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Sweet and Maxwell
Rockefeller Medicine Men : Medicine and Capitalism in America
Rockefeller Medicine Men : Medicine and Capitalism in America
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The crisis in today's health care system is deeply rooted in the interwoven history of modern medicine and corporate capitalism. The major groups and forces that shaped the medical system sowed the seeds of the crisis we now face. The medical profession and other medical interest groups each tried to make medicine serve their own narrow economic and social interests. Foundations and other corporate class institutions insisted that medicine serve the needs of "their" corporate capitalist society. The dialectic of their common efforts and their clashes, and the economic and political forces set in motion by their actions, shaped the system as it grew. Out of this history emerged a medical system that poorly serves society's health needs.
The system's most obvious problems are the cost, inflation, and inaccessibiUty of medical care in the United States. Total health expenditures in this country topped $200 billion in 1979, nearly $1,000 for every woman, man, and child. Far more of society's resources now go into medical expenditures than ever before; twice the portion of the Gross National Product was spent on medical care in 1980 than in 1950. We pay for these costs through our taxes, health insurance premiums, and directly out of our pockets. Public expenditures—four out of every ten dollars spent on personal health services—come out of our taxes. Private health insurance and direct out-of-pocket payments each account for about three out of every ten dollars. No matter what form it takes, the entire $200 billion originates in the labor of men and women in the society. President Carter estimated that the average American worker works one month each year just to pay the costs of the medical system.'
Most people feel they should be getting a lot for this money, but instead they find that it is difficult even to get the care they need. Primary care physicians—general practitioners, pediatricians, internists, and gynecologists—are scarce. Doctors and hospitals are clustered in the "better" parts of our cities and largely absent from the poorer sections and rural areas of our country. For the millions of Americans covered by Medicaid (the government subsidy program for the public assistance-linked poor), the coverage has been as sparse and degrading as the demeaning clinics it was supposed to replace. The middle class and the poor share at least long waiting periods for doctors, one of the most common constraints on the accessibility of physicians. Instead of creating a humane and accessible medical care system, Medicare and Medicaid have helped fuel inflation in medical costs by dumping new funds into a privately controlled system ready to absorb every penny into expansion, technology, high salaries, and profits.
The system's most obvious problems are the cost, inflation, and inaccessibiUty of medical care in the United States. Total health expenditures in this country topped $200 billion in 1979, nearly $1,000 for every woman, man, and child. Far more of society's resources now go into medical expenditures than ever before; twice the portion of the Gross National Product was spent on medical care in 1980 than in 1950. We pay for these costs through our taxes, health insurance premiums, and directly out of our pockets. Public expenditures—four out of every ten dollars spent on personal health services—come out of our taxes. Private health insurance and direct out-of-pocket payments each account for about three out of every ten dollars. No matter what form it takes, the entire $200 billion originates in the labor of men and women in the society. President Carter estimated that the average American worker works one month each year just to pay the costs of the medical system.'
Most people feel they should be getting a lot for this money, but instead they find that it is difficult even to get the care they need. Primary care physicians—general practitioners, pediatricians, internists, and gynecologists—are scarce. Doctors and hospitals are clustered in the "better" parts of our cities and largely absent from the poorer sections and rural areas of our country. For the millions of Americans covered by Medicaid (the government subsidy program for the public assistance-linked poor), the coverage has been as sparse and degrading as the demeaning clinics it was supposed to replace. The middle class and the poor share at least long waiting periods for doctors, one of the most common constraints on the accessibility of physicians. Instead of creating a humane and accessible medical care system, Medicare and Medicaid have helped fuel inflation in medical costs by dumping new funds into a privately controlled system ready to absorb every penny into expansion, technology, high salaries, and profits.
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