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The Uninformed Voter by Robert Levine
Release Date: April 30, 2020
A political work warns readers about the costs of an uninformed electorate.


As a prolific author, physician, and clinical professor at Yale University, Levine has produced scholarship mostly centered on aging and health care reform. In this book, he offers a cautionary tale about a rising tide of a “general lack of knowledge of how government works” and “tribalism,” which he considers fundamental threats to America’s democratic tradition. As of 2017, international studies of the globe’s most liberal democracies ranked the United States 31st in the world, a significant decline from previous years. The author convincingly—and shockingly—demonstrates widespread ignorance among Americans toward their elected representatives and the basic organization of government itself. Just as problematic to Levine is political apathy, where a majority of eligible voters fail to even show up in off-year elections. The book’s strength lies in its international approach, placing America within the context of a global shift from democracy to autocracy, with examples of Russia, Turkey, Hungary, and the Philippines serving as warnings against populist and nationalist governments drawn to authoritarianism. The volume’s title and underlying premise may be off-putting to some readers who will be uncomfortable with blaming America’s current political crisis on ignorant voters (the majority of whom cast their ballots against the nationalist, populist candidate Donald Trump in 2016). They instead may place the blame on the undemocratic nature of the Electoral College itself. Though occasionally elitist in their characterization of American voters, some of Levine’s chapters highlight the role of disenfranchisement, gerrymandering, and political corruption as contributing factors to the nation’s democratic decline. Well-researched with ample footnotes that demonstrate a firm grasp of contemporary scholarship on the subject, the work also features excellent chapters on the philosophical origins of democracy and the history of threats to the American system (for instance, contested presidential elections in 1876, 1960, and 2000, and political scandals like Watergate and the Iran-Contra Affair). Deliberately nonpartisan in its approach, the book concludes with a chapter on practical electoral reforms, such as ranked choice voting and the revamping of primaries.


This superbly researched and well-reasoned case for informed voting deftly emphasizes democratic traditions. (references)
Pub Date: April 30, 2020
ISBN: 978-1-977225-87-0
Page Count: 366
Publisher: Outskirts Press
Review Posted Online: today
Review Program: KIRKUS INDIE



The Uninformed Voter by Robert Levine
Robert Levine, author
Enter Book Website
Category: Political & Social Sciences;  Audience: Adult

Synopsis: The Uninformed Voter describes how citizens lack knowledge about the candidates, the issues and government function when they vote. Ballots cast are often determined by tribal alignment rather than information. This results in the election of politicians who are incompetent and sometimes venal, causing dysfunction at every level of government. Because of voters’ lack of information, corruption, inefficiency and partisanship flourishes in Washington and most democracies. Examples of the problems are discussed and suggestions by political scientists and philosophers about how to improve the democratic process are evaluated.


Levine’s provocative third book on politics (after 2016’s Resurrecting Democracy) examines the failures of the democratic process in the absence of an informed electorate. Levine’s thesis is that most modern voters lack knowledge about political candidates, issues, policies, and even how the government functions. He states, “The majority of voters in democratic nations can be considered politically incompetent.” He suggests that this political incompetence results in governmental inefficiencies, partisanship, and corruption within democracies.


This work makes a strong case that every voter should be informed on government procedures, policies, and candidates’ positions. Levine provides some of this information himself with capsule summaries of past American presidential candidates and democratic scandals around the world. The 2016 presidential election gets particular attention; Levine views it as a significant example of an uninformed electorate being motivated by party, media coverage, and hot-button topics rather than a considered assessment of which candidate would be best for the country. Right-leaning readers may be put off by Levine’s detailed excoriation of President Trump, though he also analyzes the Clinton campaign’s failures.


Levine only briefly addresses issues such as voter suppression and gerrymandering that directly deter citizens from exercising their right to vote. Instead, he suggests an “epistocracy” in which voters who do well on civics exams should have their votes count for more, claiming that “educational level, gender, race, wealth, or property would not matter” as anyone could “put in the time to acquire information” about candidates. Many readers will find this notion difficult to reconcile with democratic ideals and impossible to implement equitably. However, even those who disagree with Levine’s conclusions can agree that better-informed voters will likely elect more capable representatives. Readers of any political stripe will find this a thought-provoking, well sourced work of political analysis.
Takeaway: Amateur and professional political analysts will enjoy arguing over this treatise on democracy’s dependence on an informed electorate.


Great for fans of Erin Geiger Smith’s Thank You for Voting: The Maddening, Enlightening, Inspiring Truth About Voting in America.

Shock Therapy

America’s health care system is sick. There are trillions of dollars in Medicare and Medicaid mandates, hundreds of billions spent on administrative costs annually, and hundreds of billions more spent on treatments people don’t need. But there is a cure–a series of steps that could bring sanity to the system, even achieve universal coverage–and it won’t cost the taxpayers a dime.


From a veteran physician comes this remarkable, clear-eyed look at what’s wrong with how we administer and pay for health care and what can be done to fix it.


In Shock Therapy for the American Health Care System Dr. Levine offers an easily understandable diagnosis of the problems plaguing our current health care infrastructure, with discussions that include the roles of various stakeholders–insurance companies, “big pharma,” hospitals, health care providers, and patients. He also dispels a number of myths designed to make voters leery of any reform efforts. Levine’s comprehensive plan addresses everything from bloated bureaucracies to unnecessary procedures to the handling of negligence and malpractice lawsuits/claims. Throughout, Levine backs his proposals with facts and comparisons to systems in various countries and concludes that even now, with disaster looming, the ultimate goal of providing health insurance for every American is achievable and affordable.


Physicians, policy makers, the public, and other stakeholders undoubtedly have been tuned in to the current debate regarding health care reform in the United States. Although many will agree that some kind of health care reform is needed to decrease costs and improve access to care, the details on how this might best be accomplished may not be clear to most. Robert Levine’s book is a timely addition to the ongoing debate, and, even though not everyone will agree with his proposed fix, he systematically covers the issues at hand and offers possible solutions.

Levine easily pulls his readers in with the introductory chapter. Subsequent chapters provide a historical account of the evolution of the US health care system, describe its complexity, define who the shareholders are, and then move on to present the system’s problems and some interesting proposals to fix the system. Although the book is not a fast read–each chapter is dense with thought-provoking facts and well-articulated ideas–I would recommend this book to anyone interested in learning more about the issues that plague the US health care system.

The book begins by dispelling a number of myths about US health care, including that patients in the United States currently have the best health care in the world, high-cost care is synonymous with better care, and free-market policies are the best solution for reforming the now-dysfunctional health care system. Levine points out that data show that the United States places 42nd in life expectancy and currently ranks last in preventable mortality and that health care in the United States is more costly than in any other country. Citing other statistics showing that one-sixth of the US population is currently uninsured and unable to obtain medical services, he concludes that there is a good argument against the US system delivering high-quality care.

An interesting discussion continues on issues related to a free market and its inefficiency in terms of health care because of competing interests. Despite the fact that many believe that the market is the answer to all economic problems, Levine points out that patients in the United States disregard market forces when it comes to treating their critical illnesses. Patients want the best surgeons to treat “their leaking heart valves” or “their cancers,” rather than choosing a lower-priced specialist or a less than state-of-the-art therapy. Cost (price), quality, and coverage are key components in the decision to purchase health insurance, but which element will prevail is dependent on who is the purchaser. Levine explains that the affluent have the means to purchase the best coverage, while the poor have virtually no choice. Businesses typically decide based on cost, and corporations have to factor in profits for their stockholders and compensation for their executives. In addition to insurance providers and consumers, Levine manages to bring into his discussion the competing interests of individual physicians and organized medicine, hospitals and other health care facilities, the pharmaceutical and medical device industry, the legal system, and government.

Levine provides a good discussion on how physicians have historically set their fees and how, rather than reducing fees in a competitive market, they may raise prices or change the criteria for providing care (eg, a surgeon may choose to operate rather than medically treat.) Alternatively, constraints placed on physician and medical practitioners’ fees by payers often result in an increase in the amount of care to maintain an expected income. Competition between hospitals and health care facilities for patients results in duplication of high-cost technology and decreased profits, encouraging overuse and unnecessary care. Fierce competition between pharmaceutical companies and between device manufacturers has resulted in a surge of similar drugs and devices, which in turn has resulted in decreased profits, making it critical that companies keep drug and device prices high to survive. Levine goes on to say that “the market encourages people to do whatever is necessary to make money, and where health care is concerned, that is synonymous with runaway costs and poor quality of care.”

Acknowledging the necessity for change in the current system, Levine systematically describes his components for comprehensive health care reform, including the possibility of a single-payer system that is government sponsored but free from political interference and that incorporates funding from multiple sources, additional private insurance funded by the individual, regional health care entities, physician groups and practices salaried through contracts, subsidized medical education, physician extenders to provide preventive care, malpractice reform, and electronic health records. His proposed system provides for basic coverage for all, improved quality of care, and reasonable cost control that does not really fit the definition of “socialized medicine.”

The Journal of the American Medical Association (JAMA) August 11, 2010
reviewed by Elizabeth C. Burton, MD
Baylor University Medical Center, Baylor Health Care System
Institute for Health Care Research and Improvement, Dallas, TX

In 9 thoroughly annotated chapters (161 pages), Robert Levine, a practicing neurologist from Norwalk, CT, succinctly describes the evolution of the American health care system and its problems. His detailed analysis of US health care puts in plain words the source of the increasingly difficult issues we all face in our daily practices. His review names the high cost of health care and the many uninsured patients as the driving forces for comprehensive health care reform. For reform to be enacted, the public must be reassured that their health care will not be restricted, while at the same time restricting lobbyists and special interests from undue influence on legislation.

The elements of Dr. Levine’s proposal for reform include universal Medicare, salaried physicians, electronic health records, malpractice reform, additional physician extenders, and regional, nonprofit health entities to manage care for people in geographic regions. Dr. Levine demonstrates full awareness of the obstacles to such health care reform in his outline of the difficulty President Obama had in passing an economic stimulus bill early in his presidency. The accuracy of his analysis has been show by the difficulties passing health care reform this year and the continuing attempts to reverse it. Health care reform challenges in the past few months have shown that without public support, health care reform will be difficult, let alone the even more difficult task of implementing a single-payer system.

Neurology (The journal of the American Academy of Neurology) 2010; 74; 1839,
reviewed by Jasper Daube, MD

A veteran physician offers an insider’s perspective on problems in the present system for administering and paying for health care. His program of reform is more far-reaching than anything currently being proposed, and, he maintains, would provide universal coverage at no additional cost. Writing in accessible language for general readers, Levine, former chief of neurology at Norwalk Hospital and retired professor of medicine at Yale University, dispels common myths about health care reform, and reveals the roles of the various stakeholders in our current health care infrastructure: insurance companies, big pharma, hospitals, the medical device industry, health care providers, and patients. He identifies areas in the current system where huge savings could be realized, and backs up his proposals with facts and comparisons to systems in other coutries. Tables and graphy provide summaries of data.

SciTech Book News September, 2009

For anyone directly involved in the politics of health care reform or who just wants to have an intelligent and critical understanding of the major forces that have shaped the health care system this book is worth reading.

This book is extensively researched (422 references) making it a challenge to give it the credit it deserves. But it is not a dry academic attempt at explaining what is wrong with the system and what to do about it. It is easily readable and although doctors may find it particularly focused and resonant with the problems that they experience every day, the lay readers too will benefit by gathering information that they need to understand the conflicting messages and the endless stream of statistics that are seen and viewed almost daily in our newspapers and television screens.

He covers the main issues affecting health reform including the transition of insurance companies from non-profit to for-profit status, the economic ramifications of new technology, how medical liability caused defensive medicine, how drug companies’ lobbying efforts help them maintain their high profit margins.

Probably one of the author’s ideas that will invite the most responses is his solution for controlling costs by changing the way physicians are paid. He favors placing physicians on salary and getting away from fee-for-service.

The pros and cons of several countries’ health care systems, France, Japan, England, and Germany are discussed. This chapter is important because how other countries deal with health care provides important background for our national debate and receives too little attention.

I would recommend this book for medical students and residents. It’s hard for them to find such a comprehensive study on health reform so neatly packaged in one book.

Ed Volpintesta, M.D., Connecticut Medicine October, 2009

Levine, a neurologist, presents eight myths about the American health care system that keep Americans seeking market-based solutions for the system’s direct and indirect problems. The direct problems relate to cost, access, and quality; the indirect stem from unfunded Medicare liabilities. Untended, these problems will cripple the economy. The solution is a health care system with (near) universal access, strong cost constraints, and simplified usage. Levine grounds his solution in a thorough examination of the development of the health care system, its problems, and currently proposed solutions. He advocates “a single-payer system run by an independent entity, ‘Universal Medicare,’ controlled by a board of health care experts free of political interference. The author realizes that his solution is radical, but he hopes the current economic conditions will make Americans more willing to consider non-market-based solutions. He is, too, a realist who is aware of the power of the interests and political skills of those who stand to benefit from the status quo. Levine is hardly the first to argue for a single-payer system, but his cogent analysis, rooted in historical, medical, systemic and political realities, places it above other books in the genre. Summing Up: Recommended.

Choice February, 2010

Resurrecting Democracy

A Viet Nam vet and Columbia history major who became a medical doctor, Bob Levine has watched the evolution of American politics over the past 40 years with increasing alarm. He knows he's not alone. Real democracy is hamstrung by partisan grid-lock, massive cash contributions to the two gigantic political organizations, and even more massive expenditures on lobbyists; there is more than just a whiff of corruption emanating from Washington.  If the nation is have a responsive government that can restore growth to the economy and control debt, Levine argues that we need a strong centrist third party to bring about the necessary reforms. Levine's previous book, Shock Therapy For the American Health Care System took a realist approach to health care from a physician's informed point of view; Resurrecting Democracy takes a similar pragmatic approach, putting aside ideology and taking a hard look at facts on the ground.  In this carefully reasoned book, Levine shines a light that cuts through the miasma of party propaganda and reactionary thinking, and reveals a new path for American politics.


In his new book, Resurrecting Democracy, Levine presents an argument for a new centrist political party, a realist party that will cut through the miasma of entrenched propaganda and reactionary thinking. Resurrecting Democracy is a plan to overcome lockstep partisanship, restore growth to the economy and bring debt under control.

Aging Wisely

Everyone ages. Not everyone ages well. Aging Wisely explains that much of what happens to our minds and bodies as we grow older depends on our approach to life and our attitudes and feelings about ourselves. Though there are elements beyond our control, we must take advantage of those things we can control while dealing competently with adversity. In describing the impact of aging and various conditions associated with the aging process upon our minds and bodies, Aging Wisely provides readers with the knowledge needed to fight back and maximize their relevance and independence. It emphasizes the importance of maintaining the quality of our lives in addition to longevity, for survival alone does not matter if the quality of survival is poor. To age successfully, we must find satisfaction and pleasure in what we do in the time available to us.

Aging with Attitude

The Rolling Stones (now in their sixties) have sung to us for years about what a drag it is getting old, but it doesn’t have to be that way. Despite living in a youth-oriented society, many of the aged patients seen by Dr. Levine have kept their emotional zest, intellectual zeal, and empowering dignity. Levine points to well-known public figures clearly aging with dignity and vitality. And this neurologist author shows steps we can take to age and retain these qualities in defiance of a society that challenges this quest. Living longer is not enough for most of us; we don’t want to just survive. The quality of our life as we age is most important, and much of that depends on our attitudes and approach. This text includes strategies to optimize self-esteem, as well as health, including attention to nutrition, exercise, health care, education, mind stimulation, sexuality, social activation, and cosmetics and cosmetic surgery.


Readers are shown the physiological facts of aging, from cellular to systemic changes. The most common diseases in old age are described, and actions are suggested to avoid many of the diseases. Levine also explores how the disorders change abilities and self-perception. – From the publisher


Levine presents a skillfully crafted treatment of “growing older with dignity and vitality.” In ten chapters, he provides the enlightenment lacking in many other resources that attempt to analyze the phenomenon know as “aging.” An insightful introduction explains the numerous conditions and disorders of aging and analyzes strategies for coping with negative conditions of ageism—thoroughly interpreting the material for a youth-based culture. The final chapter–“Aging in the New Millennium”—projects into the 21st century scientific advances that may create an environment in which the aging population can survive and live with dignity. The book concludes with excellent notes and references to enhance knowledge and lead to further study. Anyone involved with an aging population—and that includes everyone, from the young to the professional caregivers—should read this book.

The focus of Aging with Attitude: Growing Older with Dignity and Vitality is exploring how people can approach life so that it can be rewarding and produce a sense of worth and self-respect. There is no single path; yet successful aging seems to come to each individual seeking the right path for himself or herself. Obstacles to aging well are explored and ideas that individuals can use along their paths so they can enjoy life and live it well are shared….”Aging with Attitude is enjoyable reading. Summing up: Essential. All collections, all levels.

Choice December, 2004

Defying Dementia

Levine’s book explains dementia and its causes, in all of its forms, with a focus on what research shows we can do to lower our risk of developing dementia. Written to encourage defensive action, the book is meant both as a guide and a reference to understanding and preventing dementia. It is intended for lay people interested in learning about dementia and the measures that can be taken to repel its onslaught, as well as for caregivers and family members of impaired patients. Defying Dementia is presented in three sections. First, Levine explains the various types of dementia, its increasing incidence and current treatments and therapies on the horizon. The role of physiology and fresh insights from the field of genetics are included. The second section focuses on methods that can be incorporated into a healthy lifestyle to help avoid dementia. Third, the epilogue in the newly released paperback version of Defying Dementia summarizes all the new information regarding dementia, helping the reader understand what can be done to treat and prevent this condition.


How do we motivate individuals to take action to change behavior in response to a possible threat that has not yet materialized? When the threat is dementia, argues Levine, it is an issue of considerable importance. The earlier the campaign is initiated to defeat this lurking foe, the greater the chances the combatant will emerge victorious. 

With proper actions on our part, we can achieve mastery, Levine writes. The transformation may not be easy, but recognizing the scourge of dementia is, and the way it devours the humanity of its victims may inspire us to move ahead. Preparation is the key word–building solid defenses over time. While any moment is worthwhile to begin this task, the earlier, the better.


Defying Dementia presents a comprehensive, up-to-date picture in the field of dementing diseases.
This book depicts the entire breadth and depth of this uniquely complex subject with unusual clarity and ease.

Martin J. Sadowski, M.D., Ph.D., July 2010, assistant professor of neurology, psychiatry and pharmacology, New York University School of Medicine

Defying Dementia is an informative book that might be useful to clinicians familiar with the disease and who would like to know more. A good deal of dementia-related research is summarized in a succinct and readable way given a background in neurology-related fields.–Metapsychology, June 2007

“How do we induce people to address a potential problem on the distant horizon when they currently feel well?” asks Dr. Robert Levine in his book, Defying Dementia. Dr. Levine argues that readers must understand dementia and related disorders and then take action to prevent them before they occur. With this approach in mind, Dr. Levine has divided Defying Dementia into two sections: one that explains what dementia is; the other that focuses on the types of preventative actions that readers can take to avoid it. Throughout, the book is filled with short vignettes that illustrate how others can recognize the early signs of this devastating disorder.

Solutions, Fall 2006

This guide to understanding and preventing dementia is aimed at general readers, caregivers, health professionals, and family members of impaired patients. Levine provides an overview of types, causes, symptoms, and diagnosis; discusses normal aging, mild cognitive impairment, and pseudo-dementia; and examines Alzheimer’s disease, Pick’s disease, Parkinson’s disease with dementia, dementia with Lewy bodies, and vascular and mixed dementia. Preventative measures, such as exercise, cognitive stimulation and socialization, and diet, are preceded by a discussion of causes of accelerated brain aging and other factors.

SciTech Book News, September 2006

Dementia, in its many forms, exerts a huge emotional, physical, and economic toll on victims, their families, and the social and health care delivery system. Gerontologists predict that by 2050, the number of people with these diseases will double. In this book, neurologist Levine provides an overview of the state of knowledge regarding Alzheimer’s and related dementias. Written in a sophisticated but accessible style, the book is divided into two sections. The first explains the anatomy and physiology, symptoms, diagnosis, and treatment of the full spectrum of dementias. The second section, titled “Lowering the Risk,” features four chapters offering evidence-based lifestyle changes and interventions that could potentially decrease the risk of developing dementia and/or maximize cognitive functioning. Levine’s intended audience is the intelligent layperson, but the book would be equally appropriate for selected health professionals or social service students seeking general coverage of the topic…[t]his succinct, credible resource on these devastating diseases sums up the present-day state of affairs and hints at the future.

Choice, 2/1/2007

Shock Theray
Aging Wisely
Aging Attitude

Click on NYT logo to read Sunday dialog with Robert A. Levine

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