize this work as a critical contribution to the study of American social welfare and health policy. Readers frequently note the academic density of the prose and the author's meticulous use of historical data to challenge conventional narratives about the role of government in health care.