Medi-
cine and Public Health is a broad-brush description and analysis of the social
institutions of medicine and public health in the United States

Chapter 1 provides a historical overview of the development of key com-
ponents of the health care system and makes an initial foray into problem
areas such as cost, quality of care, and political influence. Chapter 2 focuses
on the critical issue of access to health care, with special attention paid to mi-
norities, the uninsured, and low-income families. Chapter 3 discusses the
historical political-economic role of the American Medical Association and
focuses on key problems created when physicians mix the practice of medi-
cine with entrepreneurship. Chapter 4 discusses the historical development
of nursing, particularly in relationship to the historical drive of physicians for
professional dominance. Changes in the nursing work environment are dis-
cussed, including issues such as minority participation, sexism, nurse-
entrepreneurs, and labor struggles. Chapter 5 explores one of the key insti-
tutions in America's health care system: hospitals. The historical develop-
ment of the modern hospital is discussed, as well as current trends in corpo-
rate chain ownership and resulting social consequences. Chapter 6 explores
the complicated but crucial issue of managed care. The chapter discusses
why managed care has boomed recently, its relationship to the health insur-
ance industry, and actual and potential negative social consequences that this
industry has spawned across the United States. Chapter 7 surveys the alter-
native health care industry, looking at the historical struggle between alter-
native practitioners and "regular" physicians. Special attention is given to
areas such as chiropractic, homeopathy, food supplements, fraud, and cancer
quackery. Chapter 8 conducts an in-depth analysis of the powerful prescrip-
tion drug industry, paying particular attention to political influence of the
industry, marketing, and the use of ideology. Chapter 9 reviews a number of
major medical services industries, including the dialysis industry, medical
laboratories, and diagnostic imaging equipment. Selected social and
political-economic problems relevant to each industry are analyzed and dis-
cussed. Chapter 10 provides an overview of the massive federal health care
and public health establishment. Federal involvement in health care and
public health delivery, financing, regulation, and research is explored. Some
of the institutions reviewed include military medicine, Medicare, the Food
and Drug Administration, and the National Institutes of Health. Chapter 11
looks at health care institutions primarily housed in state and local jurisdic-
tions. At the state level Medicaid, is by far the largest single health care pro-
gram. It is beset with an array of major problems that merit special review.
Finally, Chapter 12 sums up the previous chapters and looks at health reform
issues ranging from proposals to take the Canadian health care system as a
potential model for the United States to the political actors and struggles in-
volved in these difficult issues.

-xix-