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Theodore Marmor, whose work has appeared in scholarly journals and books, as well as in the nation's major newspapers and magazines, here presents some of his most recent writings that illuminate the historical, political, and economic considerations lying behind various proposals now under debate. Marmor explains what we can and cannot expect from reform of American medicine, and he addresses the many conflicting claims about the remedies for America's problems with medical costs, quality, access, and organizations. He discusses, for example:
-the misplaced faith that cutting waste will greatly ease our financial troubles and markedly improve our health;
-the exaggerated arguments for "managed competition";
-the myths that either non-profit or for-profit institutions are the key to reform;
-the misleading and fearful debate over rationing;
-the lessons to be learned from Canada's and Japan's experiments with universal health insurance;
-the controversial place of Medicare in the current reform struggle;
-barriers facing implementation of any of the major health care proposals;
-and the possibility of fusing different approaches to achieve reform.
This book contains black-and-white illustrations.
The essays that make up this book reflect my reform aspirations, but they do not constitute a reformer's brief. Rather, they represent years of effort to understand the dynamics of American medicine, the political constraints that shape our policies, and the lessons that history and comparative study can offer. They reflect as well the conviction that nations do not solve socioeconomic problems with panaceas. At best, collectivities learn to cope better with the more or less intractable conflicts among objectives, interests, and limited resources and opportunities.
Proceeding from that premise, these collected writings address the institutional constraints on our capacity to reform American medicine: the legacy of our history, the character of the ordinary politics that shape fields of medical policymaking, the unusual opportunity provided by a consensus on the severity of our troubles, and the familiar risk that a fragmented policy will confuse the doable with the desirable.
Excerpted from Understanding Health Care Reform by Theodore R Marmor. Copyright © 1994 by Yale University Press. Excerpted by permission.
|Ch. 1||American Health Care Reform: Separating Sense from Nonsense||1|
|Pt. I||Medical Care Politics: Constraints on Reform||19|
|Ch. 2||How We Got to Where We Are: American Health Care Politics, 1970 to 1990||21|
|Ch. 3||Medical Care Crises and the Welfare State||31|
|Ch. 4||Nonprofit Organizations and Health Care||48|
|Ch. 5||Cutting Waste by Making Rules: Promises, Pitfalls, and Realistic Prospects||86|
|Ch. 6||Rationing: Painful Prescription, Inadequate Diagnosis||107|
|Pt. II||The Debate Over Universal Health Insurance||121|
|Ch. 7||American Medical Care Reform: Are We Doomed to Fail?||123|
|Ch. 8||Reflections on the Argument for Competition in Medical Care||139|
|Ch. 9||The Case for Straightforward Reform||146|
|Ch. 10||The Missing Alternative: How Washington Elites Pushed Single-Payer Reform Plans off the Agenda||159|
|Ch. 11||Hype and Hyperbole in Health Reform||170|
|Pt. III||Comparative Perspectives||177|
|Ch. 12||Patterns of Fact and Fiction in Use of the Canadian Experience||179|
|Ch. 13||Japan - A Sobering Lesson||195|
|Pt. IV||Policy Choices: Dilemmas and Decisions||203|
|Ch. 14||Coalition or Collision? Medicare and Health Reform||205|
|Ch. 15||Implementation: Making Reform Work||215|