A HEALTHY STATE: An International Perspective on the Crisis in United States Medical Care

The Sidels, who have written previously on foreign health care systems, now adjust their sights to the local scene, offering an analysis of current problems and suggestions for their resolution. They distinguish between health carelargely preventive measures--and medical care--treatment of actual illness--and regret that in the US the emphasis is on the latter, arising from a medical establishment which developed as an elitist, academic, technologically-oriented profession. Many people have a lousy-doctor story these days, so their observations on licensing and malpractice, fragmentation of services and treatment-related problems, hospital hierarchies and unequal access have a large potential audience. And their characterizations of four foreign health care systems are concise and balanced, tracing the sources of their development, singling out the most impressive changes they have worked and some of the sore spots as well. Their ideas for an American national health service draw on the best of these systems: the Swedish regional hospital set-up, Great Britain's equity policy and community accountability, the no-fee arrangement and integration of the health care system into the larger society of the USSR, and China's emphasis on preventive medicine and--as in the USSR--provisions for health workers other than traditionally trained doctors and nurses. Although the Sidels make their recommendations after examining our own medical history and recognizing its inherited tensions, their health and medical care systems rely on a modified society--a more caring one offering equity in every area, including a more even distribution of wealth--as well as substantial changes in medical education and the structure of health centers. Whether such fundamental changes can follow, as they believe, from ""the mobilization of a political constituency"" remains to be seen. What they have accomplished here is an informed presentation of options, shaped according to an expressed political preference.