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Health Policies, Health Politics

Health Policies, Health Politics: The British and American Experience, 1911-1965

Copyright Date: 1986
Pages: 248
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  • Book Info
    Health Policies, Health Politics
    Book Description:

    Drawing on a wide range of sources, from popular literature, movies, and television drama to government and institutional documents, this book reveals similarities in the presumptions underlying British and American health policies, while also exploring the distinctive way in which policy was shaped by political culture, class relationships, and economic resources in each country.

    Originally published in 1986.

    ThePrinceton Legacy Libraryuses the latest print-on-demand technology to again make available previously out-of-print books from the distinguished backlist of Princeton University Press. These paperback editions preserve the original texts of these important books while presenting them in durable paperback editions. The goal of the Princeton Legacy Library is to vastly increase access to the rich scholarly heritage found in the thousands of books published by Princeton University Press since its founding in 1905.

    eISBN: 978-1-4008-5580-3
    Subjects: Health Sciences

Table of Contents

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  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-viii)
    (pp. ix-2)

    Many of the vexing problems of health affairs in Britain and the United States in the 1980s are the unanticipated consequences of a policy, more precisely, a set of policies and ideals that, for most of this century, seemed self-evidently the best way to advance science and improve the health of the public. I call this policy hierarchical regionalism, by which I mean a particular logic of organization based upon a theory of how medical knowledge is discovered and disseminated.

    I use the phrase hierarchical regionalism to summarize three assumptions that became the basis of health policy in Britain, the...

  4. I Health Policy and the Perception of Medical Progress: 1910-1918
    (pp. 3-20)

    In the early twentieth century, many people in both Britain and the United States believed that health policy should be reformulated. Enormous changes were occurring in medicine. For the first time, people of all social classes expected to be hospitalized for serious illnesses. New instruments and techniques made diagnosis more precise. Scientific advances and the publicity accorded them in the press had stimulated optimism that new therapies would soon be discovered. In both countries, more stringent requirements for medical education and entry into the profession combined with the increase in hospital practice had stimulated the emergence of new medical elites....

  5. II Commitment to Hierarchy and Regionalism: Britain, 1918-1929
    (pp. 21-36)

    By the end of the First World War, social policy in Britain had become compartmentalized. Most of the people who proposed or administered social policy regarded higher wages, social and medical services, and better housing as parallel rather than competing strategies to improve the health and welfare of citizens. Advocates of new health policy gave priority to translating the results of advances in medical science into properly organized and accessible service.

    People who disagreed about many details of health policy agreed about reorganizing medical services to achieve hierarchical regionalism. Leaders of each major interest group in health affairs—general practitioners,...

  6. III The Promise and Threat of Hierarchy: The United States, 1918-1933
    (pp. 37-51)

    In the United States, as in Britain, influential individuals and groups advocated reorganizing medical services in the decade after World War I. Health politics in the two nations were, however, profoundly different. Because both general and professional politics were more centralized in Britain, interest groups worked to influence the Ministry of Health. In the United States, no single agency was an analogue of the ministry. The role of the federal government in domestic health affairs was limited to assisting the states and caring for the military, war veterans, seamen, and Indians. Although many officials of state and municipal health departments...

  7. IV Strengthening Consensus: Britain, 1929-1939
    (pp. 52-69)

    By 1929, local authorities, voluntary hospitals, and medical interest groups in Britain had begun to implement the consensus about health policy that had emerged since the First World War. Under the Local Government Act of 1929, county and borough authorities could transform hospitals built for the poor into general hospitals open to members of other classes. The governors of voluntary hospitals, especially the larger ones, had agreed to coordinate—or pretend to do so—with local authorities as the price of central government subsidy of their costs. The leaders of the major medical interest groups—general practitioners, consultants, and medical...

  8. V Acrimony and Realignment: The United States, 1932-1940
    (pp. 70-93)

    In the United States in the 1930s, a consensus about the importance of medicine in the media and among people who had money to spend for health care was not translated into national health policy. The press, movies, and radio celebrated the progress of medical science and exaggerated the virtues of those who applied it. Spending for doctors and hospitals from private, philanthropic, and public sources grew. But debates about national health policy were acrimonious. Nevertheless changes in the medical profession created the basis for a new political alliance on behalf of achieving hierarchical regionalism in installments.

    The movies, the...

  9. VI The Second World War and Health Policy: Britain, 1939-1945
    (pp. 94-114)

    By the late 1930s, although individuals and interest groups in Britain disagreed about how to define and govern regions, there was no controversy about the desirability of creating hierarchies of hospitals coordinated with other services. Moreover, unlike the United States, where prominent doctors had begun to separate the issue of increasing the supply of health services from general social policy, British interest groups continued to emphasize the social as well as the scientific justification for national health policy.

    Advocates of hierarchical regionalism within the Ministry of Health became more aggressive. In 1936, Sir Arthur McNalty, Newman’s successor as chief medical...

  10. VII The Second World War and Health Policy: The United States, 1941-1946
    (pp. 115-131)

    The organization of medicine for war influenced postwar health policy in the United States as it did in Britain. In 1932, Roger I. Lee, writing for the Committee on the Costs of Medical Care, had de fined good medical care as what respected specialists did.¹ In 1945, as president of the AMA, Lee announced that his standard had changed from how leaders of the profession practiced to the extraordinary care given to fighting men.² The same year, President Harry S. Truman, announcing his support for health policy opposed by the AMA, declared that the armed forces provided the best medical...

  11. VIII Establishing the National Health Service: Britain, 1946-1951
    (pp. 132-148)

    The National Health Service, established in 1946, reorganized but did not radically transform medical care in Britain. By the end of the war, the majority of employed workers were covered by National Health Insurance. Private insurance plans paid for doctors’ services to most other people, including many dependents of workers covered by NHI. Many people had private hospital insurance. In the 1930s, many public hospitals, subsidized by local authorities, began to compete with the voluntaries. General practitioners earned most of their income from capitation payments. After 1939, consultants were salaried by the Emergency Hospital Service. Under the EHS, moreover, local...

  12. IX A Policy for Growth: The United States, 1946-1953
    (pp. 149-168)

    Unlike Britain, where the NHS stimulated increased demand for health services in an austere economy, the United States prospered after the war. Demand for medical care was stimulated by health insurance underwritten by nonprofit or commercial organizations. The War Labor Board had encouraged employers to purchase health insurance in order to reward workers without paying inflationary wage increases. In the late 1940s, the federal courts sanctioned health insurance as a legitimate subject for collective bargaining. Moreover, health insurance as a fringe benefit received a federal subsidy because it was not counted as taxable income to either corporations or their employees....

  13. x The Priorities of the National Health Service: Britain, 1951-1962
    (pp. 169-187)

    After World War II, demand for medical care increased in both Britain and the United States. More children were born in the 1950s than in any decade since the beginning of the century. Because mortality from infectious diseases and malnutrition continued to decline, more children survived to receive preventive care, to have accidents, and, in adolescence, to receive services associated with their sexuality. Because life expectancy increased, there was more chronic disease than ever before.¹

    Although health policy in both countries implemented the principles of hierarchical regionalism, there were important differences in how the medical services of each were organized....

  14. XI A Triumphant Coalition: The United States, 1953-1965
    (pp. 188-206)

    A commission appointed by Harry S. Truman had recommended a comprehensive health policy just before Dwight D. Eisenhower became president. There was substantial support for some of the commission’s proposals for more hospital construction, increased biomedical research, regional hospital planning and coordination, and subsidized medical care for the poor and the disabled. Other proposals were controversial, especially grants to medical schools for education and a federal program of medical care for the elderly.

    During the next dozen years, the commission’s recommendations became national policy. By the end of Lyndon Johnson’s administration in 1969, federal legislation had been enacted to subsidize...

  15. EPILOGUE The Consequences of Hierarchical Regionalism
    (pp. 207-212)

    This book is a history of ideas about organizing health policy and of the priority accorded to organization in health policy because of those ideas. In the mid-1960s, as a result of the ideas I have described, many people in Britain and the United States were confident that medical science would continue to progress and be disseminated efficiently through regional hierarchies. Since the 1960s, however, health policy based on hierarchical regionalism has had unexpected consequences.

    Belief in the continuous progress of medical science and its applications was rooted in the nineteenth century. In the last half of that century, increasing...

    (pp. 213-226)
  17. INDEX
    (pp. 227-234)
  18. Back Matter
    (pp. 235-235)