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Books, Journals, New Media
October 8, 2003

Politics and Health Care

Author Affiliations

Books, Journals, New Media Section Editor: Harriet S. Meyer, MD, Contributing Editor, JAMA; David H. Morse, MS, University of Southern California, Norris Medical Library, Journal Review Editor.

JAMA. 2003;290(14):1923-1924. doi:10.1001/jama.290.14.1923-a

Another autopsy of the failure to implement a US national health plan? Yes, but Dead on Arrival is more interesting, informative, and compelling than others. Its strength lies in the integration of multiple social, economic, and political perspectives within a historical context to address the question, why no national health insurance?

Colin Gordon, associate professor of history at the University of Iowa, emphasizes the interplay of multiple, interactive forces affecting health care policy in achieving employer-provided rather than publicly funded health insurance. He also revisits and faults earlier arguments about defeated national health insurance proposals. He finds insufficiently explanatory the radicalist view that powerful, conservative political forces (eg, Congress, industrialists, the American Medical Association [AMA]) frustrated the desires of the people. He also finds institutional explanations insufficient, namely that fragmented power among state and federal governments allows economic and political interests to go in multiple directions, making it extremely difficult to reshape existing institutions or to develop new ones to meet emerging problems. Finally, he is unconvinced by the widely held liberal view that government deals with social and economic problems only after wide consensus has been reached that private solutions have been inadequate in meeting population needs.

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