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History and Health Policy in the United States

Putting the Past Back In

Rosemary A. Stevens

Publication Year: 2006

In our rapidly advancing scientific and technological world, many take great pride and comfort in believing that we are on the threshold of new ways of thinking, living, and understanding ourselves. But despite dramatic discoveries that appear in every way to herald the future, legacies still carry great weight. Even in swiftly developing fields such as health and medicine, most systems and policies embody a sequence of earlier ideas and preexisting patterns.

In History and Health Policy in the United States, seventeen leading scholars of history, the history of medicine, bioethics, law, health policy, sociology, and organizational theory make the case for the usefulness of history in evaluating and formulating health policy today. In looking at issues as varied as the consumer economy, risk, and the plight of the uninsured, the contributors uncover the often unstated assumptions that shape the way we think about technology, the role of government, and contemporary medicine. They show how historical perspectives can help policymakers avoid the pitfalls of partisan, outdated, or merely fashionable approaches, as well as how knowledge of previous systems can offer alternatives when policy directions seem unclear.

Together, the essays argue that it is only by knowing where we have been that we can begin to understand health services today or speculate on policies for tomorrow.

Published by: Rutgers University Press

Title Page, Copyright

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pp. vii-viii

Henry Ford may have told us that history is bunk, but the fact remains that much of what goes on in our social and political lives is an outgrowth of happenings in the past, the social institutions and arrangements we have developed over time, and the existing physical and social infrastructure on...

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pp. ix

This book was made possible through the support of the Robert Wood Johnson Foundation Investigator Awards program in health-policy research. We thank the foundation, and particularly the program’s leaders, David Mechanic and Lynn Rogut. Enthusiastic support and keen criticism came from...

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pp. 1-9

History matters. Shared perceptions of history can move audiences, offer powerful explanatory narratives for the present, suggest intriguing analogies with past events, and help build consensus around policy and management goals. When visible at all, however, policy history is often tailored to...

Part I: Actors and Interpretations

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1. Anticipated Consequences: Historians, History, and Health Policy

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pp. 13-31

Policy is a familiar term. But like many indispensable words, it is not easily defined. In one sense it is descriptive: policy refers to current practice in the public sector. It also has a variety of other meanings: policy may imply an “ought” of planning and strategic coherence—or a real world...

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2. The More Things Stay the Same the More They Change: The Odd Interplay between Government and Ideology in the Recent Political History of the U.S. Health-Care System

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pp. 32-48

Disentangling continuity from change in U.S. health-care policy is no task for those who crave instant intellectual gratification. The system is, of course, (in)famously stable: ever inclined to equate specialization and technology with quality, loath to impose planning on the independent institutional...

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3. Medical Specialization as American Health Policy: Interweaving Public and Private Roles

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pp. 49-79

What is health policy? On the face of it, there seems a simple answer. Health policy is what governments do, or try to do, to further health care, typically at the national level. As other essays in this volume resoundingly attest, however, seeing health policy only as what government does or fails to do gives...

Part II: Rhetoric, Rights, Responsibilities

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4. Patients or Health-Care Consumers? Why the History of Contested Terms Matters

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pp. 83-110

Since the 1980s, the use of the term health-care consumer as a synonym for patient (along with its doctor analogue, health-care provider) has become commonplace in the United States. For many observers today, especially physicians, this linguistic transformation has come to represent the...

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5. The Democratization of Privacy: Public-Health Surveillance and Changing Conceptions of Privacy in Twentieth-Century America

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pp. 111-129

The right to privacy has never been regarded as absolute. In the late nineteenth century, health officials adopted the practice of name-based reporting for infectious diseases in order to isolate cases, quarantine the exposed, and monitor the health and behavior of the diseased and their contacts...

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6. Building a Toxic Environment: Historical Controversies over the Past and Future of Public Health

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pp. 130-150

On September 5, 2003, the New York Times business section announced a startling new problem. Silicosis, an occupational lung disease caused by the inhalation of silica sand and considered in the 1940s and 1950s a “disease of the past,” was now rivaling asbestosis as the single most important...

Part III: Priorities and Politics

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7. Situating Health Risks: An Opportunity for Disease-Prevention Policy

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pp. 153-175

The health care issues that capture significant public and professional attention are not necessarily the most important. As potential points of policy intervention, some intellectual assumptions, clinical practices, and structural relationships are so tightly woven into social, economic, and scientific...

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8. The Jewel in the Federal Crown? History, Politics, and the National Institutes of Health

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pp. 176-201

The National Institutes of Health (NIH), the United States’ (and the world’s) largest single funder of biomedical research, have grown enormously since World War II. Over this period, health research grew faster than other kinds of research, and the growth was greater in the United States than...

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9. A Marriage of Convenience: The Persistent and Changing Relationship between Long-Term Care and Medicaid

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pp. 202-225

It is impossible to discuss the nation’s need for affordable long-term care services without concurrently discussing America’s Medicaid program. Since it was established in 1965, Medicaid has often, in passing, been called our health-care program for “the poor.” In truth, the program has always...

Part IV: Policy Management and Results

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10. Rhetoric, Realities, and the Plight of the Mentally Ill in America

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pp. 229-249

Deinstitutionalization of persons with mental illnesses is now a fact of life. Many have criticized its consequences and insisted that the policy has been disastrous (Isaac and Armat 1990). Few, however, have demanded that we return to institutional solutions for care of persons with mental illnesses...

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11. Emergency Rooms: The Reluctant Safety Net

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pp. 250-272

In the face of its unwillingness to guarantee health care to all, the United States has increasingly depended on the emergency room as a de facto safety net for people with nowhere else to go. Since the public knows that ERs are a place where “they can’t turn you away,” hospital emergency departments...

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12. Policy Implications of Hospital System Failures: The Allegheny Bankruptcy

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pp. 273-308

During the late 1990s and early 2000s, the economy of the United States was rocked by a series of corporate accounting scandals and bankruptcies. Before there were Enron, Arthur Andersen, WorldCom, Tyco, and Global Crossing, however, there was Allegheny. Formally known as the Allegheny Health...

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13. The Rise and Decline of the HMO: A Chapter in U.S. Health-Policy History

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pp. 309-339

Health maintenance organizations or HMOs were the object of many of the most bitter criticisms of American health care at the end of the twentieth century. Media accounts drew on experiences of doctors and patients to depict HMOs as impersonal, bureaucratic entities that were primarily...


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pp. 341-343


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pp. 345-364

E-ISBN-13: 9780813539874
E-ISBN-10: 0813539870
Print-ISBN-13: 9780813538372

Page Count: 376
Publication Year: 2006