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Commission. Though not quite a world ofphilosopher kings, Caplan seems to imagine a world of philosophic advisors to the kings. John Lantos University of Chicago nings Count. By David J. Rothman, A Twentieth Century Fund Book, Oxford University Press, 208 p., $24.95. It is relatively easy to defend the position that the current scene in medicine is uncertain, confusing and anxiety producing for patient, administrator, medical student and aging faculty. The most recent endeavor, begun in Boston and upheld by the AMA, to reclaim health care clearly supports this position. Characteristic of uncertainty is the search for answers to the problem as well as to scrutinize the past for why it evolved. The development of a national position in America is clearly the result of a variety of sequential events within the context of public opinion, vested interests, financial gain, the political milieu, overt and covert lobbying along with who is in control and who votes. Historical study in the past has been carried out by looking at important personages, analysis of documents, comparative political synthesis, and positing hypotheses. A major change in this process has been the introduction ofhistoriography as the method ofunderstanding what happened and why. This collection of six stories or events from the American medical scene as elegantly reported by Dr. Rothman provides a clear answer as to why America never installed a universal health system. He begins in the thirties, when scientific medicine was coming into its own, with the development and promulgation of Blue Cross, a private health insurance system, designed to pay hospital bills for middle class America, and how it became involved in counteracting FDR's attempts to introduce Health Security along with Social Security. The next event is a story of technology when the iron lung became part of the solution to the polio epidemic among children and the effort to have it supported almost exclusively by private funding even though FDR is manifestly involved in the battle. Perhaps the best told story is the process, pro and con testimony, organized labor and medicine, of getting Medicare to become public policy although it looked a great deal like socialized medicine and was opposed by many because of its potential damage to American health care. With a partial health insurance system on board Dr. Rothman's story about renal dialysis clearly portrays the importance of a lobbying effort by deserving persons, in this case young working individuals, a payment mechanism in place, Social Security, an ethical issue, who will get on the machine, and a responsive Congress who needed votes at what was thought would be a small annual cost. The next to last story is in contrast to the others when a technological advance, the respirator, is rejected by the public based upon extensive media coverage and indepth analysis by ethicists that there are significant problems. The final story is the Clinton administration's attempt to respond to public concern about health coverage and the organized opposition which developed as success looked possible. 610 Book Reviews This section is excellent but a bit more time must pass before the final story can be written. National policy, its shape and form, in America is ultimately established by Congressional actions as a result of public pressure, patronage, lobbying by vested interests and the political-social milieu. These well documented stories provided by Dr. Rothman clearly outline the sequential or evolutionary events which were public, involved powerful vested interests, informed the body politic and, most of all, significantly involved Congress at many levels. Other historiographers might select different events or stories but this series is excellent. The recent article in the Am. J. Public Health by Derickson [1] which describes The House ofFalk: The Paranoid Style in American Health Politics is a good example. I. S. Falk was significantly involved in Health Security as proposed by FDR and the report clearly tells the story of how a combination of individuals, organizations, and the political-social climate in Congress and the USA stopped the forward motion that had started under FDR for a national health insurance. For those who read medical history the increased use of stories to accurately describe what happened and provide...


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pp. 610-611
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