A rigorously attacking report on the institutional rather than individual malfeasance responsible for the submarginal medical care that anyone except the very rich (and informed) receive today. Much of this is due to what the authors -- Health Pac -- call the ""imperial"" trend in medicine, away from the general practitioner and toward the large monopolistic complex (hospitals, medical schools, research laboratories, etc.) which caters to the privileged while the poor and the black are shunted into inferior facilities. The report is based on New York City although the long bill of particulars is nationwide: the drug industry, ""The biggest crap game""; private health insurance ""almost as functional as a dinosaur""; hospital costs, continually rising; Blue Cross pricing itself out of the average reach; Medicaid, a ""scandal""; Medicare, a ""disaster""; etc., etc. The overall contentions and intentions here are valid and to some extent familiar through other critiques of medicine today; the approach is loose and loaded: the words ""elite"" and ""prestige"" attach themselves too often to Columbia-Presbyterian and New York Hospital and they do not charge up to $140 or $150 a day for a semiprivate room; St. Vincent's Mobile Coronary Care Unit does not only serve the ""Greenwich Village community"" but covers a much wider area -- from Chelsea to the Bowery; and large hospitals do not retain public relations specialists only to ""clean up their image"" but also to raise money for the escalating maintenance rightly itemized here even if the authors often question the ways in which funds are spent (expensive ""hardware"" of perhaps limited application but with an experimental potential?). . . . A book like this is also limited -- it's much too drastic for the general reader, let alone organized medicine.