Understanding The Healthcare Reform

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The reform of American medical care is the most important topic on the nation's domestic agenda and the centerpiece of the Clinton administration's plans for social policy and long-term economic development. This book, written by a preeminent analyst of medical politics and policy who is a frequent adviser to Congress, helps to clarify the current debate over the President's bill and the proposed alternatives to it. It is essential reading for 1994.

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.

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Product Details

  • ISBN-13: 9780300058796
  • Publisher: Yale University Press
  • Publication date: 9/28/1994
  • Series: Yale Fastback Series
  • Edition description: New Edition
  • Pages: 302
  • Product dimensions: 6.00 (w) x 9.00 (h) x 0.68 (d)

Read an Excerpt


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.
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Table of Contents

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
Notes 225
Glossary 255
Index 271
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