No health-care system is an island.

A few years ago, a new Microsoft employee was called back to his home state because his mother had suffered a mild stroke. When she was well enough to leave the hospital, Mrs. Jones (not her real name) stayed with her sister while her son completed plans to move her near him. Mrs. Jones largely recovered but was never able to live on her own again, and her periods of good health were interrupted by hospital stays to treat more and more serious problems.

The medical events of the last two years of Mrs. Jones's life show the best and the worst of the American health-care system. She received good care, including a number of very new treatments, from three different hospitals and more than a dozen doctors in two different states. As her physical abilities declined, her middle-class family was able to find good facilities providing greater degrees of care. Medicare and her own private insurance paid most of the bills; she and her family paid the rest. Her many doctors, nurses, and other care givers were professional and kind.

But the system was far from perfect. When Mrs. Jones left the first hospital for her sister's hometown fifty kilometers away, a communication failure between doctors meant that her medicine was kept at full strength when Mrs. Jones should have been on a declining dose. By the time she arrived in the North West, side effects of the high dose meant that she had to go into hospital immediately. Because her records didn't come with her, a number of expensive tests had to be repeated.

The same thing happened when she changed hospitals a year later. Her final three-week hospital stay, which did not involve any surgery, still cost $25,000. At one point, a doctor confused her with another patient and told her next doctor that her recent hospital stays were "an abuse of the system." This was less than a week before Mrs. Jones died.

These and other problems went on even though Mrs. Jones had her family to help her work through the confusing medical and social services options. Her son and daughter-in-law took turns spending many hours standing in line at one agency or on the phone with another. And it took a year before they could persuade one hospital to stop billing them for services that had been paid for in full.