Rethinking Health Care: Innovation and Change in America

Rethinking Health Care: Innovation and Change in America

Rethinking Health Care: Innovation and Change in America

Rethinking Health Care: Innovation and Change in America

Synopsis

This study of US health care describes how its reorganization has been set by developments in the national and international political economies, and shows how these developments have affected the social and economic transformations.

Excerpt


Understanding How We Got Here: Creating a Health-Care Industry

About a century ago each of the industrialized nations of the world reorganized its health-care system to follow the canons of a newly developing, "modern" medical science. As early as 1917, however, the path of health-care reorganization and development in the United States took a somewhat different direction from that seen in other countries. Decisions about national health insurance -- and the interest group coalitions that formed around this controversy -- created a set of veto groups that would influence health-care decisions thereafter. The contrast in how health care has developed has been especially striking during the 50 years since World War II. Most of the other advanced industrial nations developed some form of a national health-care system (i.e., a government-directed or coordinated program to guarantee health services for all citizens). In contrast, the United States at first created a private, professionally-oriented system focused around the concerns of physicians, who wished to set their own standards of care independent of government control, and to give the highest possible care to patients of their own choosing. About 30 years ago that private, professionally-oriented system evolved into something that, with considerable accuracy, now describes itself as a health-care industry. As that name implies, health care: in the United States has a unique relationship to the larger economy, and indeed, a unique relation to the social fabric of the nation. Physicians, while still important, no longer are at its center. This chapter seeks to understand how that happened and to identify the kinds of organizational relationships that give the health-care industry its current dynamic.

The central story of what happened does not revolve around the rise and fall of the profession of medicine -- that is only one sub-theme of the broader dynamic that has occurred. Nor will an analysis of social inequality, race and class dynamics, or the consolidation of capital satisfactorily explain the changes that have taken place. Many earlier accounts of American health-care developments attempted to fit their analysis into one or the other of these contending frames of reference. Each captures part of . . .

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