REFORMING MEDICINE: The Lessons of the Last Quarter Century by Victor W. & Ruth Sidel--Eds. Sidel
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REFORMING MEDICINE: The Lessons of the Last Quarter Century

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Have the social and political upheavals in health care since 1960 effected any permanent reform of the system? Is health care new more available to all The answer, in the informed estimate of the Sidels (A Healthy State, The Health of China), is a resounding no--and their case is roundly supported by the eleven articles here. Attempts at reform, they note, occur at three levels: national--e.g., health care financing for large groups of the population via Medicare and Medicaid; local--creation of new care-giving institutions; and professional--with the recruitment of health professionals from previously underrepresented population groups and the creation of new types of health workers. The articles, by former and present activists, are grouped accordingly. Thus we have Jack Geiger, of Physicians for Social Responsibility, on the rise and fall of community health centers in the wake of the War on Poverty; OSHA specialist Anthony Mazzocchi on changes in health care institutions to provide care for workers and other special population groups; Fitzhugh Mullan (White Coat, Clenched Fisc Vital Signs) on the National Health Service Corps, which sought to recruit new groups of health workers while increasing community access to health care. Dishearteningly, the Sidels are able to group the effects of these reforms into three categories: those that were successfully resisted by the system--like minority medical school admissions (which, after a boomlet, fell back to a non-representational level); those that were implemented in ways that left the structure of the system intact--such as the attempt to improve public hospitals (which in many ways strengthened the two-class provision of care); and those that, after a brief success, were destroyed by underfunding plus lack of professional and governmental commitment--the occupational health and safety movement being the prime example. These failed efforts teach us, say the Sidels, that real change can occur only when power is transferred from traditional holders to a broad-based coalition: the real improvement in women's health care--since 1960, the one bona ride reform--resulted from joint pressure by women (many of them well-placed), by workers and unions, and by minority activist groups. A discouraging but realistic warning: any further such reform must await a more propitious political climate. Though the glimmers of hope are faint, the lesson is a valuable one--conceived out of experience, extended with social-science insights.

Pub Date: Feb. 1st, 1983
Publisher: Pantheon