Healthy, Wealthy, or Wise? Issues in American Health Care Policy

By Charles T. Stewart Jr. | Go to book overview

Preface

For many years I have been concerned about the overemphasis on medical treatment in the maintenance of good health. 1 Medical care was, and remains, inefficient. But what precipitated work on this book was a foreboding that the sustained upward creep in the share of gross national product (GNP) going to the health care industry would erode the living standards of my children's generation. I fear for their future, when in the second decade of the twenty-first century the post-World War II baby-boom generation achieves retirement age. At that time, living standards could experience a sharp drop.

I am concerned about health costs, not over the next few years, but in the next thirty years. With continued growth in technology, in the population over sixty-five years of age, and in medical care costs, this industry, which absorbed 5.3 percent of GNP in 1960 and now takes 14 percent, is projected to absorb nearly one-third of GNP by the year 2030. 2 We could be spending almost as much on other health care issues: environmental health and household and workplace safety. These large increases in share of GNP devoted to health care imply a decreasing share of private income available for other goods and services; they also mean that most government expenditures will be needed for health care, social security, and interest payments on the debt, with little left for anything else. Resources available for private investment and research other than medical research will be reduced, slowing economic growth. Living standards will have to fall if radical change is not implemented fairly soon.

This book examines the varied causes of the rapid increase in the cost of health care over the past three decades and considers the transformation of our health care delivery system that must occur early in the twenty-first century if private standards of living are not to decline and all other government social and economic programs are not to be starved. Proposals under discussion today would not reduce health care costs. They might slow down

-vii-

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Healthy, Wealthy, or Wise? Issues in American Health Care Policy
Table of contents

Table of contents

  • Title Page iii
  • Contents v
  • Preface vii
  • Notes viii
  • 1 - Determinants of Health 1
  • Notes 6
  • 2 - Why Are Costs Out of Control? 7
  • Notes 27
  • 3 - Must Living Standards Decline? 28
  • Notes 38
  • 4 - Health Insurance Raises Demand and Supply 40
  • Notes 49
  • 5 - The Excess of Physicians and Services 51
  • Notes 77
  • 6 - The Medicalization of Health 82
  • Notes 97
  • 7 - Mental Illness 99
  • Notes 119
  • 8 - The Excessive Demand for Medical Care 123
  • Notes 136
  • 9 - Research and Technology 138
  • Notes 161
  • 10 - The Physician as Agent 164
  • Notes 179
  • 11 - Prevention: Environmental and Behavioral Modification 181
  • Notes 210
  • 12 - The Demedicalization of Health Care 213
  • Notes 222
  • 13 - What to Do? 223
  • Notes 250
  • Index 253
  • About the Author 263
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