Differential Diagnoses: A Comparative History of Health Care Problems and Solutions in the United States and France (review)

Abstract

Reviewed by: Differential Diagnoses: A Comparative History of Health Care Problems and Solutions in the United States and France Daniel M. Fox Paul V. Dutton . Differential Diagnoses: A Comparative History of Health Care Problems and Solutions in the United States and France. The Culture and Politics of Health Care Work. Ithaca, N.Y.: Cornell University Press, 2007. xi + 253 pp. $29.95, £14.95 (978-0-8014-4512-5). This book is a comparative history of similarities and differences in health policy in France and the United States during the past century. According to Dutton, the most important similarity is that financing health services has been a "mixed public-private endeavor" in both countries (p. 213). The most important difference is that the French value collective responsibility for health care more highly than the Americans do. [End Page 224] Dutton's attribution of the causes of similarities and differences in health policy is consistent with the work of most comparative historians. He attributes similarities to the countries' shared experience of urbanization and industrialization, to their growing burden of chronic disease, to the increasing cost of health care, to political action by physicians to maximize their clinical autonomy, and to policymakers who aspired to make health services more accessible, effective, and efficient. He ascribes differences in policy in the two countries to political culture and to contingencies, especially war. Differential Diagnosis has eight chapters of scholarship. When Dutton writes about France, he skillfully interprets archival, printed primary and secondary sources. In contrast, his history of health policy in the United States is informed by secondary sources and selective reading in printed primary sources. Dutton becomes an advocate in the ninth chapter. The "single most imperative reform to U.S. and French health care," he writes, "is to sever the obsolete link between employment and health security" (p. 218). Although he acknowledges that the history of employment-based financing has been quite different in the two countries, he asserts that in both it "stands in the way of economic prosperity and social justice" (p. 218). Dutton's polemic is forceful, compassionate, and simplistic. He urges Americans to emulate the French commitment to collective responsibility for health services. In his scholarly chapters, in contrast, he demonstrates that countries are more likely to ignore or adapt than to emulate policies elsewhere. Moreover, the proposals to decouple employment and health coverage in the United States that currently have the strongest political support could reduce access to care by removing approximately $200 billion dollars of employers' tax-exempt spending from the health sector. Dutton does not emphasize sufficiently major differences in health politics and policy between the two countries. Most Americans, for example, assume that health care is not primarily a public or collective responsibility despite evidence that public spending is, by some accounting conventions, more than 60% of the total. Similarly, policymakers in the United States, unlike those in France, have used antitrust law to reduce substantially physicians' monopoly control of medical services. Dutton makes a number of factual errors about the history of health policy in the United States. For instance, President Franklin Roosevelt opposed including health insurance in the legislation that created Social Security before the events described on pages 81-82; the United Hospital Fund, which Dutton describes as a significant participant in a controversy about Blue Cross/Blue Shield in New York City, is a public charity, not a powerful association of hospitals (pp. 128 and 130); Douglas Coleman was a leading Blue Cross executive, not the federal Secretary of Health, Education and Welfare (p. 166); and the planning formula in the Hill-Burton Act of 4.5 acute care beds per 1,000 people was not an arbitrary ceiling but the application of research by staff of the Committee on the Costs of Medical Care in the late 1920s (p. 188). [End Page 225] This reviewer, no expert on French history, found only one apparent error in Dutton's pages on that country. He describes as an example of adverse selection what seems to have been an instance of fraud (p. 126). Daniel M. Fox Milbank Memorial Fund Copyright © 2009 The Johns Hopkins University Press