Argues for more transparent, democratic and safer healthcare practices to keep patients better informed and hold poor-performing doctors and flawed systems accountable.

New York Times Bestseller “Every once in a while a book comes along that rocks the foundations of an established order that's seriously in need of being shaken. The modern American hospital is that establishment and Unaccountable is that book.”-Shannon Brownlee, author of Overtreated Dr. Marty Makary is co-developer of the life-saving checklist outlined in Atul Gawande's bestselling The Checklist Manifesto. As a busy surgeon who has worked in many of the best hospitals in the nation, he can testify to the amazing power of modern medicine to cure. But he's also been a witness to a medical culture that routinely leaves surgical sponges inside patients, amputates the wrong limbs, and overdoses children because of sloppy handwriting. Over the last ten years, neither error rates nor costs have come down, despite scientific progress and efforts to curb expenses. Why? To patients, the healthcare system is a black box. Doctors and hospitals are unaccountable, and the lack of transparency leaves both bad doctors and systemic flaws unchecked. Patients need to know more of what healthcare workers know, so they can make informed choices. Accountability in healthcare would expose dangerous doctors, reward good performance, and force positive change nationally, using the power of the free market. Unaccountable is a powerful, no-nonsense, non-partisan diagnosis for healing our hospitals and reforming our broken healthcare system.

A co-developer of the medical care list outlined in Atul Gawande's best-selling The Checklist Manifesto presents an urgent call for action that advocates more transparent, democratic and safer healthcare practices to keep patients better informed and hold poor-performing doctors and flawed systems accountable.

From the Tea Party to Occupy Wall Street, however divergent their political views, these groups seem united by one thing: outrage over a system of power and influence that they feel has stolen their livelihoods and liberties. Increasingly, protesters on both ends of the political spectrum and the media are using the word “corrupt” to describe an elusory system of power that has shed any accountability to those it was meant to help and govern. But what does corruption and unaccountability mean in today’s world? It is far more toxic and deeply routed than bribery. From Super PACs pouring secret money into our election system, to companies buying better ratings from Standard & Poors, or the exteme influence of lobbyists in congress, all are embody a “new corruption” and remain unaccountable to our society’s supposed watchdogs, which sit idly alongside the same groups that have brought the government, business and much of the military in to their pocket.

America is highly polarized around elections, but unelected actors make many of the decisions that affect our lives. In this lucid history, James R. Copland explains how unaccountable agents have taken over much of the U.S. government apparatus. Congress has largely abdicated its authority. “Independent” administrative agencies churn out thousands of new regulations every year. Courts have enabled these rulemakers to expand their powers beyond those authorized by law—and have constrained executive efforts to rein in the bureaucratic behemoth. No ordinary citizen can know what is legal and what is not. There are some 300,000 federal crimes, 98 percent of which were created by administrative action. The proliferation of rules gives enormous discretion to unelected enforcers, and the severity of sanctions can be ruinous to citizens who unwittingly violate a regulation. Outside the bureaucracy, private attorneys regulate our conduct through lawsuits. Most of the legal theories underlying these suits were never voted upon by our elected representatives. A combination of historical accident, decisions by judges and law professors, and self-interested advocacy by litigators has built an onerous and expensive legal regime. Finally, state and local officials may be accountable to their own voters, but some reach further afield, pursuing agendas to dictate the terms of national commerce. These new antifederalists are subjecting the citizens of Wyoming and Mississippi to the whims of the electorates of New York and San Francisco—contrary to the constitutional design. In these ways, the unelected have assumed substantial control of the American republic, upended the rule of law, given the United States the world’s costliest legal system, and inverted the Constitution’s federalism. Copland caps off his account with ideas for charting a corrective course back to democratic accountability.

A unique insider's account of the Harper government so damning that it cannot be ignored. Kevin Page was appointed by the federal Conservatives to be the country's first parliamentary budget officer in March 2008. The move fulfilled a Tory campaign promise to deliver greater government transparency and accountability. He was later denounced by the same people who had appointed him to scrutinize their spending. When he challenged the government on several issues--most notably about the true costs of the F-35 fighter planes--and publicly claimed the government was misleading Canadians, Page was vilified. Later, he was called "unbelievable, unreliable and incredible" by then-Finance Minister Jim Flaherty. Page's term was not extended. Page's assessment of the F-35 procurement was proven right, a major embarrassment to the Harper government. But his overriding concern is that Parliament does not get the information and analysis it needs to hold the executive--the prime minister and cabinet--to account. Parliament, he argues, is broken, with power centralized in the PMO. The civil service appears cowed, and members of parliament almost never see enough financial analysis to support the policy decisions they make. That was true of the tough-on-crime legislation and military procurement as well as recent changes to the Canada Health Transfer and Old Age Security. In this shocking insider's account, Page argues forcefully that elected officials need accurate, independently verified data to support the implementation of policies and programs. Unaccountable is an urgent call to action for all Canadians.