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David J Rothman, Beginnings count: the technological imperative in American health care, Oxford University Press, 1997, pp. xii, 189, L24.95 (0-19-511118-4).
The United States spends a good deal of money on health care ($3219 per capita in 1995), much of it on the "powerful and costly medical technologies" for which US medicine is known world-wide (p. 3). And the US remains the only country where a substantial amount of health care is paid for by individuals directly (20.8 per cent) or through private, nongovernmental, health insurance (31.5 per cent). In his historical essay on medical technology, David Rothman puts these well-known facts together, arguing that "since the 1930s, health care policy in the United States has reflected the needs and concerns of the middle classes" (p. 4): specifically, their "romance with medical technology" and their preference for using the marketplace, not government, to satisfy their medical wants. The result, he argues, was a medical care system which was not only the costliest in the world, but which left those unable to afford it "to fend for themselves" (p. 5).
Rothman presents his case through a series of chapters which alternate discussions of medical technology with discussions of health care finance: iron lungs for polio victims are paired with the rise of Blue Cross health insurance, 1930s to 1950s; a chapter on the introduction of Medicare (1965) is followed by one on the 1972 extension...