A physician laments the rise of corporations and the decline of the doctor-patient relationship in American medicine.
Marr (Biochemistry and Molecular Biology of Parasites, 1995) asserts that American medicine has been radically changed by technological innovations, the growth of private and public health insurance, and the profit motive. Over the past half-century, these factors have “altered medical care almost beyond recognition.” Although technology brought many advances, the advent of “Star Trek medicine” helped distance doctors from patients by inserting “physician extenders” —medical assistants, nurses, and techs—into patient care. Outside clinics mainly staffed by these workers grew as insurance companies attempted to control costs. Private and government insurers tried to tamp down rising health care costs by saddling physicians with complex and time-consuming cost-control programs. But doctors aren’t really the problem, Marr argues. Physicians account for only about 10 percent of America’s medical bill. Technology, profits, and other factors have driven the explosion in costs, along with added layers of bureaucrats, managers, and executives. “Medicine lost its soul when big business entered,” Marr writes. As doctors became more like team managers than personal physicians, they distanced themselves from patients, who were “relegated to the status of a product.” Ultimately, this will increase misdiagnoses, he avers. Compared to other advanced nations, the U.S. has extraordinarily high per capita medical costs, while citizens enjoy only mediocre health. Marr has produced a tightly written, forcefully argued indictment of the U.S. health care system that’s well-documented and benefits from his insider knowledge of how hospitals and health care professionals work. His explanation of what led to this mess is succinct and clear. Although it’s hard to feel sorry for handsomely paid physicians, Marr’s argument that they’re more victims than beneficiaries of the corporatized, bureaucratized system rings true, though he could bolster his case with more details about just how much of the massive U.S. medical bill bureaucracy, for-profit hospitals, and insurance companies account for. He’s probably right, however, that this sick system will ultimately crash—a prediction that calls into question his perhaps too-pessimistic conclusion that the system’s structure can’t be changed.
A compact, perceptive diagnosis of the nation’s terminally ill health care system.Pub Date: Feb. 6, 2015
ISBN: 978-1-4917-5484-9
Page Count: 134
Publisher: True Directions
Review Posted Online: Feb. 24, 2016
Review Program: Kirkus Indie
Categories: GENERAL NONFICTION
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This early reader is an excellent introduction to the March on Washington in 1963 and the important role in the march played by Martin Luther King Jr. Ruffin gives the book a good, dramatic start: “August 28, 1963. It is a hot summer day in Washington, D.C. More than 250,00 people are pouring into the city.” They have come to protest the treatment of African-Americans here in the US. With stirring original artwork mixed with photographs of the events (and the segregationist policies in the South, such as separate drinking fountains and entrances to public buildings), Ruffin writes of how an end to slavery didn’t mark true equality and that these rights had to be fought for—through marches and sit-ins and words, particularly those of Dr. King, and particularly on that fateful day in Washington. Within a year the Civil Rights Act of 1964 had been passed: “It does not change everything. But it is a beginning.” Lots of visual cues will help new readers through the fairly simple text, but it is the power of the story that will keep them turning the pages. (Easy reader. 6-8)
Pub Date: Jan. 1, 2001
ISBN: 0-448-42421-5
Page Count: 48
Publisher: Grosset & Dunlap
Review Posted Online: May 20, 2010
Kirkus Reviews Issue: Dec. 1, 2000
Categories: GENERAL NONFICTION
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Noted jazz and pop record producer Thiele offers a chatty autobiography. Aided by record-business colleague Golden, Thiele traces his career from his start as a ``pubescent, novice jazz record producer'' in the 1940s through the '50s, when he headed Coral, Dot, and Roulette Records, and the '60s, when he worked for ABC and ran the famous Impulse! jazz label. At Coral, Thiele championed the work of ``hillbilly'' singer Buddy Holly, although the only sessions he produced with Holly were marred by saccharine strings. The producer specialized in more mainstream popsters like the irrepressibly perky Teresa Brewer (who later became his fourth wife) and the bubble-machine muzak-meister Lawrence Welk. At Dot, Thiele was instrumental in recording Jack Kerouac's famous beat- generation ramblings to jazz accompaniment (recordings that Dot's president found ``pornographic''), while also overseeing a steady stream of pop hits. He then moved to the Mafia-controlled Roulette label, where he observed the ``silk-suited, pinky-ringed'' entourage who frequented the label's offices. Incredibly, however, Thiele remembers the famously hard-nosed Morris Levy, who ran the label and was eventually convicted of extortion, as ``one of the kindest, most warm-hearted, and classiest music men I have ever known.'' At ABC/Impulse!, Thiele oversaw the classic recordings of John Coltrane, although he is the first to admit that Coltrane essentially produced his own sessions. Like many producers of the day, Thiele participated in the ownership of publishing rights to some of the songs he recorded; he makes no apology for this practice, which he calls ``entirely appropriate and without any ethical conflicts.'' A pleasant, if not exactly riveting, memoir that will be of most interest to those with a thirst for cocktail-hour stories of the record biz. (25 halftones, not seen)
Pub Date: May 1, 1995
ISBN: 0-19-508629-4
Page Count: 224
Publisher: Oxford Univ.
Review Posted Online: May 20, 2010
Kirkus Reviews Issue: March 1, 1995
Categories: GENERAL NONFICTION
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