Beginnings Count: The Technological Imperative in American Health Care

Hardcover | May 1, 1997

byDavid J. Rothman

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In the wake of the recent unsuccessful drive for health care reform, many people have been asking themselves what brought about the failure of this as well as past attempts to make health care accessible to all Americans. The author of this original exploration of U.S. health policy suppliesan answer that is bound to raise some eyebrows. After a careful analysis of the history and issues of health care, David Rothman concludes that it is the average employed, insured "middle class"--the vaguely defined majority of American citizens--who deny health care to the poor. The author advances his argument through the examination of two distinctive characteristics of American health care and the intricate links between them: the ubiquitous presence of technology in medicine, and the fact that the U.S. lacks a national health insurance program. Technology bears theheaviest responsibility for the costliness of American medicine. Rothman traces the histories of the "iron lung" and kidney dialysis machines in order to provide vivid evidence for his claim that the American middle class is fascinated by technology and is willing to pay the price to see the mostrecent advances in physics, biology, and biomedical engineering incorporated immediately in medical care. On the other hand, the lack of a universal health insurance program in the U.S. is rooted in the fact that, starting in the 1930s, government health policy has been a reflection of the needs andconcerns of the middle class. Playing up to middle class sensibilities, the American presidents, Senate and Congress based their policy upon the private rather than the public sector, whenever possible. They encouraged the purchase of insurance based on the laws of the marketplace, not provided bythe government. Private health insurance and high-tech medicine came with a hefty price, with the end result that about 40 million Americans could not afford medical care and were left to fend for themselves. The author investigates the moral values underpinning these decisions, and goes to thebottom of the problem of why the United States remain the only developed country which continually proves unable to provide adequate health care to all its citizens.

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In the wake of the recent unsuccessful drive for health care reform, many people have been asking themselves what brought about the failure of this as well as past attempts to make health care accessible to all Americans. The author of this original exploration of U.S. health policy suppliesan answer that is bound to raise some eyebrow...

David J. Rothman is Bernard Schoenberg Professor of Social Medicine, Professor of History, and Director of the Center for the Study of Society and Medicine at the Columbia College of Physicians and Surgeons. Trained in social history at Harvard University, he has explored American practices toward the deviant and dependent. In 1987 he...

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Format:HardcoverDimensions:208 pages, 8.43 × 5.75 × 0.83 inPublished:May 1, 1997Publisher:Oxford University Press

The following ISBNs are associated with this title:

ISBN - 10:0195111184

ISBN - 13:9780195111187

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Table of Contents

1. Blue Cross and the American Way in Health Care 2. The Iron Lung and Democratic Medicine 3. Medicare for the Middle Class 4. Dialysis and National Priorities 5. Rationing the Respirator 6. No Limits

Editorial Reviews

"Rothman is most successful in illustrating modern society's preoccuption with medical technology -- the "magic bullets" that help compensate, though not entirely and not equitably, for the life-styles, socioeconomic conditions, and environmental elements that dictate health outcomes. The casestudies demonstrate the powerful social bias toward innovation and diffusion of any technology with significant benefits for identifiable individuals."--The Journal of American History