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Health Policy in Historical Perspective, A Review Essay

Published online by Cambridge University Press:  14 October 2011

Theodore R. Marmor
Affiliation:
Yale University
Richard W. Smithey
Affiliation:
Yale University

Extract

All social inquiry, history included, is both theoretical and comparative. This does not mean the analyst is self-conscious about either the theoretical approach or the comparative methods. But it does imply that there is no escaping a theoretical orientation—the concepts employed, the logic of explanation, the descriptive lens of characterization—and no alternative but to make comparisons over time, over space, or across topics. Both A Political Economy of Medicine by J. Rogers Hollingsworth and Health Policies, Health Politics by Daniel Fox raise questions about how one ought to undertake policy history and the comparison of national systems of medical care.

Type
Review Article
Copyright
Copyright © The Pennsylvania State University, University Park, PA. 1989

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References

Notes

1. For a more extensive discussion of the uses of comparative research, see Marmor, Theodore R., “Cost vs. Care: America's Health Care Dilemma Wrongly Considered,” Health Matrix, 9.1 (Spring, 1986), 1924.Google Scholar

2. Health, United States, 1986 (Washington, D.C)Google Scholar Tables 72 and 74, pp. 162 and 194.

3. Wildavsky, Aaron, “Doing Better and Feeling Worse: The Political Pathology of Health Policy,” in Knowles, John H. ed., Doing Better and Feeling Worse, (New York, 1977).Google Scholar

4. See Dutton, Diana B., Worse than the Disease: Pitfalls of Medical Progress (New York, 1988).CrossRefGoogle Scholar

5. See also Marmor, Theodore R., The Politics of Medicare (New York, 1973)Google Scholar, and David, Sheri I., With Dignity: The Search for Medicare and Medicaid (Westport, CT, 1985)Google Scholar.

6. Health Service Agencies—205 of them all over the country—were equipped with the authority to say no to major capital expansion but without a financial carrot to induce anyone to do very much but rush to the state legislature or to the courts to protect planning restraint. PSROs (Professional Standards Review Organizations)—the program to monitor quality of care—were given to yet another set of agencies, dominated by physicians, disconnected in practice from the payment by Medicare, Medicaid, or the commercial and nonprofit health insurance plans.

7. See Marmor, Theodore R., Schlesinger, Mark, and Smithey, Richard, “A New Look at Nonprofits: Health Care Policy in a Competitive Age,” Yale Journal on Regulation 3 (Spring 1986), 313–49,Google Scholar and Gray, Bradford H., The New Health Care for Profit: Doctors and Hospitals in a Competitive Environment (Washington, D.C., 1983)Google Scholar.

8. Shapiro, Robert Y. and Young, John T., “The Polls: Medical Care in the United States,” Public Opinion Quarterly, 50 (1986), 418–28.CrossRefGoogle Scholar

9. Howard M. Leichter, “Free to be Foolish? Politics and Changing Lifestyles in Britain and the United States” (manuscript in preparation), chapter 1, p. 5.

10. Ibid., 7.

11. Lalonde, Marc, A New Perspective on the Health of Canadians (Ottawa, 1975).Google Scholar

12. Starr, Paul and Marmor, Theodore, “The United States: A Social Forecast,” in Kervasdoue, Jean de, Kimberly, John R., and Rodwin, Victor G., eds., The End of an Illusion: The Future of Health Policy in Western Industrialized Nations (Berkeley, 1984), 236Google Scholar; Paul Starr, “The Politics of Therapeutic Nihilism,” Working Papers for a New Society (Summer 1976).

13. Russell, Louise, Is Prevention Better than Cure? (Washington, D.C. 1986)Google Scholar

14. R. G. Evans, personal communication.

15. Leichter, Foolish.

16. This section is drawn from Theodore R. Marmor, “Health and Efficiency,” New Society, 5 February 1988.

17. Although there are worries about nurses leaving the NHS to work in the private health sector and leaving the profession entirely, there are still more nurses per capita in Britain (85 per 10,000) than in the United States (50 per 10,000) and in West Germany (35 per 10,000). And the NHS now treats 1.2 million more people annually than in the years before the Tories came to power. From Norman Gelb, “The Thatcher Prescription: Britain's Ailing Health Service,” The New Leader, 11–25 January, 8.

18. For joint reviews, see Gerald N. Grob, “New Wine in New Bottles: The History of Health Policy,” Reviews in American History (September 1987), 365–73; W. Andrew Achenbaum, Journal of Social History (Fall 1987), 357–59. For reviews of Health Policies, Health Politics: The British and American Experience, see Journal of Public Health Policy (Autumn 1987), 438–39; Albion Review of Books (June 1987), 137–38; Lancet, 10 October 1987; Journal of the History of Medicine 42 (April 1987), 220–22; Gert H. Brieger, “Comparing Health Policies,” Medical Humanities Review July 1987), 83–86; ISIS 78 (1987), 2, 292:264–65; Journal of Health Politics, Policy and Law 12 (Winter 1987), 818–20; and Kenneth M. Ludmerer, “Assumptions Underlying Health Policy,” Science, 28 November 1986, 1131–32. For reviews of A Political Economy of Medicine: Great Britain and the United States, see Journal of the History of Medicine 43 (January 1988), 114–16.

19. See Marmor, Theodore R., Wittman, Donald A., and Heagy, Thomas C., “The Politics of Medical Inflation,” in Marmot, T. R., Political Analysis and American Medical Care: Essays (New York, 1983), 6175Google Scholar; Theodore R. Marmor, “Commentary” on “American Health Policy” by Kenneth Wing, Cose Western Reserve Law Review 36.4 (1985–86), 686–92; Evans, Robert G., “Health Care in Canada: Patterns of Funding and Regulation,” Journal of Health Politics, Policy and Law, 8.1 (Spring 1983), 143Google Scholar; and Evans, Robert G., Strained Mercy: The Economics of Canadian Health Care (Toronto, 1984).Google Scholar