Wonderful and Broken: The Complex Reality of Primary Care in the United States

by Troyen A. Brennan

Overview

How can we save primary care from collapse and improve health care outcomes?

Primary care in the United States faces an existential crisis. Its value is unchallenged: policy experts argue that the primary care sector is critical to the quality and equity of the health care system. On the other hand, studies show that primary care is underfunded, providers are struggling with burnout, and an increasing number of patients lack access to this essential care. In Wonderful and Broken, Troyen A. Brennan offers a timely exploration into the precarious state of primary care in the American health system today. Drawing on years of field research and firsthand accounts from clinicians, this book paints a picture of both the current struggles and emerging solutions that define the primary care landscape.

With health care costs rising and clinician burnout at an all-time high, Brennan examines whether value-based care can truly rescue primary care from the brink of collapse. At the heart of this book are the compelling stories of doctors, nurses, and care teams who are forging a new path, championing preventive care, and prioritizing patient relationships. From the efforts of government policies to the involvement of venture capitalists, the book unveils the multifaceted approaches being employed to shift health care from a fee-for-service model to one centered around value, quality outcomes, and equitable access.

But will these efforts be enough? Brennan does not shy away from the hard questions, offering both a critique of past failures and hope for a more equitable future. Essential reading for policymakers, health care professionals, and anyone concerned about the future of American health care, Wonderful and Broken illuminates the pivotal role primary care must play in achieving sustainable and effective reform.

Product Details

ISBN-13:	9781421452197
Publisher:	Johns Hopkins University Press
Publication date:	10/07/2025
Pages:	488
Product dimensions:	6.00(w) x 9.00(h) x 1.50(d)
Age Range:	18 Years

About the Author

Troyen A. Brennan is an adjunct professor of health policy and management at the Harvard T. H. Chan School of Public Health. A former professor of medicine at Harvard Medical School and the former chief medical officer at CVS Health, he is the author of The Transformation of American Health Insurance: On the Path to Medicare for All and Just Doctoring: Medical Ethics in the Liberal State.

Table of Contents

Foreword
1. The Somewhat Recent History of Primary Care
2. Are there Signs of a New Deal for Primary Care?
3. What Can the Federal Government Do to Promote Primary Care?
4. The States' Role in Primary Care Reform
5. State-Based Health Insurers' Role in Primary Care
6. The National Health Insurers (and Other Corporations)
7. The Role of Private Equity
8. The Future of Primary Care

What People are Saying About This

From the Publisher

Vivid, incisive, and urgent. This is essential reading on why American health care is failing—and how rebuilding primary care can fix it.
—Atul Gawande, MD, MPH, author of Being Mortal: Medicine and What Matters in the End

Brennan's book is brilliant. He has full grasp of what makes primary care wonderful and how it is broken. He offers a clear and realistic vision of how primary care should evolve and even thrive—and the steps that key stakeholders should take to make that possible.
—Thomas H. Lee, MD, Chief Medical Officer, Press Ganey

Brennan skillfully highlights the persistent tension between the well-established benefits of primary care—for both individuals and the broader health care system—and a system that too often hinders the realization of those benefits. He calls on us to move beyond these entrenched barriers and to build a health care system that truly places patients and primary care at its center.
—R. Shawn Martin, Executive Vice President/CEO, American Academy of Family Physicians

Wonderful and Broken is a must-read for anyone who wants to understand why our health system is so dysfunctional and what can be done to fix it. With data and compelling storytelling, Brennan illustrates how we are only limited by our willingness to spend resources differently in order to reduce overall health care costs while extending lives and improving health.
—Russell S. Phillips, MD, Harvard Medical School Center for Primary Care

Wonderful and Broken captures primary care's reality perfectly. As a practicing family physician, I recognize Dr. Brennan's descriptions all too well. I'm grateful for his nationwide exploration of primary care models, and I share his optimism that primary care can still be rediscovered to lift the US from the basement of health outcomes among developed nations.
—Robert L. Phillips Jr., MD, MSPH, American Board of Family Medicine

Editorial Reviews

Few, if any, health care experts can claim the enormous breadth of experience that Troy Brennan can. He tackles how to turn around our health care system with careful attention to the evidence, a scholar's sense of balance, and a commitment to honesty. An instant 'must read' for anyone who cares about finding our way to better health care.
—Donald Berwick, MD, MPP, Institute for Healthcare Improvement; praise for The Transformation of American Health Insurance

Troyen Brennan is uniquely qualified to write a book explaining how American health care policy has evolved and where it might be going, having been at various times in his career a clinician and physician administrator, and an executive in health insurance, pharmacy benefit management, and retail pharmacy companies. You are sure to learn things about health policy you didn't know. This book has my strongest recommendation.
—Joseph P. Newhouse, Harvard University; praise for The Transformation of American Health Insurance

Blending insights from a career in the top echelons of medicine, business, and academia, Brennan's book is a must-read, exposing how US health insurance has produced a bloated healthcare system and why Medicare for All is not a liberal pipedream but a lifeboat that businesses will embrace.
—Leemore Dafny, Harvard University; praise for The Transformation of American Health Insurance

A superb description of the government and commercial evolution of the uniquely American health financing, insurance, and delivery system. Troyen Brennan describes the inevitable financial and social trends pushing us toward a more equitable, effective health insurance system. The employer can be an important contributor to a value-based system to improve outcomes and reimbursement. If employers fail, then government's role may continue to expand, hopefully in public and private collaboration.
—Ronald A. Williams, RW2 Enterprises; praise for The Transformation of American Health Insurance

From the Publisher