"A Problem from Hell:" American and the Age of Genocide focuses on the instances of twentieth century genocide and examines how the United States reacted to these situations. Power discusses the genocides that occurred in Turkey, Germany, Cambodia, Iraq, Bosnia, Rwanda, Srebrenica, and Kosovo. She also discusses the development of international laws against genocide and the dedication of activists, such as Lemkin, Proxmire, Dole, and others, who attempted to compel the United States to ratify the Genocide Convention which would have compelled them to intervene when genocides occurred.

Power makes several claims in the book. First, she argues that the United States has been very slow to act in the face of genocidal situations. Although violence in some regions was a distinct possibility, both policymakers and the public assumed that such violence could not occur. The policymakers doubted accounts from survivors and refugees and dismissed them as too sensational to be true. Policymakers trusted the reassurances of the very governments committing acts of atrocity. For example, Power demonstrates that the United States continued to believe and accept the promises of Milosevic even after he had already orchestrated two genocides in the former Yugoslavia. The UN and Western powers have continually relied on traditional diplomacy and attempts to broker cease-fires as means to settle international incidents.

Power argues that U.S. officials altered the language of accounts of genocide in order to produce doubts about the nature of the violence. Often, U.S. officials labeled the violence which occurred as civil war, rather than genocide, as they did in the former Yugoslavia and Iraq. The U.S officials also, at times, argued that the conflicts were inevitable. For example, when the three sets of genocide occurred in the former Yugoslavia, officials contended that the violence stemmed from ancient conflicts and was bound to erupt at some point. These alternate versions of events hindered concerned policymakers and activists in their efforts to get support for action to stop the genocide.

Finally, Power suggests throughout the book that the United States and other Western powers have not done enough to prevent or stop genocides. Illustrating that these nations had enough information to know that genocide was indeed happening and that they had options for action, she argues that policymakers and civilians chose ineffective negotiations and inaction in situations of genocide. Rather than sending troops to create safe areas for victims and enforce cease-fires, the United States has time and time again, done little to help victims. Indeed, the United States took roughly forty years to ratify the international law making genocide a crime because policymakers were afraid that the move might either implicate the United States or commit them to action in cases of genocide.

Although international laws were created to ban the destruction of nations, races, and ethnicities, prosecution of perpetrators has had its own sets of issues. It was not until the 1990s that any person guilty of genocide was brought before an international tribunal or court and tried for their actions. In fact, many perpetrators remain free within their respective countries. The United States and the UN have given UN peacekeepers orders in some cases not to apprehend perpetrators, even when their location is well known.