A compact, perceptive diagnosis of the nation’s terminally ill health care system.

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Fall from Grace

A PHYSICIAN'S RETROSPECTIVE ON THE PAST FIFTY YEARS OF MEDICINE AND THE IMPACT OF SOCIAL CHANGE

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

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Stricter than, say, Bergen Evans or W3 ("disinterested" means impartial — period), Strunk is in the last analysis...

THE ELEMENTS OF STYLE

50TH ANNIVERSARY EDITION

Privately published by Strunk of Cornell in 1918 and revised by his student E. B. White in 1959, that "little book" is back again with more White updatings.

Stricter than, say, Bergen Evans or W3 ("disinterested" means impartial — period), Strunk is in the last analysis (whoops — "A bankrupt expression") a unique guide (which means "without like or equal").

Pub Date: May 15, 1972

ISBN: 0205632645

Page Count: 105

Publisher: Macmillan

Review Posted Online: Oct. 28, 2011

Kirkus Reviews Issue: May 1, 1972

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DEAR MR. HENSHAW

Possibly inspired by the letters Cleary has received as a children's author, this begins with second-grader Leigh Botts' misspelled fan letter to Mr. Henshaw, whose fictitious book itself derives from the old take-off title Forty Ways W. Amuse a Dog. Soon Leigh is in sixth grade and bombarding his still-favorite author with a list of questions to be answered and returned by "next Friday," the day his author report is due. Leigh is disgruntled when Mr. Henshaw's answer comes late, and accompanied by a set of questions for Leigh to answer. He threatens not to, but as "Mom keeps nagging me about your dumb old questions" he finally gets the job done—and through his answers Mr. Henshaw and readers learn that Leigh considers himself "the mediumest boy in school," that his parents have split up, and that he dreams of his truck-driver dad driving him to school "hauling a forty-foot reefer, which would make his outfit add up to eighteen wheels altogether. . . . I guess I wouldn't seem so medium then." Soon Mr. Henshaw recommends keeping a diary (at least partly to get Leigh off his own back) and so the real letters to Mr. Henshaw taper off, with "pretend," unmailed letters (the diary) taking over. . . until Leigh can write "I don't have to pretend to write to Mr. Henshaw anymore. I have learned to say what I think on a piece of paper." Meanwhile Mr. Henshaw offers writing tips, and Leigh, struggling with a story for a school contest, concludes "I think you're right. Maybe I am not ready to write a story." Instead he writes a "true story" about a truck haul with his father in Leigh's real past, and this wins praise from "a real live author" Leigh meets through the school program. Mr. Henshaw has also advised that "a character in a story should solve a problem or change in some way," a standard juvenile-fiction dictum which Cleary herself applies modestly by having Leigh solve his disappearing lunch problem with a burglar-alarmed lunch box—and, more seriously, come to recognize and accept that his father can't be counted on. All of this, in Leigh's simple words, is capably and unobtrusively structured as well as valid and realistic. From the writing tips to the divorced-kid blues, however, it tends to substitute prevailing wisdom for the little jolts of recognition that made the Ramona books so rewarding.

Pub Date: Aug. 22, 1983

ISBN: 143511096X

Page Count: 133

Publisher: Morrow/HarperCollins

Review Posted Online: Oct. 16, 2011

Kirkus Reviews Issue: Aug. 1, 1983

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