Only then will we be able to begin the long, difficult process of driving the profit motive out of the direct provision of medical care and recovering the lost art of healing. It goes without saying that members of the medical-industrial complex are determined to thwart any legislation that moves in that direction.
If we take the right-hand fork, we will reinforce the notion of health care as a privilege, boost the role of and encourage the further expansion of the corporatization of American medicine that Paul Starr predicted. Stratification of access to medical care according to income will grow even more rapidly. That will signal a retreat from the ideal of health care as a right.
Everybody seems to agree that we can't fail to act. If we continue ahead with no change in course, we will drive into a ditch as costs continue to explode and access to care further deteriorates.
Whatever the outcome, the story of the evolution of the health- care system in the United States holds important and cautionary lessons for other nations, as they too struggle to strike the suitable balance between expenditure, quality, and access to health care compatible with their own cultures.
The Heart of Power is a valuable contribution to better under- standing that story. But it is not the entire story. Perhaps Blumenthal and Morone could apply their considerable talents to writing a sequel to The Heart of Power that examines the issues raised by the relentless corporatization of medical care in the United States. Maybe they could call it The Heart of Darkness, had Joseph Conrad not used the title already.
I have a recurrent dream, and not a pleasant one. I wander the temple of medicine seeking Asclepius, but find instead only Mammon. It doesn't have to be that way, even in exceptionalist America.
Stay tuned.
References
1.Starr, P. (1982) The Social Transformation of American Medicine. New York: Basic Books.
2. Mahar, M. (2006) Money Driven Medicine: The Real Reason Health Care Costs So Much. New York: HarperCollins.
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