US Health Policy and Health Care Delivery: Doctors, Reformers, and Entrepreneurs

Abstract

From its no-nonsense title to its straightforward conclusion, US Health Policy and Health Care Delivery offers a clear, concise, and informative history of the failure of the United States to establish a system of universal health care. Taking a structural approach, Carl F. Ameringer argues that the system of health care delivery, as it has evolved in the United States, is “poorly equipped and designed to meet the challenges of universal access” (p. 2). In the systems to which Ameringer compares the United States'—those in Australia, Canada, France, Germany, and Great Britain, all of which provide universal health care—the government establishes the frameworks within which doctors and hospitals function. In this country, in contrast, access to health care has been negotiated among “three separate and autonomous policymaking arenas” (p. 13). The professional arena, which principally refers to organized medicine, is controlled largely by doctors. The market arena, which encompasses health systems, insurers, pharmaceutical companies, and nursing homes, is controlled by entrepreneurs and corporate interests. The forces in control in the government arena, which includes legislatures, federal and state agencies, courts, and special interest groups, have been variable, depending on the political climate of a particular era. From the interrelated histories of clashes, negotiations, and compromises within and among each of these three “arenas,” he argues, the American health care system was created, and therein lies its problems.