Medicine's Journey Through Ignorance, Bigotry, Poverty, and Politics To America's Uninsured

An indictment of nationalized health care and a clarion call for free-market alternatives.

Ear-nose-and-throat doctor Smith (Darwin’s War, 2008) and Parente, a professor of health finance at the University of Minnesota, combine their practical experiences, theoretical insights and ideological passion in this examination of health care. They review the history of medicine from early hunter-gatherer societies to early 20th-century “establishment funds” that spawned the modern health-care industry. Chapters cover Medicare and Medicaid, the problems of poverty and the uninsured, polarized politics and the deal-making that produced the Patient Protection and Affordable Care Act (PPACA), signed into law in 2010. The book’s final third details alternative health-care approaches. Most compelling are the authors’ arguments for consumer-driven health care, using medical savings accounts to dispel the illusion that coverage is free. The authors also provide detailed explanations of state-run high-risk pools, interstate insurance sales, privatized Medicare and the concept of shifting control of Medicaid to states via block grants. If IRS rules were changed to allow doctors to deduct charity care, the authors contend, it would achieve the equivalent of universal insurance coverage. Generally, Smith and Parente advocate “discrete solutions to specific problems” instead of “a wholesale transformation of the relationship between the American people and their government.” However, their assertion on the book’s back cover, “Cost effective health care reform can be obtained through the free market with little or no government control needed,” may strike some readers as hyperbole, as their alternatives would likely require significant regulation. The authors bemoan the “unremitting progressive dialogue published in America’s so-called elite medical publications,” but they suffer from a similar tonality problem; they use the terms Democrat, liberal, progressive, Left, “neofascist Left,” socialist and communist interchangeably. According to the authors, PPACA supporters are “Obama’s health care sycophants,” and the authors imagine that “Marx and Engels would be proud.” Overall, the book already seems a bit dated. It was published in August, apparently in anticipation of judicial nullification of all or part of PPACA, but the U.S. Supreme Court’s June 28 decision, and the 2012 presidential election, make it read a bit like last week’s newspaper.

A look at health care that provides a wealth of historical background and some persuasive arguments but has a partisan tone that will likely limit its audience.