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Julius B. Richmond
Rashi Fein
Foreword by Jimmy Carter
Copyright Date: 2005
Published by: Harvard University Press
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  • Book Info
    Book Description:

    In this important new book, Julius Richmond and Rashi Fein recount the fraught history of health care in America since the 1960s, showing how the promises of medical advances have not been matched either by financing or by delivery of care. As a new crisis looms, and the existing patchwork of insurance is poised to unravel, American leaders must again take up the question of health care. This book brings the voice of reason and the promise of compromise to that debate.

    eISBN: 978-0-674-04271-1
    Subjects: Public Health, Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-viii)
  2. Table of Contents
    (pp. ix-x)
  3. Foreword
    (pp. xi-xii)

    When I was President, I wrestled with the twin problems of rapidly rising health care expenditures and the millions of uninsured and underinsured Americans. Over the years since I left office, these problems have gotten worse. Our nation seems even further away from dealing with these threats to the physical, mental, and financial health of all Americans.

    I am pleased, therefore, to see this book by two distinguished students of American health care. One of them, Julius Richmond, served ably in my administration as Surgeon-General and Assistant Secretary for Health, and has continued to be my esteemed adviser. Doctors Richmond...

  4. Introduction
    (pp. 1-6)

    There is a disconcertingly large gap, more correctly a chasm, between the scientific glories of American medicine and the delivery failures of the American health care system. The same newspapers that report the latest laboratory and clinical findings and hold out hope for new and more effective therapies also tell us about a dysfunctional insurance system, about the 45 million Americans who, without health insurance, receive less health care and have no protection against the financial impact of illness, and about the anger and irritation of patients, physicians, legislators, and others who encounter or fund American medicine.

    We do not...

  5. Part I The Early Years: 1900–1965

    • 1 The Educational and Scientific Revolution: Higher Standards and Changing Priorities
      (pp. 9-29)

      Scientific advances taking place in the early twentieth century were destined to have a significant impact on diagnostic and therapeutic interventions available to physicians, the understanding of disease patterns, and the nature of medical education and physician preparation for the emerging modes of practice. Discoveries in the natural sciences and the increasing availability and applications of the compound microscope fostered the development of pathology, bacteriology, physiology, pharmacology, and biochemistry as sciences basic to the study of medicine. The development of x-ray examinations, electrocardiography, and laboratory examinations of body fluids, based on new knowledge in physics and chemistry, were beginning to...

    • 2 The Consumer Revolution: Increasing Access to Medical Care
      (pp. 30-52)

      Although physicians were considered authorities on all matters medical, in the mid-twentieth century measures designed to deal with the fact that medical care had become more effective and, not coincidentally, more expensive, did not generally emanate from the medical community. Medical educators were busy educating, medical researchers were busy doing research, medical specialists were consolidating their newly founded societies, and general medical practitioners were represented by the American Medical Association (AMA), which was busy trying to fend off legislative initiatives. As a consequence of the virtual lack of interest in undertaking actions designed to influence events taking place outside the...

  6. Part II In the Wake of Medicare and Medicaid: 1965–1985

    • 3 Emerging Tensions between Regulation and Market Forces: Dealing with Growth
      (pp. 55-88)

      Many Americans may find it difficult to appreciate the impact of the social ferment of the mid-1960s associated with the civil rights revolution and President Lyndon Johnson’s declaration of a “War on Poverty.” The 2000 census reports that today’s median age is 35.3 years. Thus over half our population had not yet been born four decades ago when the Civil Rights Act of 1964 was enacted and when the President articulated his goal of creating a “Great Society.” They may not understand the significance of the Voting Rights Act of 1965, of place names like Montgomery or Selma, of terms...

    • 4 Education for the Health Professions: The Impact of Growth
      (pp. 89-126)

      Health care and the nation’s health status are dependent on many factors. Important as health insurance and access to health care services are, they are only two of many variables affecting the health of the population, and thus only two of the many variables with which all administrations should be concerned. It is easy to focus on the various economic arrangements in health care because they are important, the subject of government activity, and the center of media attention. That focus, however, makes it easy to overlook the purpose of the various economic arrangements and of the economic activity in...

  7. Part III Moving to the Present: 1985–2005

    • 5 The Entrepreneurial Revolution: A Changing Face for Medicine
      (pp. 129-157)

      It is understandable that when, as at the end of World War II, health expenditures were approximately 4.5 percent of GDP, investors and financiers had little interest in the health sector. But by the mid-1980s, as national health expenditures increased to over $400 billion and almost 11 percent of the GDP, financiers saw the delivery of health care services as a significant part of the American economy and an area for potential investment and possible profit. The interest in health delivery organizations that generated profits was not an entirely new development: for-profit hospitals had long existed, mainly in the southern...

    • 6 Beyond the Dollars: Progress in Health and the Role of Public Health
      (pp. 158-188)

      The public certainly has many valid reasons to value health care services. Nonetheless, as in earlier time periods, major improvements in vital statistics are due to factors that can be considered outside the medical care delivery system. Improvements in living conditions, nutrition (albeit, the latter increasingly offset by obesity), and environment, as well as changes in behavior (for example, the decline in smoking and increase in exercise) have made the actual difference. Efforts to quantify the impact of medical care have suggested that perhaps it accounts for 10 percent of the improvements to public health.¹ Given the very large economic...

  8. Part IV Anticipating the Next Revolution: 2005 and Beyond

    • 7 Medical Challenges and Opportunities
      (pp. 191-227)

      In these, our concluding chapters, we look to the future. None of us know precisely how the United States will change during the twenty-first century, the “values” that will impel us in the years ahead, the shape of our international relations, the size and nature of our economy, the structure of our society, the particular ways in which medicine will evolve, and what “revolutions” will occur. Nevertheless, we do know that today’s health care system, the manner in which it is organized, its level of funding, and the ways that health services are financed for and by our population are...

    • 8 Increasing Equity: Achieving Universal Health Insurance
      (pp. 228-264)

      The most recent major effort to enact a comprehensive universal insurance program was the Clinton plan of 1993. As discussed earlier, while many factors contributed to its failure of adoption, especially significant was the growth and concomitant power of the insurance industry and of its lobbying capacities. The industry exploited the general ambivalence about government’s ability to manage large-scale programs (perhaps captured most cynically in the bumper sticker, “If You Like the Post Office You’ll Love National Health Insurance”). Earlier positive attitudes toward government’s capacities, as reflected in public approval of the Manhattan Project and the mission to land a...

  9. Notes
    (pp. 265-294)
  10. Index
    (pp. 295-307)