search for solutions. It cannot be assumed that the roles they have played in
the past will be the same roles they play in the future. In some cases it cannot
be assumed that they will have any role at all in the future.

Private Medicine and Public Health surveys the broad expanse of health and
health care institutions in America from a critical, macro, political-economic,
and social problems-oriented perspective. Moreover, the issue of racism
emerges repeatedly as central to the analysis.

A critical perspective does not blithely accept the common or official expla-
nation of why things are the way they are. A critical analysis may start with a
thorough description of a social institution or process, but it goes beyond
that. It tries to dig under assumptions and peer around ideologies that are
used to justify vested interests but that may play fast and loose with facts. A
critical analysis exposes the relationship between ideologies and objective in-
terests, particularly financial interests. A critical analysis of the tobacco indus-
try, for example, would note that the industry repeatedly testifies at hearings
across the country that there is no definitive proof that smoking tobacco
causes cancer. While a few well-paid scientists parrot this distortion of scien-
tific method, the rest of the scientific world understands that the correlation
between smoking and various cancers is strong enough to assume a causal
relationship and to develop public policy based on that assumption. The ide-
ological stance of the tobacco industry has little to do with an honest debate
about the scientific determination of a causal relationship, but it has every-
thing to do with avoiding lawsuits, blunting antismoking campaigns, and
maximizing profits.

Private Medicine and Public Health has a macro focus. Macro units of analy-
sis include social institutions, corporations, government programs, political
coalitions, and social processes. Health care in the United States is increas-
ingly organized in for-profit corporations, such as health maintenance orga-
nizations, hospitals, and nursing homes. Moreover, hospitals and nursing
homes, for example, are increasingly organized into huge corporate regional
and national chains. These corporate behemoths not only represent the cur-
rent face of medicine in America, but they are determining its future as well.

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