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

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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IN MY PLACE

From the national correspondent for PBS's MacNeil-Lehrer Newshour: a moving memoir of her youth in the Deep South and her role in desegregating the Univ. of Georgia. The eldest daughter of an army chaplain, Hunter-Gault was born in what she calls the ``first of many places that I would call `my place' ''—the small village of Due West, tucked away in a remote little corner of South Carolina. While her father served in Korea, Hunter-Gault and her mother moved first to Covington, Georgia, and then to Atlanta. In ``L.A.'' (lovely Atlanta), surrounded by her loving family and a close-knit black community, the author enjoyed a happy childhood participating in activities at church and at school, where her intellectual and leadership abilities soon were noticed by both faculty and peers. In high school, Hunter-Gault found herself studying the ``comic-strip character Brenda Starr as I might have studied a journalism textbook, had there been one.'' Determined to be a journalist, she applied to several colleges—all outside of Georgia, for ``to discourage the possibility that a black student would even think of applying to one of those white schools, the state provided money for black students'' to study out of state. Accepted at Michigan's Wayne State, the author was encouraged by local civil-rights leaders to apply, along with another classmate, to the Univ. of Georgia as well. Her application became a test of changing racial attitudes, as well as of the growing strength of the civil-rights movement in the South, and Gault became a national figure as she braved an onslaught of hostilities and harassment to become the first black woman to attend the university. A remarkably generous, fair-minded account of overcoming some of the biggest, and most intractable, obstacles ever deployed by southern racists. (Photographs—not seen.)

Pub Date: Nov. 1, 1992

ISBN: 0-374-17563-2

Page Count: 192

Publisher: Farrar, Straus and Giroux

Review Posted Online: May 20, 2010

Kirkus Reviews Issue: Sept. 1, 1992

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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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