The Health Care Mess: How We Got Into It and What It Will Take To Get Out

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If we can decode the human genome and fashion working machines out of atoms, why can't we navigate the quagmire that is our health care system? In this important new book, Julius Richmond and Rashi Fein recount the fraught history of health care in America since the 1960s. After the advent of Medicare and Medicaid and with the progressive goal to make advances in medical care available to all, medical costs began their upward spiral. Cost control measures failed and led to the HMO revolution, turning patients into consumers and doctors into providers. The swelling ranks of Americans without any insurance at all dragged the United States to the bottom of the list of industrialized nations.

Over the last century medical education was also profoundly transformed into today's powerful triumvirate of academic medical centers, schools of medicine and public health, and research programs, all of which have shaped medical practice and medical care. The authors show how the promises of medical advances have not been matched either by financing or by delivery of care.

As a new crisis looms, and the existing patchwork of insurance is poised to unravel, American leaders must again take up the question of health care. This book brings the voice of reason and the promise of compromise to that debate.

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Editorial Reviews

American Prospect
What sets Julius Richmond and Rashi Fein's The Health Care Mess apart from the pack is its expanded perspective. Rather than approaching health as a purely political issue, they detail the evolution of the health-care industry, especially the research sector, teaching infrastructure, and hubs of care delivery. For them, health care is a story not merely of failed political machinations but of new medicines and more advanced treatments. As both were involved in government efforts to expand care during the 1960s and 70s, they're particularly strong when discussing the 'bumper crop' of transformative health legislation and failed efforts to achieve universal coverage during that period.
— Ezra Klein
New England Journal of Medicine
Over the course of their distinguished careers, the authors have participated in innumerable debates on matters of health care policy, large and small. They are veterans of fights over covering the uninsured, physician training, mental health, and substance abuse, and over funding for research, patient care, and medical education. They have extensive experience with the behavior of federal and state agencies, academic medical centers, insurers, and bureaucrats and bureaucracies, along with deep knowledge of the varying ways in which the United States has financed and delivered health care services. This book distills these experiences into a sophisticated historical and institutional perspective on why our health care system looks the way it does...The book is worth reading for the authors' perspective on how we ended up where we are and on ways and means of getting somewhere else.
— David A. Hyman
Publishers Weekly
As Americans become healthier and live longer, we increasingly concentrate on preventing illness or injury from making some of those extra years an agony. We spend far more than any industrialized country on health care-and get far less for it. How did we get here? Former surgeon general Richmond and medical economist Fein offer a judicious, account making it blindingly clear that any decentralized system with multiple centers of influence (HMOs, employer-sponsored insurance plans, etc.) will force each segment of the health-care world to act in its own interest: the young and healthy opt out of mass coverage plans, which prevents their contributions from being spent on the aged and infirm; companies pass costs on to government or its own employees. In such a climate, what starts as rational self-interest inevitably morphs into a never-ending "quest for profits," which is where we are today. Bringing to this dry yet important subject authoritative knowledge and insight, the authors slice through the intricacies like an experienced surgeon. Their proposed solution is government-financed universal health insurance, though they admit our legislators have not had the stomach for it in the past. (Sept.) Copyright 2005 Reed Business Information.
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Product Details

  • ISBN-13: 9780674019249
  • Publisher: Harvard University Press
  • Publication date: 9/6/2005
  • Edition description: New Edition
  • Pages: 320
  • Product dimensions: 5.82 (w) x 8.60 (h) x 1.11 (d)

Meet the Author

Julius B. Richmond, M.D, is a founder of Head Start and the former Surgeon General under President Jimmy Carter. He is currently the John D. MacArthur Professor of Health Policy, Emeritus, at Harvard University.

Rashi Fein, Ph.D., is Professor of Medical Economics, Emeritus, at Harvard Medical School, and the author of Medical Care, Medical Costs: The Search for a Health Insurance Policy.

Jimmy Carter is Former President of the United States and was awarded the Nobel Peace Prize in 2002.

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Table of Contents

Pt. I The early years : 1900-1965
1 The educational and scientific revolution : higher standards and changing priorities 9
2 The consumer revolution : increasing access to medical care 30
Pt. II In the wake of Medicare and Medicaid : 1965-1985
3 Emerging tensions between regulation and market forces : dealing with growth 55
4 Education for the health professions : the impact of growth 89
Pt. III Moving to the present : 1985-2005
5 The entrepreneurial revolution : a changing face for medicine 129
6 Beyond the dollars : progress in health and the role of public health 158
Pt. IV Anticipating the next revolution : 2005 and beyond
7 Medical challenges and opportunities 191
8 Increasing equity : achieving universal health insurance 228
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