THE CASE FOR AMERICAN MEDICINE: A Realistic Look at Our Health Care System and the Utopian Alternatives

Mr. Schwartz is the professor, the New York Times editor and the Kremlinologist, and author of a number of critically approved books. Thus one hesitates to damn out of hand this new book which repudiates most of what we've been led to believe is wrong with health care today -- or what he calls ""the conventional liberal wisdom"" or ""simplistic"" stereotypes. (Speaking of simplistic -- ""the great popularity of a television program like Marcus Welby, M.D. would not be possible if most Americans saw their doctors as the grim, cold and hostile figures the most impassioned critics depict."") One of the most important points Schwartz makes is that health cannot be divorced from environmental and biological determinants. True. That we are getting better medicine today is affirmed by longer life expectancy figures and the elimination of certain diseases. And that there are Scylla and Charybdis aspects to almost anything you want to argue about -- overdoctoring, underdoctoring, negligence. He altogether dismisses the doctor shortage and considers redistribution ""hardly so urgent"" (even if -- Selig Greenberg -- there are 5000 communities without a doctor); he also claims that 25% of hospital beds (figures again) are unoccupied without considering in what areas they are untenanted. And there is a long discussion of costs, inflated by Medicare and Medicaid, and of Kennedy's HMO (Health Maintenance Organization) and also the Kaiser-Mermenente structure -- the latter leading to a greater disaster area. That other parti pris -- taken energetically but reductively -- you can also remember that Dr. Kildare was just as well loved in what he considers the not so advanced days of American medicine.