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Doody's Review ServiceReviewer: Conevery A. Bolton, BA (Harvard University)
Description: Historian David Rothman traces the ways in which middle-class demand for high-tech medical interventions has shaped the course of American medicine in the twentieth century.
Purpose: This book grapples with a central question of contemporary American life: how is it that a country with an extremely high level of skilled technological intervention in the ailing human body countenances the vast inequity of access to basic and complex health services?
Audience: This book will be of interest to medical professionals and historians as well as to members of the public interested in the historical roots of contemporary dilemmas over health insurance, managed care, and the role of the federal government in American healthcare.
Features: Six chapters, arranged chronologically, highlight turning points in medical technology, access to health services, and national vs. private responsibility for the expenses of healthcare. Successive chapters discuss the beginnings of Blue Cross in the 1930s, provision of iron lungs in the 1940s and 1950s, debates over Medicare in the early 1960s, federal assumption of the costs of kidney dialysis in the early 1970s, the advent of the respirator in the last third of this century, and the Clinton health plan of the early 1990s. The book's index is useful, and the print quality is good.
Assessment: Rothman's argument is nuanced and historically informed; his writing is clear and straightforward; and his conclusion, that technology in American medicine has been intimately connected with increasing inequality, is thought-provoking and unsettling. Beginnings Count wields a sharp argument, but no bombast. Although Rothman implicitly assails the failure of American medicine to widen access to healthcare, especially technological interventions, to those below the "middle classes," he does so in measured arguments and careful prose, backed up by scholarly research and occasionally enlivened by dry wit.