Political savvy and a forthright approach make this study of health-care costs important and interesting. Fein begins with a lucid exposition of the complicated issues which comprise the current insurance/cost escalation/inefficiency tangle. Then he traces the history of health insurance from its 1929 Texas origins, through the birth of private coverage and Blue Cross and Blue Shield. He follows the evolution of a National Health Insurance beginning in the 20's, as it changed and evolved with varied political and social pressures impeding its progress in each era, through the Truman presidency. Notwithstanding the failure of this initiative, Fein consistently credits Americans and their leaders with a commitment to principles of democracy and equality. The inadequacies and inefficiencies of Medicare and Medicaid are discussed, but Fein praises the programs as an embodiment of these moral ideals. He contends that the current health-care system (escalating costs, third-party payers, HMOs) is a mass of contradictions--a wasteful and haphazard approach to the goal our society professes to consider essential: the equitable distribution of accessible, reasonably priced health care. Examining alternatives, Fein disassembles the arguments for a ""free market"" solution to the crisis, arguing that health care cannot be treated as a commodity. His solution: a national health insurance program which would be undertaken by a complex web of state and federal initiatives seeking to insure coverage for every citizen. In sum, while his specific proposals may be viable, his premise--that American idealism and moral commitment can overcome the difficulties--seems debatable.