History and Health Policy in the United States: Putting the Past Back In

Foreword

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 which we build. Scientific discovery, technical innovations, and social revolutions may bring large changes, but most of our policies and processes evolve from preexisting patterns. Some get comfort from thinking we are avant garde and that we are on the threshold of new ways of thinking and doing, but legacies carry great weight. Many so-called innovations are, when investigated further, little more than a recasting of earlier ideas and arrangements. Some might think that health and medicine are different, reflected in the dramatic expansion of knowledge and technological innovation in the past fifty years—the unraveling of the genome and fantastic new developments in the pipeline such as new biomaterials (artificial skin and blood) and treatments fitted to individuals’ genes. Some may even believe that in this dynamic scienti fic arena an understanding of history is more avocation than necessity. But these beliefs lead us to reinvent the wheel and repeat mistakes that could be avoided with a broader cultural, social, and historical perspective. Many think that HMOs are new organizational inventions, but similar entities in a great variety of forms have been around for more than a century; others may believe that new forms of payment such as capitation, prospective reimbursement of institutions, and blended reimbursement systems are innovative payment arrangements to deal with modern changes in health care, but these arrangements , too, are older than most of us. Under the British National Insurance Act of 1911, for example, capitation was established as a way of paying general practitioners. Few if any of the problems we have faced in paying professionals in the past twenty years would have been in any way surprising with even minimal attention to the past, in the United States and elsewhere. And even a cursory examination of the history of anti-smoking efforts would provide useful guidance about future challenges in preventing not only smoking but also obesity. This volume on history and social policy is a product of The Robert Wood Johnson Foundation’s Investigator Awards in Health Policy Research program. Initiated in 1992, this competitive program provides awards each year to a vii Foreword select group of investigators with innovative ideas and interdisciplinary projects that promise to contribute meaningfully to our understanding of significant health and health-care issues and to improve policy formulation. Since 1992 we have supported a broad range of approximately 150 scholars from medicine, public health, economics, political science, sociology, law, journalism , and history. The program is tied to no individual discipline or orientation. It seeks to support scholars with ambitious perspectives and ideas whose broad investigations would not ordinarily be supported by research organizations like the National Institutes of Health, the National Science Foundation, or other funding organizations. The program is more than just a collection of individuals and a portfolio of research projects. We also bring together scholars and researchers from different disciplines and areas of research, and with varying perspectives, to think about and work on important cross-cutting issues. This is a voluntary activity, building on the enthusiasm and interest of our investigators in crossdisciplinary understanding and collaboration. The book’s authors are associated with The RWJF Investigators’ Awards program and have participated in an ongoing group seeking to better illuminate how the lessons of history can enhance our understanding of how to deal with emerging and future policy challenges. The contributors come from different disciplines and points of view and there is no “party line” here. This work is based on the belief that exploring the historical basis of health-care events will contribute to overall understanding of the health-care system and more discerning policy making. As director of the program I want to especially thank Rosemary Stevens, an investigator awardee and member of our National Advisory Committee, who led this group effort with her usual sagacity and thoughtfulness and her co-editors Charles Rosenberg and Lawton Burns. Lynn Rogut, deputy director of the program, provided administrative support and guidance, and the contributors enthusiastically and often passionately participated in this effort. Special thanks are due to David Colby and James Knickman of the Robert Wood Johnson Foundation and Risa Lavizzo-Mourey, the foundation’s president...