Health care in America: a history

Abstract

HEALTH CARE IN AMERICA: A HISTORY John C. Burnham Baltimore: Johns Hopkins University Press, 2015, 616 pp., $34.95 (paperback), $65.00 (hardcover).There is a broad general consensus that if we were starting with a blank slate and designing a health care system or enterprise for the United States today, the finished product likely would bear only very limited resemblance to the jumbled patchwork in evidence currently. Of course, though, we do not have the freedom to work with a tabula rasa and instead function as creatures who are both informed and empowered, on one hand, and bound, on the other, by our history. Our history, depending on one's perspective, either properly restrains us from making abrupt, radical changes or improperly prevents us from making needed, rational changes. In either event, knowing something about our history is necessary to understand why the present American health care system-for better or worse-looks like it does.Health Care in America: A History tells one version of this story, from the perspective of Ohio State University historian John C. Burnham. This volume not only details the evolution of medical science but also explains changes in how that medical science has been provided to patients and how providers have been paid for what they provide. This book is a scholarly accomplishment, written for serious students of medical history and health policy, of nearly 500 pages of text, many fascinating pictures and other graphics, 88 pages composed of more than a thousand endnotes, and a 16-page topical index.The 400-year time span covered is 1607 (the date of the first permanent European settlement in the New World) through the first decade of the 21st century. To support the author's central theme, he traces the progression of health care in the United States chronologically through the epochs of deference to tradition (1607-1880s) into modernization (1880s-1980s), characterized as the process of organizational and technological innovation, and finally into a post-1980s epoch characterized by a significant shiftin the physician-patient relationship.Out of this rich historical rendition, the reader may draw many lessons, some obvious but others perhaps unexpected. One lesson is that the current consumer information age (exemplified, e.g., by medical information on the Internet, direct-to-consumer advertising of medical products and services for real and industry-created diseases and defects, and the marketing of home testing kits) is a direct descendant of the earliest days of health care delivery in the United States when, for instance, doctors wrote books and articles for the lay public and competitively marketed their services directly to patients. A second lesson is that issues pertaining to the method, source, and amount of provider payment for services rendered (such as hidden cross subsidies for hospitals) are timeless and ongoing. Similarly, concerns about health care access and affordability, with accompanying problems relating to health disparities, have been a constant challenge since the earliest days of American medicine. Many of yesterday's gripes and fears about our health care system sound distinctly familiar today. In the realm of the physician-patient relationship, present critics ought to note with irony the complaints widely voiced 60 years ago about medical practice becoming too high tech at the expense of high touch, with physicians functioning more as coordinators of care plans rather than as direct one-on-one healers. …