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May 18, 1994

Power and Illness: The Failure and Future of American Health Policy

Author Affiliations

University of Pennsylvania Philadelphia

JAMA. 1994;271(19):1545. doi:10.1001/jama.1994.03510430101044

Good policy requires a strategic focus, the antithesis of conventional wisdom—if it ain't broke, don't fix it. The US health care system can never be accused of taking a strategic, systems view of its health problems. Dr Fox opens his analysis of health policy by noting immediately, "The contemporary disarray in health affairs in the United States is a result of history. It is the cumulative result of inattention to the burden of chronic disabling illness." I would add that it is also the result of political characteristics (pluralism, individualism, divided government powers), social ethos (volunteerism, lack of consensus), and economic perspective (capitalism, uncritical reliance on the mythic market).

The central theme is that combating infection and other acute disease has been the main force distorting every aspect of US health care policy, even though chronic disease was recognized by the 1920s as the major health issue. However, Dr Fox

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