Study Guide #2 - Wellesley College

Political Science 317Study Guide #2The Social Transformation of American MedicineThe Abraham book g

PoliticalScience317 StudyGuide#2 TheSocialTransformationofAmericanMedicine TheAbrahambookgaveusasenseofhowtheAmericanhealthcaresystemoperatestoday. Buthowdidweendupwithsuchacomplex,fragmentedsystem?Tounderstandwhy,for example,wehaveanationalprogramforthoseover65,butnotforchildren,orwhywehave suchacomplexarrayofprivateemployer-relatedhealthinsuranceoptions,wchavetoknow thehistoryofAmericanhealthcarepolicy.Thatisthepurposeofthisbook.Noticethat whileprovidingthehistory,Starrisalsotryingtoexplainit.Inparticularhe'stryingto explainsomethingthatisatthecenterofthiscourse:whydoestheAmericanhealthcare systemlooksodifferentfromthesystemsofotheraffluentnations?Hisexplanationis complicated,andyoushouldn'ttakeitasgospel—asyou'llseeinthenextfewweeks,there aremanycompetingexplanations.ButIwantyoutoatleastbeabletounderstandhis explanationandbeabletotalkaboutitintelligently. Thebookwaswritteninthe1980sandendswithasurprisinglyaccuratepredictionofwhat thenexttwodecadesofhealthpolicywouldlooklike,(Allthesame,wewillreadnexta summaryofthepasttwentyyearsofhealthpolicywrittenbyauthorswhoactuallyobserved it.)Thisisaveryrichbookthatcoversanenormousarrayoftopics,fromthegrowthof medicalmalpracticelitigationtothedevelopmentof"alternative”medicine,butthereisa grandnarrativethatrunsthroughoutit.Themedicalprofessionuseditspoliticalpowerto fendoffgovernmentcontroloveritspractices,evenwhilesecuringmoreandmore governmentfundingforhealthcare.Theconsequencesofthisareclear:Thecombinationof increasinggovernmentfundingandfewcostcontrolsledtoskyrocketinghealthcare spending.Thisinturnhasledpolicymakerstosearchforwaystousethe"marked'andthe privatesectortocontrolcosts.Theirony,then,isthatinresistinggovernmentcontrolso strongly,thedoctorsmayhavesimplytradedinonesetofmastersforanother. Thenarrativeof"managedcare,,,thefirstbigprivatesectorresponsetohealthcarecosts, hasitsownironies...butthafsforlaterinthecourse. Origins (235-279)Whyare“intermediaries"athreattodoctors?